Pubdate: Fri, 10 Jan 2014
Source: Baltimore Sun (MD)
Copyright: 2014 The Baltimore Sun Company
Contact:  http://www.baltimoresun.com/
Details: http://www.mapinc.org/media/37
Author: John Fritze
Bookmark: http://www.mapinc.org/find?137 (Needle Exchange)

GROUPS PUSH TO LIFT NEEDLE EXCHANGE BAN

They Want Congress to Use Must-Pass Budget Bill As Vehicle to Change Law

WASHINGTON - Needle exchange advocates are urging lawmakers to use a 
coming must-pass budget bill to lift the decades-old prohibition on 
spending federal funds for clean syringes for drug users, supporters 
of the effort said Thursday.

The groups are pressing members of Congress, including Senate 
Appropriations Committee Chairwoman Barbara A. Mikulski of Maryland, 
to ease a ban they say does little to curb drug abuse but stymies 
efforts to prevent HIV and hepatitis infections caused by dirty needles.

Lawmakers approved the ban in 1988 as the crack epidemic was sweeping 
the country and the Reagan administration had expanded the nation's 
war on drugs. Congress has repeatedly extended the provision even as 
it has revisited other federal drug policies, such as mandatory 
minimum sentences for drug offenses.

"This is really a holdover policy from an earlier era," said Dr. 
Chris Beyrer, an epidemiologist at the Johns Hopkins Bloomberg School 
of Public Health. "We see this as a window - perhaps a modest window 
- - to lift the ban."

Beyrer is among more than 70 Maryland health care professionals who 
signed a letter to Mikulski recently asking her to push for the ban's 
repeal. Mikulski, a Democrat, supports doing away with the policy, 
but it appears unlikely that the GOP-led House will back that move.

"It prevents disease, saves lives and saves money," Mikulski said in 
a statement, noting that an earlier Senate version of the funding 
bill she oversaw removes the ban. "It's now up to the House to do the same."

Congress has historically addressed the issue in legislation used to 
fund government operations. Because of partisan gridlock in 
Washington, lawmakers have recently relied on stopgap spending 
measures that have largely kept the status quo in place for years.

That changed last month when Republicans and Democrats negotiated a 
rare budget agreement that set spending for 2014 at a little over $1 
trillion. Lawmakers have until Wednesday to fill in the details of 
how the money will be spent or risk another government shutdown.

Advocates stress they're not seeking additional money for exchanges. 
Instead, they want states to be able to choose to spend federal 
health funding they already receive on the syringe programs.

The Baltimore City Health Department exchanges roughly a half-million 
syringes each year, said Dr. Patrick Chaulk, an acting deputy 
commissioner at the city agency. About three-fourths of the program's 
roughly $800,000 budget comes from the city and the rest comes from the state.

An increase in funding would allow the city to upgrade the RVs it 
parks around the city to distribute the needles in neighborhoods and 
expand medical care that is often delivered to users simultaneously, 
Chaulk said.

Advocates say Baltimore's work on the issue is partly responsible for 
lowering the share of new HIV diagnoses attributable to injection 
drug use from about 53 percent a decade ago to 16 percent in 2010.

"For most of these people, it's literally the only point when they're 
going to have someone coaxing them into treatment," he said. "It's 
not 100 percent effective, but it's still the only opportunity."

Lifting the ban has received some support from Republicans - notably 
Rep. Ileana Ros-Lehtinen of Florida, who has co-sponsored legislation 
on the issue in the past - but the exchanges have generally met 
opposition from the GOP.

In 2009, when Democrats took control of Congress and the White House, 
the ban was lifted. About two years later, when Republicans reclaimed 
the House, it was reinstated.

Calvina Fay, executive director of the Drug Free America Foundation, 
said that if needle exchanges operated with more oversight, they 
might be successful. But, she argued, there's little accountability 
in ensuring drug users seek addiction treatment along with the clean needles.

And she said there is not enough effort made to ensure people don't 
wind up sharing the clean syringes they receive once they're back home.

Michael Collins, a lobbyist for the New York-based Drug Policy 
Alliance, argues that without the federal funding the potential 
impact that a network of exchanges could have on a community has not 
been fully realized - particularly as state and local budgets have 
continued to be squeezed.
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MAP posted-by: Jay Bergstrom