ONE STEP TOWARD CURBING TWO PREVENTABLE DISEASES

Hepatitis C virus (HCV), the most common blood-borne infection in the
United States, is usually transmitted by exposure to contaminated blood.
Approximately 3.9 million people in the United States are infected with
Hepatitis C, with approximately 50,000 of those individuals residing in San
Diego County.

HCV, unlike other common forms of viral hepatitis, becomes chronic in the
majority of people infected and can produce death through complications of
cirrhosis of the liver and liver cancer. For these reasons, the Centers for
Disease Control and Prevention predicts that Hepatitis C will kill more
people annually than AIDS by 2010.

I have spent the last 20 years of my life caring for people with HIV and
AIDS in this community. At UCSD Owen Clinic, where 2,300 people are under
care for HIV infection, 23 percent of the patients also carry HCV. Of those
who acquired HIV from injection drug use (IDU), 60 percent carry HCV.

Through my work, I have learned a lot about how we, as a society, react to
epidemics that are fueled by human behavior of which many people
disapprove. Both HIV and HCV have that in common.

Injection drug abuse, the major mode of transmission of HCV, is not
something we can or should support. But, it is a fact of life, and
approximately 25,000 to 28,000 injection drug users reside in San Diego
County. If you add to that number their sexual partners and children who
are potentially at risk for acquiring infections, both blood borne and
sexually transmitted (HIV, Hepatitis B, HCV), the public health importance
of dealing effectively with injection drug abuse is compelling.

How should we deal with the public health consequences of injection drug abuse?

The primary means we have used to date is to reduce or eliminate injection
drug use -- a goal long sought after by criminalizing the practice and by
providing drug treatment. The criminal approach has been enormously
expensive and ineffective. While abstinence-based drug treatment has been
shown to be effective, our elected officials and public health experts have
failed to commit sufficient resources so that drug treatment "on demand" is
available to those motivated to stop using.

In San Diego County, moreover, we do not even provide heroin addicts with
publicly funded access to methadone maintenance programs -- a proven method
of treatment. These programs are to heroin users what nicotine patches are
to smokers. However, some view the provision of methadone as condoning drug
abuse and "sending the wrong message."

Americans pride themselves on being practical. I would submit that it is
time we become practical about the public health consequences of injection
drug abuse in San Diego County. We need to break the link between injection
drug abuse and the transmission of preventable diseases while we continue
to struggle to find adequate resources to bring addicts into treatment and
limit supply and distribution of drugs through action of our criminal
justice system.

We need to reduce the harm of ongoing injection drug abuse while we
continue efforts to control it. A key component of harm reduction is the
deployment of clean syringe exchange programs. The U.S. Surgeon General
recently reviewed all of the scientific studies of clean syringe programs
since April 1998 and issued a report on March 17, 2000 that stated: Syringe
exchange programs as part of a comprehensive HIV prevention strategy are an
effective public health intervention that reduces the transmission of HIV
and do not encourage the use of illegal drugs.

On Oct. 16, 2000, the San Diego City Council directed the city manager to
convene a task force, which I had the honor of chairing, that comprised
local professionals in health care, science, law enforcement and concerned
citizens. This task force was charged with developing the practices and
procedures to be used in a Clean Syringe Exchange Pilot Program. On June 16
of this year, the Task Force submitted its report and recommended the
implementation of a privately funded one-year pilot clean syringe exchange
program to be closely linked to drug detoxification and recovery programs.
Yesterday, a City Council committee approved these recommendations, which
merit the public's support.

If the full council adopts these recommendations, perhaps we will begin to
move beyond an understandable concern about sending mixed messages to
recognizing the central moral facts of the case. While neither condoning
nor increasing drug use, syringe exchange programs save lives and bring
addicts into treatment.