NEEDLE-TRADING PROGRAMS HAVE FEW INROADS IN U.S.

That February night, Gary Langis was doing his usual thing. That is,
he was delivering sterile hypodermic needles to two heroin addicts
here, and picking up dirty needles to be sure they were disposed of
safely.

A former addict himself, whose wife died of AIDS she contracted from
drug use, Mr. Langis said he felt compelled to make such deliveries
often, working with an underground group of needle-exchange volunteers
called the New England Prevention Alliance.

Needle exchange is explicitly legal in Massachusetts only in a
handful of cities running pilot programs, and Lynn, a northern suburb
of Boston, is not one of them. As he walked away from the delivery,
Mr. Langis was arrested.

A jury quickly acquitted him this month of illegally distributing
syringes, but the dispute is not really over.

"It's a violation of the law," said Lt. Tom Reddy of the Lynn police.
"If they were to come back and distribute needles again, they would be
arrested again for it."

Mr. Langis's case highlights the continuing conflicts over needle
exchange in spots around the country, conflicts that tend to pit
public health officials against law enforcement officials, town
liberals against town conservatives, raising moral charges all around.

The scientific consensus in favor of needle exchanges has steadily
solidified. Last month, the Centers for Disease Control and Prevention
issued findings that needle-exchange programs, which now number more
than 130 in at least 31 states, "are an effective public health
intervention that reduces transmission of H.I.V. and does not
encourage the illegal use of drugs."

But many localities remain unconvinced, fearing that needle exchanges
only increase drug use and the crime associated with it. Matthew
Straight, a councilor from Fitchburg, Mass., who opposes a
needle-exchange bill being considered by the State Legislature, said,
"I feel this bill decriminalizes drug use, and only supports the habit."

In Massachusetts, one of the most liberal states in the country, only
four cities, including Boston, have opened needle exchange programs.
Several cities that were offered grants to start exchanges turned the
money down, and several where drugs contribute most to the H.I.V.
rates have voted down needle exchanges, either by referendum or City
Council action.

The result, in Massachusetts and other states, is a patchwork unusual
for criminal law: a town where it is legal to distribute needles sits
next to a town where distribution remains a crime. And national
experts say such patchworks exist across the country.

"It is common to have states where localities decide," said Allan
Clear, executive director of the Harm Reduction Coalition, a
nationwide network of groups that advocate on behalf of drug users and
needle-exchange programs.

Those states include California, he said, where cities like San
Francisco and Santa Cruz have legalized needle exchanges, while San
Diego and Orange County have not. Even in New York, Mr. Clear said,
where needle exchanges have run legally in Manhattan for years, Staten
Island continues to oppose them, as does New Jersey next door.

The lack of legal approval in so many spots, Mr. Clear said, has kept
probably about half of all needle exchanges in the country technically
underground, though some have the tacit approval of
authorities.

Such town-to-town inconsistency frustrates public health officials and
advocates for people with AIDS. They argue that H.I.V. knows no
boundaries. In Massachusetts, they also point out that in the towns
that have needle exchanges, H.I.V. transmission caused by injected
drugs now constitutes a significantly lower percentage than in towns
that ban the exchanges.

The bill before the Massachusetts Legislature would make needle
exchange legal everywhere in the state. A similar bill passed last
year but was vetoed by Gov. Paul Cellucci, who said the issue should
be left to local control.

About a dozen states at a time are usually considering such
needle-exchange laws, and two or three have enacted them each year for
the last several years, according to the National Conference of State
Legislatures. Several states, including New York, have also recently
passed laws to legalize the purchase by the public of a limited number
of syringes in pharmacies.

The United States Surgeon General's office and the Department of
Health and Human Services have endorsed needle-exchange programs, but
the federal government provides no money for them.

At a hearing this month on the proposed Massachusetts needle-exchange
law, the public health commissioner, Howard Koh, told lawmakers that
of the 700 to 800 new H.I.V. infections reported in the state every
year, more than half of those infected contracted the virus through
drug use. Drugs have become the disease's "primary engine" in the
state, Mr. Koh said; in some cities, nearly three-quarters of H.I.V.
carriers got it from needles.

Here in Lynn, an old seaside city nicknamed by some the City of Sin,
the issue of needle exchange raises similarly conflicting views -- and
the debate becomes even more urgent when set against the backdrop of
the city's growing drug problem.

According to state statistics, 604 people who were admitted to
publicly financed substance-abuse programs in Lynn in 1997 reported
using a needle for drugs; that number rose by nearly 29 percent in
2000, to 777. And those were only the people coming for treatment.

Deaths from heroin overdoses have also been on the rise, and the city
has increased enforcement and set up a task force to try to stop the
trend.

But Lynn has also made great strides in recent years toward
revitalization, said Timothy Phelan, a city councilor at large, and
many here fear a needle exchange somewhere downtown would mean a
setback in the city's efforts to boost itself, Mr. Phelan said.
Elderly residents worry that they would be mugged walking to the
supermarket, he said, and there is "a strong Nimby element -- not in
my backyard."

Aside from economics and crime, Mr. Phelan said, "My strong personal
belief is that if you provide the needles, I personally think you are
exacerbating the problem of drug use. It's like, when I'm in Boston,
I'll walk by a homeless person on the street begging for money, and
you can see a couple of empty bottles next to them. I won't give them
money because I think they'll buy another bottle, but I've given them
my brown bag lunch before."

His City Council colleague Deborah Smith Walsh supports needle
exchange as a way to keep addicts healthy and get them into treatment,
but Ms. Walsh said she was very aware of being in the minority.

"Lynn is an old urban community," she said, "and because of that, it's
quite parochial and conservative in its thinking. So I think it's
difficult for people in the community to look upon a needle exchange
program as a positive type of treatment."

"Quite a few people look upon needle exchange as enabling an addict,"
she said, and it will take a great deal of education about the
research on needle exchange to convince them otherwise.

It is akin, Ms. Walsh said, to the public education that has been
needed to bring acceptance of teenage pregnancy programs and condom
distribution.

Lieutenant Reddy of the Lynn police said the police opposition to
needle exchange stemmed from the view that what was at issue was a
tradeoff between helping addicts and protecting the nearly 100,000
people who make up the rest of the city's population.

The experience of other police departments, Lieutenant Reddy said he
had heard, is that needle exchanges bring in more addicts and thus
more pushers, and that they all linger, increasing the crime rate.

"Why do innocent people have to suffer because of the conscious
decision of someone who chose to take criminal action?" he asked.

The Lynn City Council has passed an ordinance specifying that a needle
exchange can come to the city only with its approval. Unless the
Legislature passes the statewide bill, no one expects that to happen
soon.

So the stage seems set for the next needle-exchange arrest. Such
arrests are rare around the country.

"We're going to continue our mission," Mr. Langis said. "Our mission
is completely clear, that we will provide sterile injection equipment
to at-risk populations, no matter what ZIP code they live in."