Pubdate: Thu, 28 Oct 2004
Source: Courier-Post (Cherry Hill, NJ)
Copyright: 2004 Courier-Post
Author: Kevin Riordan
Bookmark: (Heroin)
Bookmark: (Methadone)
Bookmark: (Needle Exchange)
Bookmark: (Treatment)


As someone who lost a best friend to AIDS and also knows people whose lives 
have been damaged or destroyed by addiction, I've got mixed feelings about 
Gov. James E. McGreevey's executive order authorizing "needle exchange" 

It's a fact that someone who injects drugs with a syringe used by an 
infected person can get AIDS. Currently, 51 percent of New Jersey's 64,219 
HIV infections occurred because of intravenous drug use.

It's also a fact that no one's ever gotten AIDS from a fresh, sterile syringe.

And it's sad but true that an addict sick for a fix will borrow a needle if 
no clean "works" are available.

Such is the voracious and implacable nature of addiction.

So if clean works are readily available, as they soon will be in Camden and 
Atlantic City as a result of the governor's order, it follows that rates of 
new infection caused by dirty needles will fall. And because an infected 
user can pass HIV to a spouse or partner via sex, overall transmission 
rates could fall as well.

These would be good things, needless to say.

While opponents claim needle exchange programs encourage drug use, I can't 
imagine anyone deciding to become, say, a heroin addict simply because 
clean works can easily be had. People become addicted to heroin because 
heroin is available, and because they are physiologically, psychologically 
and spiritually vulnerable to the siren call of self-medication. Same goes 
for garden variety alcoholics, or nicotine fiends, for that matter.

Addiction is a disease and has been recognized as such by the medical 
profession for decades.

Nevertheless, I can't help but wonder if the availability of clean needles 
might indirectly enable, if not encourage, certain users to keep on using. 
By removing a particular obstacle and alleviating a specific fear, could 
needle exchange programs inadvertently help perpetuate addiction, at least 
for some people?

This is difficult to measure, much less, prove.

Addiction and recovery are complex and imperfectly understood phenomena. 
Addiction is often and wrongly seen as stemming from a failure of willpower 
or immorality; recovery, as either impossibly rare (it isn't) or impossible 
without divine intervention (unlike our president, I don't claim to have 
conversed with God, so I don't know whether this is true or not).

I do know, however, that there aren't enough inpatient treatment programs 
to stem the destructive and expensive tide of addiction and alcoholism.

In this managed care era, most addicts and alcoholics who need inpatient 
care can't get it, or can't get enough of it (the 28-day standard is 
ancient history).

And we're not anywhere near providing a system of "treatment on demand" 
that could enable addicts to take immediate advantage of a moment of 
clarity (or a moment of HIV panic) that might help begin the recovery process.

James F. Mulligan, M.D., is medical director of the Cumberland County-based 
Seabrook House, one of South Jersey's oldest and best-known addiction 
treatment facilities. He doesn't see a downside to the availability of 
clean works.

"I don't think it makes any difference in the addicted person who's a 
needle user," Mulligan says, adding that fear of dirty needles or HIV are 
not "enough of a rational point of enlightenment . . . or a changing point 
in their (addicts') lives" to jump-start the recovery process.

What typically inspires such enlightenment, he continues, is an outside 
event, such as the demands of a spouse or an employer, or trouble with the law.

These sorts of immediate and "significant negative consequences" are what 
can persuade an addict to seek treatment, Mulligan says - not the fear of 
possibly contracting AIDS sometime in the future.

Mulligan makes a cogent point.

I certainly respect his observations.

But I can't help wonder, and worry, whether needle exchange - like 
methadone - might bring with it not only the intended benefits but also 
unintended consequences.
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MAP posted-by: Richard Lake