Pubdate: Fri, 27 Sep 2002
Source: Albuquerque Tribune (NM)
Copyright: 2002 The Albuquerque Tribune
Author: Barbara Ferry
Note: Ferry is a freelance writer based in Santa Fe.


New Mexico has been more progressive in tackling some aspects of drug 
reform than virtually all other states, today's author reports, but further 
progress will depend mostly on the next governor.

Although he's never used it himself, Kevin Santry can teach you how to 
shoot up heroin. Packed into his SUV, Santry has everything you need (well, 
almost) to do the job: the little round metal cups you use for cooking the 
drug, dental cottons to strain out the gunk, alcohol swabs, rubber 
tourniquets for tying around your arm and, of course, needles.

Santry will give you these things for free; he'll even deliver them 
straight to your door. While he's there, he might give you a pamphlet 
advising what to do if a friend overdoses while you're shooting up together 
and you're scared of the cops ("Stay until you hear the sirens get really 
close, then split").

Santry is director of the state-funded syringe exchange program operated 
out of Youth Development Inc., a 30-year-old community organization in 
Albuquerque's South Valley. He's a foot soldier in the battle to keep New 
Mexico's drug users, and ultimately the rest of the population, healthy. He 
teaches heroin users to shoot up correctly because those who don't know how 
to inject into a vein get infections that can spread to the heart and 
become fatal. He hands out complete drug kits because infectious diseases, 
such as Hepatitis C and HIV, can be spread through contaminated works.

Besides drug paraphernalia, he dispenses vaccinations against Hepatitis A 
and B, soap, razor blades and Pampers, as well as referrals to a host of 
services, including drug and alcohol programs. He delivers syringes 
door-to-door to avoid conflicts with neighborhood associations that don't 
want bunches of drug users near their homes and because it gives him a 
chance to interact with his clients.

Today, the clients include a man and woman who meet Santry outside their 
West Side apartment with a red plastic "bio bucket" full of used needles. 
Both are extremely skinny. The man has had Hepatitis C for 14 years.

"I guess I've got it by now, too," says the woman with a shrug. They like 
the needle exchange program just fine. "We used to sharpen 'em on the 
floor," the man says.

This needle exchange work is not for the faint-hearted, but then again, 
public health work never was. In 1902, New York City health officials 
arrested an Irish immigrant cook named Mary Mallon whom they had determined 
was spreading typhoid fever to the people she cooked for. After Mallon was 
released and went back to work as a cook using a false name, public health 
officials re-arrested her and exiled her to an island in the East River for 
the rest of her life. She went down in history as Typhoid Mary.

A hundred years later, it's hard to imagine public health officials 
wielding such power. As Laurie Garrett recounts in her masterful tome, 
"Betrayal of Trust," public health has been losing ground ever since its 
glory days at the turn of the last century, when zealous sanitarians could 
order diseased people into quarantine. Privatization of health care, 
erosion of federal funding, morality, politics and even civil liberties, as 
in the case of Typhoid Mary, can be at odds with public health goals.

But New Mexico, at or near the bottom of just about all of those health and 
well-being indicator lists, appears to be a leader in the public health 
arena, especially on issues related to drugs. New Mexico is one of two 
states that funds needle exchange (Hawaii is the other).

Last year, New Mexico was the first state to distribute Narcan, an antidote 
to overdoses, which state health officials say is responsible for nine 
"saves" so far.

Since 2001, pharmacists can legally sell syringes to drug users without 
fear of prosecution. Health officials are currently negotiating to get 
methadone treatment into jails.

"The other states see us as treading new ground," says Don Torres, a 
16-year veteran of the department who heads the Hepatitis, HIV and AIDS 
programs. Some credit for these changes is due to our fearless leader, Gary 
Johnson (Puff Daddy to his dueling partner, former federal drug czar Barry 
McCaffrey), though the political story is more complicated than that.

The sheer number of injection drug users and their obvious impact on the 
state is probably another factor. (The Office of Epidemiology estimates the 
numbers at 14,000, but Torres believes the real number is at least double 

Not An Election Issue

How the Johnson-era programs and any further reform proposals will fare 
under a new governor is a subject of speculation.

"Keeping Injection Drug Users Free of HIV and Hepatitis" is not a campaign 
message you're likely to see on billboards this election season. Given 
Johnson's almost single-minded pursuit of the drug issue, the gubernatorial 
candidates, unsurprisingly, just don't want to talk about it.

"I can guarantee you that whatever they feel about it personally, drug 
reform is not going to be a central campaign platform," says Sen. Cisco 
McSorley, an Albuquerque Democrat, a member of Johnson's drug task force. 
"This is not going to be the dummy distracter issue of the season."

If public health crusaders of yesteryear were Victorians bent on bringing 
hygiene to the masses in order to prevent disease from spreading into their 
own middle-class neighborhoods, today's crusaders are from a decidedly 
different subculture. Some are former or current drug users, and many, like 
Santry, distributed needles when doing so was still illegal.

About 15 years ago, supplying clean needles was illegal just about 
everywhere. That didn't stop Santry, then living in his native Jersey City. 
Heroin use was rampant, and for a time the city had the highest AIDS rate 
in the country.

