Pubdate: Sun, 27 Nov 2005
Source: Eagle-Tribune, The (MA)
Copyright: 2005 The Eagle-Tribune
Contact:  http://www.eagletribune.com/
Details: http://www.mapinc.org/media/129
Author: Chris Markuns, Staff writer
Bookmark: http://www.mapinc.org/hr.htm (Harm Reduction)
Bookmark: http://www.mapinc.org/find?137 (Needle Exchange)

OVER-THE-COUNTER SYRINGE SALE DIVIDES STATE

Massachusetts is on the brink of selling hypodermic syringes over the
counter, a move that comes with a pair of totally opposite but equally
simple arguments.

Opponents consider the idea and suspect the world's gone mad: Heroin
is illegal, they correctly point out; heroin is bad. We should be
making it harder -- not easier -- for people to shoot it into their
veins.

Supporters do the math and come away with their own no-brainer of a
conclusion: Used needles spread AIDS and hepatitis C, both of which
kill people. They'll concede the high to cut down on horrible disease.

"Of course, we don't know exactly what's going to happen," said Dr.
Wayne Pasanen, medical director at the Lawrence treatment facility
Habit Management. "But we know what we have now isn't working."

The proposed law -- passed overwhelmingly by the House this month and
due to be taken up by the Senate in January -- would allow people 18
and up to buy needles at pharmacies without a prescription. But it
would require an educational insert about treatment, disposal and
disease prevention to be given with every purchase. It also would no
longer be illegal to possess them.

The debate behind it is as relevant in Essex County as anywhere, with
local law enforcement having spent the past few years highlighting the
region's battle with heroin addiction and some communities dealing
with its widespread sale as well.

And the accompanying struggle with blood-borne diseases also has local
significance, since Hispanics have been impacted as much as any race
by needle-transmitted AIDS. Infection either through dirty needles
directly or sex with someone who used one accounted for 31 percent of
all AIDS cases among Hispanics in 2000, according to the Centers for
Disease Control.

Overall in Massachusetts, more than a third of the AIDS or HIV cases
are needle-related.

These are issues that Lawrence police Chief John J. Romero has been
confronted with before, never more blatantly than last year's
anonymous drop-off of numerous "how-to heroin kits" -- more than 100
clean needles, dozens of tourniquets, small metal cups for cooking
heroin -- in plastic bags in an alley off Broadway, along with a note
pointing people to the state's needle exchange program.

Romero wasn't pleased then -- police believe the bags were left by one
of the state's four Boston-area needle exchange programs, but couldn't
prove it -- and he isn't on board with an over-the-counter approach
now.

"I can see what they're trying to do; however, I think anything that
makes using drugs easier, it's not a benefit," he said, unable to get
past the fundamentally mixed message of providing the tools to break
the law.

"I'd rather see the money put into treatment. If somebody's arrested,
why not make it mandatory for them to be in a program?" Romero said.
"I don't think making needles over the counter is really treating the
problem."

State Sen. Steven Baddour, D-Methuen, suspects the proposal will have
enough votes in the Senate, but don't expect his to be one of them. He
sees needle availability promoting use without preventing the spread
of disease.

"You've got a lot of kids living in Andover, Methuen and elsewhere
getting pressured from all fronts right now and saying no, and part of
the reason they're saying no is they don't want to inject with a dirty
needle," he said. "What users and dealers will say is, 'Don't worry
about the needle. Here's a new needle, and every time you buy a bag
I'll give you a new needle.'"

But to Pasanen and others who work closely with addicts, such fears
display a fundamental misunderstanding of heroin addiction and its
stages. They say very few begin with needles.

"The notion that somehow the dealer is going to put together a package
of needles along with the packet of dope is, to me, almost absurd,"
said Pasanen, a North Andover resident who is also a vice president at
Lowell General Hospital. "People start by taking pills and then they
start sniffing, and when they become addicted and sick and they find
the IV route is more efficient, they move on to (needle) use."

Once addicted, needle availability doesn't determine use, said Kevin
Norton, president and CEO of CAB Health & Recovery in Danvers, a
nonprofit treatment program with offices throughout North of Boston.

"The addiction is what drives, not the works," he said.

Massachusetts would be the 48th state to make needles available over
the counter, and advocates point to studies showing reductions in HIV
and hepatitis C after such a move, with no correlated increase in drug
use.

"This is my field. I keep up with it, and there is no study
demonstrating an increase in drug abuse in any area where there are
freely available needles," said Jonathan R. Miller, treatment
coordinator at Team Coordinating Agency in Haverhill.

Pasanen says that 85 percent of the patients he treats with methadone
- -- used to help get them off heroin -- have been exposed to hepatitis
C.

"Here in Massachusetts ... we don't have needles and syringes
available and we have one of the highest problems of opiate abuse in
the country," he said. "I think the main issue is harm reduction."

Still, concerns remain about what the change would do to the four
state-funded needle exchange programs, which require
addict-to-counselor contact, an offer of detox, and a dirty needle to
be turned in for every clean one. Such programs have had difficulty
spreading because communities resist them, Baddour admitted, but he
prefers the approach and believes they would become obsolete.

"I think if this bill passes," he said, "needle exchange is forever
dead."

Foes also worry about whether suburban users will wander into their
local pharmacy for needles, given the stigma of what such a purchase
would mean, and where users will dispose of dirty needles.

There's also the question of how available they'll truly be. The bill
is backed by the Massachusetts Pharmacists Association and
Massachusetts Independent Pharmacists Association, but pharmacies
won't be required to carry them and some likely won't.

"Our policy is to require prescriptions," said Tony Sabutis, owner of
Pillbox Pharmacy in East Hampstead, N.H., a state where needles have
been available since 1992.

He believes selling needles to someone without knowing they'll use
them appropriately "wouldn't be ethical as far as I was concerned."

They are all challenges that must be tracked and watched, say
supporters, but none ultimately comes close to trumping the end result.

"It's a common-sense, solid prevention, harm reduction approach,"
Norton said. "I see the concerns, but I think there's a greater public
health concern."
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MAP posted-by: Derek