Pubdate: Tue, 01 Dec 2015
Source: San Francisco Chronicle (CA)
Copyright: 2015 Hearst Communications Inc.
Author: Debra J. Saunders
Bookmark: (Needle Exchange)


In 1997, I went to a "needle exchange" in San Francisco to see 
firsthand how the "harm reduction program" prevented the spread of 
HIV among addicts. Exchange staff offered vitamins, treatment for 
sores and referrals to kick the habit; addicts handed over carefully 
bundled needles in a one-dirty-for-one-clean exchange. Users' 
participation demonstrated that they had not given up on themselves.

The needle program began with good intentions. In the 1990s, addicts 
often shared needles - and HIV. The pioneer program promised to save 
lives make users responsible for syringe disposal. Little did I know 
that over the next two decades, in San Francisco and other U.S. 
cities, "needle exchange" would morph into "syringe access."

Under the new order, San Francisco Public Health Department 
spokeswoman Rachael Kagan explained, "You don't need a needle to get 
a needle." Users who show up at a "syringe access" center can get a 
"starter kit" of 20 needles. If they want more than 20 needles, they 
have to present used needles. I walked into a nearby facility and 
walked away with my own starter kit in a discreet plain brown bag.

San Francisco now asks users to leave their discarded syringes in 
drop boxes at public toilets, pharmacies and clinics. I got a 
"sharps" disposal box with my 20-needle kit. Alas, there's another 
oft-used disposal venue - city streets and sidewalks. If you walk 
around the city, then you've seen the used needles.

Exchange staffers across the country concluded over the years the 
one-for-one component didn't work for users who could scrounge up 
only one or two syringes, Daniel Raymond, policy director of the Harm 
Reduction Coalition in New York, told me. It "ended up being 
counterproductive for the public health goal" of stopping the spread 
of HIV. Some centers stopped requiring a one-for-one trade. Even 
without the requirement, Raymond said, users bring in dirty needles - 
at a rate of 80 percent, 90 percent, even more than 100 percent at 
some centers. Access, not exchange, is now considered a "best practice."

San Francisco gave away 2.4 million syringes last year. It's not 
clear that the "access" program is responsible for the record number 
of resident complaints about needle litter. But then, the switch from 
"exchange" to "access" occurred without public debate, or an airing 
of possible consequences. Having sold the public on needle exchange, 
advocates unilaterally moved to a model that doesn't ask junkies to 
do something as basic as pick up after themselves.

With its goal of making self-destructive behavior less destructive, 
"harm reduction" always has been a dicey proposition. To work, 
programs must not enable more risky behavior than they prevent. In 
the 1990s, research found that needle exchanges increased the number 
of needles used without increasing drug use itself.

With record complaints about dirty needles, it seems as if, in a bid 
to protect the most self-destructive elements in society, San 
Francisco has put everyone else's health at risk by eliminating the 
exchange half of the bargain. Mayor Ed Lee's office sent me a 
statement that noted the mayor "is relying on the public health 
experts about how to best distribute needles to prevent the 
transmission of fatal diseases." Lee knows needle litter is a problem 
and has staff working on how to pick up used needles faster. In 
short, taxpayers get to fund needle giveaways for habitual offenders, 
pay to clean up after them, and learn to navigate in a landscape with 
needle litter - in the cause of public health.
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MAP posted-by: Jay Bergstrom