CLEANNEEDLE PROGRAMS SAVE LIVES AND MONEY by By Kenneth A. Vail and Dawn Day
Copyright (c) 1997, Plain Dealer Publishing Co.

Hundreds of lives will be saved in the next few years if
Cleveland's clean needle programs are supported and allowed
to expand. Mayor Michael R. White has taken an important
step toward saving those lives: He is negotiating with
Xchange Point, an AIDS service organization, so that it can
reopen its clean needle program.

Cleanneedle programs, by slowing the spread of HIV, can
save the lives of people who inject drugs, their
nondrugusing wives and husbands and their newborn
children.

Consider the difference access to sterile needles makes.
Uninfected young adults who experiment with injecting
illicit drugs and then stop have their whole lives before
them. HIVinfected individuals who stop using illicit drugs
must face painful, debilitating and costly illnesses and
treatment and, very likely, premature death.

Cleanneedle programs not only save lives, they save
millions of dollars. For every HIV infection avoided, at
least $120,000 in medical costs are saved. The new protease
inhibitors that are prolonging the lives of a number of
AIDS sufferers are not changing the situation with regard
to cost. The new drugs cost as much as $15,000 a year.

In the last five years, six major studies funded by the
federal government have concluded that clean needle
programs reduce HIV transmission and do not increase the
use of injected drugs. Many public health experts,
including the former Surgeon General Dr. Joycelyn Elders,
have spoken out in favor of clean needle programs.

Opponents of needle exchange programs say they do not
believe the research. Researchers can make mistakes, but
the evidence in the case of cleanneedle programs is
massive. In the face of a spreading and deadly epidemic, we
need to act on the information available.

Some who oppose cleanneedle programs say they are
concerned that when we give out sterile needles, we are
relaying a double message. But we have many policies that
inform people who inject drugs that their behavior is
antisocial and selfdestructive everything from public
service announcements to prison sentences.

And even without cleanneedle programs, we send double
messages about drug use. When a person who injects drugs
has an overdose or suffers a severe reaction to a substance
used to cut the drug, we rush that person to a hospital and
give him or her the best medical care we can. We do not
want them to die. We do not say to the drug user's family
and friends, "Sorry, we cannot give your family member
lifesaving medical care because it would send the wrong
message." Getting sterile needles to people who inject
drugs is also about medical care and saving lives.

Americans understand that injecting drugs is a bad idea
and that people in need of preventive medical intervention
should receive it. A recent national survey found that
twothirds of all Americans favor needle exchange
programs as a way of saving lives and stopping the spread
of HIV/AIDS. Given the medical consensus that has emerged
on the effectiveness of sterile needles as a way of
avoiding the spread of drugrelated HIV/AIDS, it is
difficult to see the denial of access to sterile needles as
anything other than the denial of access to a lifesaving
medical intervention.

Cleanneedle programs like Xchange Point are not just
about giving out clean needles. Needle exchange workers
also provide sex education, condoms, referrals to HIV
testing and referrals to drug treatment, as well as other
services.

Cleanneedle programs help protect police from the
danger of a needle stick when they are frisking someone.
Needle exchange programs take infected needles out of
circulation. A sterile needle with its protective cap is no
danger to a police officer.

Clean needle programs help reduce problems with
discarded needles. In a Portland, Ore., neighborhood where
discarded needles had been a problem, fewer discarded
needles were found after the exchange opened, because drug
users had an incentive to keep their dirty needles and
trade them in for sterile ones at the exchange. With
sterileneedle programs that reach substantial numbers of
drug users, we can slow this horrible AIDS epidemic among
injecting drug users in Cleveland before it is widespread.
Let us do it now.