Source: Denver Post Contact: Tue, 5 Aug 1997 The Denver Post Saturday, August 2, 1997 Page 7B We can fight epidemic with needle exchange By Dr. David E. Hutchison Denver Medical Society physicians believe that Denver must begin a needle exchange program immediately, and we support Mayor Wellington Webb's efforts to do so. The addiction and infection realities encountered daily by the medical community are overwhelming. Lest we forget, we are in the midst of an epidemic, and an epidemic changes the practice of medicine. We cannot solve the drug problem, but we can stop spreading incurable diseases. HIV and AIDS now infect more than 817,000 people in America, many of whom never touched a heroinfilled needle and who probably won't ever know what sex is, let alone risky sex, because they are children under age 13. More than 90 percent of these children inherited HIV from their mothers, who either used drugs intravenously or had sex with partners who did. The Centers for Disease Control says 7,296 children in our nation are infected, but the figure is probably much higher. While AIDS patients are being kept alive for many years thanks to the latest drugs, there still is no cure. So we must manage the epidemic. Needle exchange works in 87 American cities. It can work here if legislators, law enforcement officers and others will set aside their preconceptions. If we don't try a needle exchange, then we risk the public health for the sake of politics. There is no credible evidence of increased drug use when these programs are implemented, nor do these programs attract new drug users, according to an Institute of Medicine study. Further, a needle exchange can be an effective component of a comprehensive strategy to reduce HIV infection. The U.S. Department of Health and Human Services reports that needle exchange programs slow the spread of AIDS, and the CDC urges that the ban on needle exchanges be lifted. These public health agencies are responding to welldocumented evidence that the benefits of needle exchanges are not offset by potential increases in drug use. Denver has 11,600 intravenous drug users, and about 20 percent of them are HIVinfected, the Colorado AIDS Project reports. Denver also has 1,428 reported cases of hepatitis A, B and C, about 60 percent related to injection drug use. That's a conservative estimate of 3,176 Denver residents infected by either HIV or hepatitis and using needles to inject drugs. The average cost to run a city needle exchange is $169,000 a year. With protease inhibitor drugs, the cost to treat an adult with AIDS is, conservatively, $300,000. Ultimately, we all pay for this epidemic. Supplying addicts with the needles to continue their drug habit is a confusing concept. However, the message of a needle exchange is: "We know you are addicted, and while you may not have the courage to quit now, we assume you are a good person with a bad habit. You do not want to pass your disease to anyone else if you have it, nor do you want to get it from another addict. So we ask you to do your part by turning in your used needle for a new one." We believe most addicts will participate, and the program can become a springboard for change. Research shows that when health workers meet regularly with addicts to exchange needles, that point of contact repeatedly encourages the addict to quit. The message is being received throughout the country. In two years, needle exchange programs have increased 45 percent nationally. Many of these programs began in states where needle exchange was illegal. While we do not endorse breaking the law, we suggest that laws must serve the people or be changed. Colorado law is not in the best interests of public health. Sadly, giving needles to addicts is good public health policy. In an epidemic, the rules are different. In the past, we advocated washing hands and building sewers to stop spreading germs and eliminating mosquitoes to cure malaria. Now we suggest a new radical solution. The Denver Medical Society endorses needle exchanges as part of a comprehensive strategy to reduce the transmission of bloodborne pathogens such as HIV, AIDS and hepatitis. In an epidemic, it is the right thing to do. ____ Dr. David E. Hutchison, president of the Denver Medical Society, is a retired vascular, thoracic and general surgeon, past president of the medical staff at Mercy Hospital and a member of the board of the American College of Surgery.