NEEDLE SWAPS HAVEN'T LOWERED DEATH RATES

If "Free Needles Are Just Common Sense" (Letters to the Editor, June 26),
then that's just another illustration of what nonsense "common sense" can
be. Prof. Alcabes of NYU School of Medicine says that injection drug abuse
is subordinate to "an overarching consideration: epidemic disease." For
him, this implies that public health protection demands that "we must give
out clean needles just in case it prevents HIV from finding its way into
one more person, or two."

As Dr. Satel pointed out in the June 8 editorial-page article to which
Prof. Alcabes responded, studies in two Canadian cities showed that
individuals who participated in needle exchange programs actually increased
their likelihood of seroconversion (i.e., infection with HIV) compared with
those who did not participate. These studies actually tested the subjects,
as opposed merely to using behavioral assumptions as the basis of
probability projections, the method of many studies purporting to "prove"
the efficacy of needle exchange.

Responding to the same article, Dr. Fleischman and Mr. Stein of the New
York Academy of Medicine cite the value of needle exchange programs in
guiding addicts to treatment.

However, many so-called programs have no such component--as, for example,
the private citizen in San Francisco who passes out 2-for-1 needles, no
questions asked--and the addiction rates in cities with needle exchange
don't indicate success in putting addicts into treatment. Indeed, San
Francisco, with its long-standing official endorsement of needle exchange,
has one of the highest death rates from injection drug overdose of all
cities in America.

Stuart Creque Moraga, Calif.


Checked-by: (Joel W. Johnson)