"I was watching all my high school friends die of AIDS, so I guess you 
could say I got politically motivated," he says. But underground programs, 
like the one in Jersey City, couldn't get enough needles to addicts.

"There were not enough syringes to go around," Santry recalls. "If we gave 
out a syringe, we knew it was still going to get used many, many times. So 
it was symbolic, a political statement more than anything else."

All that changed when Santry moved to New Mexico and took a job with an 
above-ground needle exchange program here. New Mexico, compared with New 
Jersey, was needle heaven. Registered users bearing laminated ID cards 
could turn in dirty needles and get an equal number of clean ones.

"We give people all the syringes they need," Santry says. "That's the only 
way you can ensure they use a clean one every time."

And, remarkably, given a program that uses taxpayer money to provide 
addicts with beaucoup needles, complete drug kits ("Get your Kits on Route 
66" was the slogan of a national syringe exchange conference held in 
Albuquerque in April), information on how to avoid getting busted and 
training in how to shoot up, New Mexicans, for the most part, have not 
freaked out.

There have been conflicts, however, between syringe exchange programs and 
their neighbors. As a result of an Albuquerque City Council vote last 
December, syringe exchange programs in the Duke City are now restricted to 
mobile units. However, the moral and political rhetoric of the type argued 
nationally by conservative groups such as Concerned Women of America 
("Needle exchange programs put government in the role of subsidizing bad 
and addictive behavior") has been muted or absent.

Support Grows

Law enforcement, often an opponent, has also supported the program, or at 
least not opposed it. "We're against legalization, but needle exchange 
seems to help people get off drug use and maybe eventually to become 
productive members of society again" was the mild comment of Albuquerque 
police spokesman Jeff Arbogast. The state's district attorneys, who adopted 
a wait-and-see attitude at the outset, according to Torres, have come 
around to support the program.

Darren White, the former Department of Public Safety secretary who quit 
because of his opposition to Johnson's drug reform proposals, says the 
health department needs to prove that syringe exchange in New Mexico is 
actually working.

"In theory, (needle exchange) is great. But what is this program doing? Is 
it reducing diseases or is it just supplying clean needles to addicts?" 
White asks. Now running as a Republican in the Bernalillo County Sheriff's 
race, White is also concerned that needle exchange is adding to the overall 
number of discarded dirty needles found on the street.

"It goes without saying that not everybody's going to be responsible," 
White says.

State Secretary of Health Alex Valdez says the generally positive response 
can be explained in part because New Mexicans have gotten more 
sophisticated about drug policy during the last four years. "People hear 
the term `legalization' and that's incendiary. They hear the phrase `drug 
reform' and that's kind of inflammatory. But talk about sound public health 
principles and you can build a fair degree of consensus around that," says 
Valdez, who says he's convinced that his programs will be supported by the 
next governor.

But scientific evidence in favor of syringe exchange hasn't necessarily 
translated into well-funded programs around the country. Syringe exchange 
is supported by the American Medical Association, the U.S. Centers for 
Disease Control and the National Academy of Sciences, all of which believe 
it decreases disease transmission while not increasing drug use. But 48 
states don't have legislation allowing for statewide funded programs. Many 
of the 200 programs around the country operate without authorization and 
face shortages, which undermine their effectiveness, according to a report 
by the Ford Foundation.

Congress has renewed a ban on federal funding for needle exchange seven 
times. President Clinton didn't act to lift the ban despite the urging of 
his Secretary of Health and Human Services, Donna Shalala. President Bush 
is even less likely to do so.

Perhaps New Mexico has been more accepting of needle exchange because, 
Torres says, "It seems like everybody knows someone who is affected by this."

Wasn't Always So

After four years of watching Johnson dueling drug czars on national 
television, it may be difficult to recall a time when the governor's 
position on drugs was unknown. But that was the case in 1997 when Steve 
Jenison, the physician administrator for the infectious diseases bureau, 
testified before the Legislature on syringe exchange.

Jenison reported on a study he had directed on disease rates among 
injection drug users. Jenison's study found that New Mexico is different 
from New Jersey in another respect. At the time of the study, less than one 
percent of injection drug users carried HIV, but 82 percent carried 
Hepatitis C. That meant that drug users were clearly spreading Hepatitis C 
through contaminated needles to other drug users.

But HIV, which is more easily spread to the general population through 
sexual contact, hadn't appeared yet.

The state health office saw it had a window of opportunity to ward off an 
increase in HIV. "(Syringe exchange) wasn't Johnson's baby in any way. It 
came out of the Department of Health," says Katharine Huffman, director of 
state-based projects for the Drug Policy Alliance, formerly the Lindesmith 

But no one knew whether Johnson, who didn't come out in favor of drug 
reform until after he was re-elected in 1998, would sign the bill. He did, 
of course, and later went on to give keynote speeches at needle exchange 

Santry passionately believes that state drug users' access to clean needles 
has forestalled an AIDS epidemic among users. "It hasn't happened here, and 
it hasn't happened because of syringe exchange," he says, pounding the 
steering wheel, as he drives to his next delivery.

