Clean-needle programs save lives and money

by Kenneth A. Vail and Dawn Day

Vail is the director of Xchange Point in Cleveland. Day is the
director of the Dogwood Center in Princeton, N.J.

Hundreds of lives will be saved in just 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.

Clean-needle programs, by slowing the spread of HIV, can save the
lives of people who inject drugs, their nondrug-using 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.
HIV-infected individuals who stop using illicit drugs must face
painful, debilitating and costly illnesses and treatment and,
very likely, premature death.

Clean-needle 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
now 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 clean-needle programs is massive. In the face of a
spreading and deadly epidemic, we need to act on the information available.

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

And even without clean-needle 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 life-saving medical care because it would send the
wrong message. Getting sterile needles to persons 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 two-thirds 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
drug-related 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.

Clean-needle 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.

Clean-needle 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, Oregon, 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 sterile-needle 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.

Kenneth A. Vail and Dawn Day