Pubdate: Wed, 5 Aug 2009
Source: Washington Post (DC)
Page: A13
Copyright: 2009 The Washington Post Company
Contact:  http://www.washingtonpost.com/
Details: http://www.mapinc.org/media/491
Author: Michael Gerson
Cited: PreventionWorks! http://www.preventionworksdc.org/
Bookmark: http://www.mapinc.org/find?137 (Needle Exchange)
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)

HELPING AMERICA'S LEAST WANTED

The RV arrived at a corner near D.C.'s Marvin Gaye Park, also known 
to locals as "Needle Park." A steady procession of addicts came to 
the door, mounted a few steps and sat down. One by one, they dropped 
used needles into a container and received new needles in return, 
along with alcohol wipes and the small, bottle-cap-like "cookers" in 
which heroin is heated.

Reggie Jackson, Teefari Mallory and Hazel Smith -- staff members at 
PreventionWorks, Washington's largest needle-exchange program -- are 
at the park twice a week, offering clean needles to prevent disease 
transmission, condoms, drug treatment referrals, HIV/AIDS testing and 
a few kind words. "You still play the guitar?" "You'll have a swollen 
hand if you keep going there." "Love you, baby."

It is the eyes and arms of addicts that draw your attention. Eyes 
that are glassy, or unnaturally bright, or tired beyond exhaustion. 
Arms that are ulcerated sticks or purpled parchment; with repeated 
use, needles become blunt and tear the skin. Some addicts adopt a 
defensive politeness -- "yes, sir" -- and quickly leave. Others want 
to talk -- "I love plants, and I love kids" -- trying to provide 
hints of their humanity. They are America's least wanted.

They are also at the center of a controversy. Needle-exchange 
programs have always been politically controversial, with opponents 
arguing that they send a mixed moral message about drug use. The 
House of Representatives recently passed an amendment banning 
exchanges in the District within 1,000 feet of places where children 
gather -- which, if approved by the Senate, would effectively put 
programs like PreventionWorks out of business. Staffers joke that 
they could work only in graveyards and the middle of the Potomac.

This restriction might make sense if needle-exchange programs 
increased the number of addicts. But they don't. Anthony Fauci, 
director of the National Institute of Allergy and Infectious Diseases 
at the National Institutes of Health, has comprehensively reviewed 
the scientific studies on needle exchange. "It does not," he says, 
"result in an increase in drug abuse, and it does decrease the 
incidence of HIV. . . . The idea that kids are going to walk out of 
school and start using drugs because clean needles are available is 
ridiculous."

My experience in Washington was consistent with Fauci's view. Addicts 
who came for needles were generally in their 40s and 50s. The 
availability of clean needles no more caused their addiction than the 
provision of clean shot glasses would cause alcoholism.

The main purpose of needle exchange, according to Jackson, the 
supervisor of the mobile unit, is to keep people alive until they can 
get clean -- a process that can take years, if it happens at all. 
Needle-sharing is the third-leading cause of HIV infection in our 
nation's capital. It is also a major contributor to the spread of 
hepatitis C, the main cause of liver transplants in the United 
States. Jackson is well acquainted with these facts because, while an 
addict, he contracted both diseases. "If they had a truck like this 
in the '60s, '70s and '80s," he told me, "maybe I wouldn't have 
gotten infected."

The staff members of PreventionWorks build long-term relationships 
with people no one else knows by name. Because of this, they have a 
good feel for when addicts are ready for treatment. While I was in 
the RV, Jackson signed up two addicts for detox. Mallory used her own 
car to drive one addict, with whom she had been working for eight 
years, to treatment. "He's ready, ready to go," she said, fighting tears.

Critics claim that needle-exchange programs create a moral hazard by 
legitimizing drug abuse. But it does not legitimate drug abuse to 
help people with the clinical disease of addiction avoid other deadly 
diseases until they are ready for help. Sacrificing the lives of 
addicts to send an "unmixed" moral message actually sends a troubling 
moral message: that the unwanted have no worth.

As each addict leaves the RV, Smith -- who was an addict on the 
street herself four years ago -- tells them, "I love you." When I 
asked her why, she said: "If someone years ago had told me they loved 
me, it might not have been so long."

Street addicts are connected to the rest of us by only a few 
invisible strands -- people such as Smith, Jackson and Mallory -- and 
those strands should not be severed. 
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MAP posted-by: Richard Lake