MYTHS VS. REALITIES IN NEEDLE EXCHANGE PROGRAM

As the Baltimore City Health Commissioner and a native Californian, I
was very pleased to be involved in hosting a delegation of San
Diegans from the health and criminal justice fields recently. They
were in our city to look at how we are addressing the overlapping
problems of drugs, AIDS and hepatitis C.

Part of the time we spent showing them some of our effective drug
treatment programs, the funding for which has tripled in the past
three years. We are strong proponents of the notion that a heavy
investment in drug treatment and prevention programs is a major
weapon in the fight against crime, AIDS and other consequences of
drugs. The rest of the time, the delegation looked at our needle
exchange program, another component in our drug strategy.

In light of the current debate on needle exchange occurring in San
Diego, it might be useful to hear what we have found.

Baltimore implemented a city-run needle exchange program in August
1994. Our program is focused on two priorities: reducing the spread
of HIV/AIDS and serving as a bridge to intensive drug treatment. We
operate our program out of two vans which go to the same eight
locations each week. At each site, addicted individuals exchange
dirty, used syringes for sterile, new ones.

They can obtain testing and counseling for HIV, hepatitis C and
tuberculosis, and referrals for mental health or medical services at
one of our health department clinics or a nearby university.

Just as importantly, we have over 300 drug treatment slots
specifically reserved for needle exchange clients who are ready for
treatment. Because of these reserved slots, our clients often get
into treatment more quickly than other addicted individuals in the
community.

What have we found?

Baltimore's needle exchange program has done exactly what it was set
up to do: the incidence of HIV among our clients is down 40 percent
compared to all other addicts in the city; and we have placed 1,500
of our clients into intensive drug treatment, where over 75 percent
are successful in that treatment, despite the fact that our clients
are among the most hard-core, difficult to reach drug addicts in the
city.

What about the terrible consequences of needle exchange prophesied in
recent newspaper editorials -- more crime, more dirty needles
littering the streets and a dangerous message being sent to kids?

Well, extensive studies by Johns Hopkins University researchers have
debunked each of these concerns. In fact, in the areas surrounding
our needle exchange sites, there have been significant decreases of
both discarded needles and crime, when compared to other
drug-infested areas without a nearby needle exchange site. And, in a
study of over 1,000 students in four Baltimore high schools,
including one located only a block from a needle exchange site,
needle exchange was not found to encourage drug usage -- the
overwhelming contributors to that were parental, friend or peer drug
use.

Invariably, when presented with both our well-documented evidence of
the effectiveness of needle exchange and our conclusive proof that
negative consequences of needle exchange do not materialize,
opponents of needle exchange turn to Baltimore's drug problem as
evidence that Baltimore's needle exchange is a failure. So, before
such letters to the editor appear to that effect, let me address that
concern.

Baltimore does have a serious drug problem. However, this drug
problem is decades old and has not increased since the needle
exchange's inception. In fact, our clients have decreased drug usage
by approximately 20 percent after enrolling in our program. It is
also true that we, like many cities, have a large problem with
narcotic overdoses. However, there is no evidence that this is
related to needle exchange. Experts here and elsewhere say the main
reason for the overdose problem is the tremendous increase in purity
of heroin that has occurred on the East Coast over the past few years.

The bottom line: there is absolutely no scientific or medical reason
to continue to oppose the implementation of well-run needle exchange
programs. San Diegans must understand that it is simply politics that
is preventing this life-saving effort from getting under way.

Beilenson, a physician, is commissioner of health for the Baltimore
City Health Department.