But health officials know that proving a negative is a hard thing to do.

"The onus is on us to show how effective the program has been," says Vivian 
Amelunxen, HIV prevention program manager for the Department of Health. 
"It's like asking how many people have not gotten HIV because you did this 
particular outreach. And that's very difficult to answer."

A new study of infection rates among drug users could provide evidence that 
the program is helping slow disease transmission. The department hasn't had 
the money to do such a survey, though given the very high rates of 
Hepatitis C and very low rates of HIV in 1996 Torres predicts there would 
not be much change.

The health department is preparing a "transition statement" on syringe 
exchange and other harm reduction in defense of the programs. "It's unknown 
how a new governor is going to react to these programs, so we're trying to 
anticipate that," Jenison says.

Says Torres, "We'll cross our fingers."

Ducking For Cover

"We're no Gary Johnson," says Dave Contarino, campaign manager for Bill 
Richardson, a bit wearily. Contarino sounds like the last thing he wants to 
talk about is heroin and needles. He will grant, however, that the would-be 
Democratic governor wants to look at "creative and innovative ideas" for 
dealing with drug abuse and wants to continue with programs that have 
"proven to be effective."

Even if these programs are worthwhile, Johnson's single-minded devotion to 
drug reform has been largely a waste of time in Contarino's view. "If all 
that effort that went into drugs had been spent on education, on the 
economy, we might be somewhere by now," he says.

All of which was more forthcoming than the John Sanchez campaign, which 
didn't call back at all. (Richardson has said he would support medical use 
of marijuana and Sanchez, while in the House, voted against it).

Green Party gubernatorial candidate David Bacon, who believes in expanding 
treatment and decriminalizing "at least marijuana," says, "If we put that 
money (spent on enforcement) into treatment and education then we wouldn't 
solve the problem entirely, but we could get to a lot better place."

Johnson might have seemed a fumbling spokesman for the cause when in 1999 
he first casually let it drop that he advocated the legalization of heroin. 
But Huffman says that as Johnson refined his message, he, and the drug 
reform movement, gained credibility.

"What sounded, because of the way it was first expressed, just sort of 
extreme and impossible and ridiculous evolved into a nuanced debate over a 
whole range of issues. He really did go out of his way to try to educate 
himself," says Huffman, who set up an office across from the Roundhouse 
expressly for that purpose.

She says the drug reform movement has gained enough momentum to continue 
post-Johnson. "It's not going to be a high priority or high visibility 
issue for the next governor," she says, but that may be better from a 
policy standpoint."

For Democrat McSorley the big hole in Johnson's plan has been his lack of 
support for funding a major drug treatment initiative.

"The issue that still needs to be faced is funds for rehabilitation," 
McSorley says. McSorley believes more legislators would have supported both 
public health and sentencing reforms had Johnson been willing to spend more 
money for drug treatment.

In the last session, legislators and the governor compromised on a $9 
million increase in treatment spending, to be split between the Department 
of Corrections and the Behavioral Health Services Division.

Valdez points out that the additional funds represented a 30 percent 
increase in the treatment budget. But McSorley insists that is only a fifth 
of what's needed to address the problem comprehensively.

"And he even balked at that amount," McSorley complains. "He wanted to 
spend $5 million and take it out of the tobacco settlement money, which 
would have created all kinds of problems for us. And this was in a year 
when we still had surpluses."

Since Johnson avoided campaigning on the drug reform issues, and the 
current round of candidates are, for the most part, avoiding talking about 
it, McSorley says the state still hasn't had a real political debate about 
drug reform.

"But what we've seen is that it doesn't seem to be a third rail issue 
either way," he says. "It crosses all kinds of ideological lines." 
Republicans who opposed Johnson on drug reform were re-elected, as were 
Republicans who supported the governor.

Nevertheless, McSorley is pessimistic that the next governor will want to 
take up the issue, given the perception that Johnson has been overly 
devoted to it, and given the price tag. "This isn't something individual 
legislators can do on their own. We need the full-on support of a governor."

Back On The Street

For the public health crusaders, Johnson's support has been amazing," in 
the words of the state's harm reduction coordinator, Phillip Fiuty, who 
distributed needles and even Narcan before it was legal. "It's having 
someone in a position of authority who acknowledges what people do as 
opposed to just denying that it's here."

Santry's next delivery stop is a shooting gallery outside a dilapidated 
house. The woman who owns the house wants help fixing it up, but Santry 
tells her she needs to deal with her addiction first and reminds her to 
call the alcohol program he's already referred her to.

"The City Council wants to know `how many needles did you get in, how many 
did you give out?'" Santry says, ducking under the open tailgate of his 
truck to get out of the broiling sun. "They leave the people out of the 

"At a certain point I figured out I was put on earth to limit suffering," 
he says with a Jersey accent and a shrug. "I guess I figure that's what 
this is all about."

Ferry is a freelance writer based in Santa Fe. She previously was an 
awarding-winning reporter at the Santa Fe New Mexican. She currently is 
working on a public radio documentary about the Mexican border for 
Homelands Productions. This article first appeared in the Santa Fe 
Reporter. It also was published on the Internet at:
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