NEEDLE 'EXCHANGES' OFTEN AREN'T

As director of the International Scientific and Medical Forum on Drug Abuse,
a brain trust of the world's leading physicians and scientific scholars
dedicated to advancing research of drug use and drug abuse, I was disturbed
by an item in the March 30 Metro in Brief column, "Maryland Researchers Back
Needle Exchanges."

The article stated, "The nation's scientific community is united in ruling
that giving clean needles to HIV-infected addicts is good public health
policy." This is false.

First, most needle "exchange" programs are not exchanges at all, but are
needle giveaways -- since participants rarely exchange a dirty needle for a
clean one -- which means that the dirty needles remain on the streets.

Second, the science of these programs is uncertain. Supporters of needle
giveaways gloss over gaping holes in the data -- holes that leave
significant doubt regarding whether the programs exacerbate drug use and
whether they lead uniformly to decreases in HIV transmission. Recent
evaluation of the Vancouver Needle Exchange Program, one of the largest in
the world, showed it to be a tremendous failure. The HIV rate among
participants is higher than among injecting drug users who do not
participate in the program. The death rate due to illegal drugs in Vancouver
has skyrocketed since 1988, the year the program was introduced. The highest
rates of property crime in Vancouver are within two blocks of the needle
giveaway program. And most important, there has been a trade-off between
needle giveaways and drug treatment.

Public health risks may outweigh potential benefits of needle giveaway
programs. Each day, more than 8,000 young people in this country will try an
illegal drug for the first time. Heroin use is up among youths. While
perhaps eight people contract HIV directly or indirectly from dirty needles
each day, 352 start using heroin, and more than 4,000 die each year from
heroin/morphine-related causes (the number-one drug-related cause of death).

Needle giveaway programs should not be funded at the expense of treatment.
The administration was correct when it refused last year to use federal tax
dollars to fund needle giveaways, since such programs undermine treatment,
which should be our priority.

A significant portion of the scientific community does not support giving
needles to addicts but rather supports abstinence-based treatment, which has
been shown to work.

Calvina L. Fay, St. Petersburg, Fla.

The writer is director of the International Scientific and Medical Forum on
Drug Abuse of the Drug Free America Foundation.