Pubdate: Sun, 19 Sep 2004
Source: Star-Ledger (NJ)
Copyright: 2004 Newark Morning Ledger Co
Author: Susan K. Livio
Bookmark: (Needle Exchange)


The decade-long debate over providing clean needles to intravenous
drug users in New Jersey has hinged on a pair of questions: Would
needle-exchange programs save lives by preventing the spread of the
virus that causes AIDS? Or would they cost lives by encouraging drug

New Jersey is one of only two states (Delaware is the other) that do
not offer some form of legal access to needles. But beginning
tomorrow, state lawmakers will introduce fast-tracked bills to change
that -- with support from Gov. James E. McGreevey, who says he wants
to sign the legislation before his planned departure on Nov. 15.

The proposals on the table do not represent a blanket endorsement of
needle exchange. They would merely allow municipalities to volunteer
to run their own programs, and permit drug users to buy syringes
without a prescription. Still, in a state where the idea has proved so
controversial for so long, the debate is sure to be fierce.

Frustrated by the lack of progress, municipal officials in Atlantic
City and Camden, two cities with chronic AIDS problems, struck out on
their own this summer, passing local ordinances to allow needle
programs. Earlier this month, however, a Superior Court judge halted
the effort in Atlantic City, saying it violated state law.

New Jersey has lost more than 31,000 people to AIDS, and ranks fifth
among states in the number of AIDS cases. State health officials say
60 percent of those cases can be attributed to drug use -- twice the
national average. But the debate in Trenton has always bogged down
over conflicting data and passionate disputes about the morality of
facilitating drug use.

"To the best of our knowledge, there is no real scientific evidence to
say needle exchange is effective," says Marlene Lao-Collins, associate
director of social concerns at the New Jersey Catholic Conference.

The conference, representing the state's bishops, is part of a
coalition of groups that oppose the legislation. Lao-Collins and
others question studies that have relied on self-reporting --
including those that trust IV drug users to answer truthfully about
whether they've shared needles.

But self-reported data is far from the only evidence available, says
Roseanne Scotti, executive director of the nonprofit New Jersey Drug
Policy Project, which leads the legalization effort.

In 1997, for instance, a British medical journal, The Lancet, studied
81 cities worldwide and found that HIV cases increased by nearly 6
percent per year in the 52 cities without needle exchanges, and
decreased by about 6 percent in the 29 cities with them.

"There is overwhelming evidence needle exchange works at this point,"
Scotti said.

As the debate in Trenton gets underway, lawmakers will be bombarded
with scientific reports. Those most likely to come up include:

National Institutes of Health, 1997: State Health and Senior Services
Commissioner Clifton R. Lacy often cites this report as the one that
most influenced his decision to support needle exchange.

An independent panel of epidemiologists, social workers and mental
health professionals convened by NIH reviewed and discussed all the
relevant research, and issued an "emphatic" endorsement of needle
exchanges. (The federal government's ban on funding needle exchanges
was never lifted, however.)

"Studies show reduction in risk behavior (sharing needles) as high as
80 percent in injecting drug users, with estimates of a 30 percent or
greater reduction of HIV," the panel report said. Laws against syringe
exchange "expose millions of people to unnecessary risk." Echoing many
other studies, the NIH report did not find evidence that needle
exchanges led to increased drug use.

Baltimore, 2001: This program in Maryland's largest city -- with
14,500 participants, the sixth-largest in the country -- has been
declared a resounding success by city health officials and proponents
of needle exchange.

But a survey three years ago found some needles were simply discarded
after use and users were often "drawn to the convenience of getting
needles on the street," according to the study's lead author, Carl
Latkin, an associate professor at Johns Hopkins University.

Baltimore Public Health Officer Peter Beilenson admits not all needles
get returned. Still, he said, "the bottom line is this is an HIV
reduction program and there has been a 40 percent reduction in new HIV
infections (among needle exchange participants) compared to other addicts."

Montreal, 1996, and Vancou ver, 1997: Both studies reported that
addicts who used needle exchanges were twice as likely to become
infected with HIV than addicts who didn't rely on the program.

Former President Bill Clinton's drug czar, Barry McCaffrey, cited the
studies in 1998 as proof that needle exchange was a failure.
Assemblymen Kevin O'Toole (R-Essex) and Sam Thompson (R-Middlesex)
cited them as recently as Thursday in a press release. The authors of
the studies, however, have publicly accused McCaffrey and others of
misinterpreted their research.

In a 1998 op-ed published in the New York Times, researchers Julie
Bruneau and Martin T. Schechter acknowledged the higher HIV-infection
rates among participants. But, they wrote, people who used needle
exchanges -- typically located in poor cities -- tended to engage in
the riskiest behavior.

Drug users who could afford to buy needles in drug stores, meanwhile,
were less likely to share them. The authors also noted Canadian drug
users were more likely to use cocaine instead of heroin, "injecting up
to 40 times a day" and easily exhausting their needle supply.

The bottom line: "In Canada, local governments acted on our research
by expanding needle exchanges and adding related services," the
authors said.

If the scientific debate facing New Jersey lawmakers is thorny, the
moral arguments will be even more vexing.

Lawmakers will be asked to decide which is more compassionate: giving
addicts the tools to shoot up but continuing to skimp on drug
treatment programs, or withholding clean needles and letting addicts
spread a deadly disease to sexual partners and children.

Opponents of the legislation, who have assembled a coalition called
Citizens Against Needle Exchange, include the conservative League of
American Families, the Catholic Conference and Drug Watch
International, a nonprofit that opposes drug legalization. The groups
are lining up people to testify in legislative hearings, including
pharmacists worried about liability issues and clergy concerned about
the impact on neighborhoods.

The Rev. Stephen Perzan, an assistant pastor in Philadelphia whose
former church was located next to a needle exchange, will describe how
"many needles were left in our neighborhood, in spite of the
exchange," Perzan said. Standing in line with the addicts on numerous
occasions, Perzan said he heard participants talk about where to score
their next high. "I saw what it did to our neighborhood," he said.

Sen. Ronald Rice (D-Essex), one of the coalition's strongest
legislative allies, disseminated a 52-page packet to the Legislative
Black Caucus last week containing scathing critiques of leading
scientific studies, prepared by conservative-leaning organizations
such as the New Jersey Family Policy Council and the Heritage Foundation.

He also included an impassioned plea: "I personally believe that ...
if such legislation is voted into law, that this class of people
within our community would remain junkies, criminals and
dysfunctional, particularly within the urban neighborhood."

Proponents of needle exchange, anticipating such arguments, have
organized their own speakers to defuse them. On the issue of
neighborhood fears, for instance, Beilenson of Baltimore said he sent
his staff to seek support from neighborhood associations before
opening syringe exchange sites.

Supporters will also stress their long list of institutional
endorsements: the Medical Society of New Jersey, the New Jersey
Hospital Association, the Black Ministers Council, the state Nurses
Association, various drug store owner associations and so on. They can
point as well to the recommendations of an AIDS advisory commission
appointed by former Gov. Christie Whitman, which supported needle
exchange despite Whitman's staunch opposition.

Needle exchange advocates say they feel that although the science is
on their side, their challenge is to simplify the issue like the
opponents have.

"They'll say it's like giving an alcoholic a bottle of whiskey, like
giving someone on a diet ice cream," said Sen. Joseph Vitale
(D-Middlesex), a sponsor of the bills. "The only difference is none of
these things will give you AIDS and kill you."
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MAP posted-by: Richard Lake