NEEDLE EXCHANGE ISSUE HAS MANY SHADES OF GRAY

As someone who lost a best friend to AIDS and also knows people whose lives
have been damaged or destroyed by addiction, I've got mixed feelings about
Gov. James E. McGreevey's executive order authorizing "needle exchange"
programs.

It's a fact that someone who injects drugs with a syringe used by an
infected person can get AIDS. Currently, 51 percent of New Jersey's 64,219
HIV infections occurred because of intravenous drug use.

It's also a fact that no one's ever gotten AIDS from a fresh, sterile syringe.

And it's sad but true that an addict sick for a fix will borrow a needle if
no clean "works" are available.

Such is the voracious and implacable nature of addiction.

So if clean works are readily available, as they soon will be in Camden and
Atlantic City as a result of the governor's order, it follows that rates of
new infection caused by dirty needles will fall. And because an infected
user can pass HIV to a spouse or partner via sex, overall transmission
rates could fall as well.

These would be good things, needless to say.

While opponents claim needle exchange programs encourage drug use, I can't
imagine anyone deciding to become, say, a heroin addict simply because
clean works can easily be had. People become addicted to heroin because
heroin is available, and because they are physiologically, psychologically
and spiritually vulnerable to the siren call of self-medication. Same goes
for garden variety alcoholics, or nicotine fiends, for that matter.

Addiction is a disease and has been recognized as such by the medical
profession for decades.

Nevertheless, I can't help but wonder if the availability of clean needles
might indirectly enable, if not encourage, certain users to keep on using.
By removing a particular obstacle and alleviating a specific fear, could
needle exchange programs inadvertently help perpetuate addiction, at least
for some people?

This is difficult to measure, much less, prove.

Addiction and recovery are complex and imperfectly understood phenomena.
Addiction is often and wrongly seen as stemming from a failure of willpower
or immorality; recovery, as either impossibly rare (it isn't) or impossible
without divine intervention (unlike our president, I don't claim to have
conversed with God, so I don't know whether this is true or not).

I do know, however, that there aren't enough inpatient treatment programs
to stem the destructive and expensive tide of addiction and alcoholism.

In this managed care era, most addicts and alcoholics who need inpatient
care can't get it, or can't get enough of it (the 28-day standard is
ancient history).

And we're not anywhere near providing a system of "treatment on demand"
that could enable addicts to take immediate advantage of a moment of
clarity (or a moment of HIV panic) that might help begin the recovery process.

James F. Mulligan, M.D., is medical director of the Cumberland County-based
Seabrook House, one of South Jersey's oldest and best-known addiction
treatment facilities. He doesn't see a downside to the availability of
clean works.

"I don't think it makes any difference in the addicted person who's a
needle user," Mulligan says, adding that fear of dirty needles or HIV are
not "enough of a rational point of enlightenment . . . or a changing point
in their (addicts') lives" to jump-start the recovery process.

What typically inspires such enlightenment, he continues, is an outside
event, such as the demands of a spouse or an employer, or trouble with the law.

These sorts of immediate and "significant negative consequences" are what
can persuade an addict to seek treatment, Mulligan says - not the fear of
possibly contracting AIDS sometime in the future.

Mulligan makes a cogent point.

I certainly respect his observations.

But I can't help wonder, and worry, whether needle exchange - like
methadone - might bring with it not only the intended benefits but also
unintended consequences.