HEROIN PROGRAM'S DEADLY TOLL

Needle Exchanges Save Lives but May Imperil Workers

SAN FRANCISCO -- Pete Morse devoted his life to saving the lives of
heroin users. A dreadlocked community activist with a Ph.D in
history, he bore a tattoo that read: "Injury to one is an injury to all."

So his friends and colleagues were shocked when he was found
unconscious in 2007 on a bathroom floor with a needle by his side.
Doctors pronounced the 36-year-old Mr. Morse dead from an overdose of
heroin, alcohol and cocaine.

Mr. Morse spent more than 10 years working in drug-addiction programs
that follow the principle of harm reduction. This philosophy argues
that the best way to save users' lives isn't to force them off
illegal drugs. Instead, its adherents teach safer ways to use drugs
- -- supplying clean needles to prevent the spread of disease, for
example, or teaching how to avoid overdosing. The programs are
credited with saving lives in cities across the U.S.

But harm-reduction leaders have struggled to address a
sometimes-lethal issue: dangerous drug use by the very workers who
are supposed to help users. In the circles of New York and San
Francisco where Mr. Morse worked, at least five harm-reduction
staffers have died of overdoses. These included needle-exchange
founders in both cities, as well as psychologist John Watters, a
needle-exchange advocate who started a study to track how outreach
programs benefited drug users. Mr. Watters died from an opiate
overdose in 1995.

Worker drug abuse is "a huge problem," says Jon Zibbell, the founder
of a Massachusetts drug users' coalition who is now an assistant
professor at Skidmore College. "We prevent [overdoses] among our
clients," he says. "So we should try to prevent them among our workers."

Studies suggest that needle exchanges work. In San Francisco, Chicago
and New Mexico, heroin-related deaths dropped after users were taught
how to administer an anti-overdose medication to each other. In New
York City, the rate of new HIV infections among injection-drug users
dropped more than 75% between 1995 and 2002 as the number of clean
needles distributed doubled, according to a study by epidemiologists there.

Needle-exchange programs, like those in San Francisco, can help
reduce HIV infections and drug overdoses, WSJ's Bobby White reports.
But while federal funding for such programs has grown in recent
years, they still face many challenges.

Yet needle-exchange programs can exact a toll on those who operate
them. Staffers typically earn little or no money for working on bleak
urban front lines with traumatized users. Programs tend to be run on
the cheap, often giving little of the training and support that are
standard for other social-service workers. Those dealing with other
factors -- depression, history of drug use or personal stresses --
may find it particularly hard to cope. Drug abuse is "an occupational
hazard," says Alex Kral, a San Francisco epidemiologist who oversees
the study Dr. Watters started.

Many exchanges hire workers who are active or former users. Other
volunteers, however, have had no exposure to hard drugs before
entering the field. Friends and family of Mr. Morse say they believe
he learned to shoot heroin years after he first worked in a needle exchange.

Mr. Morse's family members say they don't blame harm-reduction
programs for his heroin use. Mr. Morse suffered from depression, they
say, and accidentally overdosed shortly after he learned that a
family member had been diagnosed with a grave illness.

Some needle-exchange advocates say it would be unfair to pin his and
other deaths on an approach that they say saves lives. The
fatalities, these people say, represent a small portion of the
field's workers. They argue that drug overdoses also occur among the
staff members of abstinence programs, the other main branch of drug
outreach, which also often hires former users. There are no
statistics that compare overdose rates of workers in the two types of programs.

Those who do believe that the needle-exchange deaths are a problem
propose two broad solutions. Critics say exchanges that countenance
illegal drug use should be reined in. Supporters say that if
anything, the programs should receive more funding, in part to better
train and support their workers.

State and local government funding for needle exchanges tripled in
2007, to $14 million, compared with 1996. That's minuscule compared
with the $1.75 billion that Congress gave states last year for
conventional drug-treatment programs. President-elect Barack Obama
said in 2007 that he may be willing to lift a ban on federal funding
for needle exchanges. A bill now in the House of Representatives
would free federal money for exchanges nationwide.

Busy Studying

Pete Morse was raised in Bloomfield Hills, Mich. On an otherwise
conservative block of the affluent Detroit suburb, he grew up
listening to Peter, Paul & Mary, according to his mother, Patty
Morse. He excelled in school.

At DePauw University in Indiana, the lanky, 6'1" Mr. Morse ran on the
varsity cross-country team and volunteered with a Red Cross HIV
prevention project, his mother said. He seemed too busy running,
studying or attending political rallies to drink or smoke much pot,
recalls Vince Guimont, a fraternity brother who shared a room with
Mr. Morse for three years. "He was always the person who had it
together," Mr. Guimont says.

After graduating in 1992, Mr. Morse spent the year hiking in New
Mexico, says his father, Pete Morse Sr. He also volunteered for the
first time at a needle exchange. But soon he went back to school,
beginning work on a doctoral degree, on the history of U.S. labor and
social movements, at State University of New York at Binghamton. He
joined the Industrial Workers of the World, or Wobblies. His tattoo
- -- "injury to one is an injury to all" -- is an IWW slogan.

In 1996, his master's degree completed, he moved to New York City.

New York was in the throes of an AIDS crisis, and intravenous drug
use was a prime pathway of transmission. AIDS activists believed they
wouldn't have much success getting users to quit, but they thought
they could slow the disease's spread by allowing users to trade their
shared needles for a supply of clean ones.

New York City legalized some needle exchanges in 1992. Public support
for the programs grew throughout the decade. "We stepped to the
plate," says Jason Farrell, who in the early 1990s co-founded a
Manhattan needle exchange where Mr. Morse volunteered.

As exchanges spread, New York's incidence of HIV among injection-drug
users dropped. In the three-year period ending in 1995, 44% of New
York's intravenous-drug users were HIV-positive. By the four-year
period ending in 2002, the infection rate among the population had
fallen to 17%, according to a study by Don Des Jarlais, a doctor at
New York's Beth Israel Medical Center.

But there were casualties among workers. In 1996, Brian Weil, who
founded two New York syringe exchanges, suffered a fatal opiate
overdose, according to the New York city medical examiner's office.
Three years later, Angela Daigle, who worked at both exchanges with
Mr. Morse and started a women's clinic at the Lower East Side
exchange, also died from an opiate overdose, according to the medical examiner.

Mr. Farrell says he and many of the other grassroots activists who
founded exchanges spent their limited funds on supplies and direct
services. Their workers were often encouraged to put in long hours
with little professional training. Some volunteers were ill-equipped
to deal with the burnout.

"There were a lot of shortcomings in management skills in a lot of
folks, including myself," said Mr. Farrell. "A lot of us got into
this not to run big organizations, but to address a public-health issue."

Heroin, long considered an outsider drug, was enjoying a mainstream
moment. With South American traffickers increasing imports, heroin
became cheaper and more widely available. Fashion designers used
pale, bony models to popularize "heroin chic." Mr. Farrell says the
late 1990s brought an influx of volunteers who were "well-schooled,
white, upper-middle-class kids that tend to romanticize and be
infatuated with the heroin lifestyle."

'OK to Use Heroin'

Even after seeing overdoses among clients and peers, some volunteers
began using hard drugs. Without proper training, Mr. Farrell says,
those charged with teaching safer drug use sometimes "misinterpret
that to think, 'It's OK to use heroin.'"

It's unclear when Mr. Morse first tried heroin. Writing years later
on a blog he kept, Mr. Morse said he had been shooting amphetamines
while living in New York.

His younger sister, Carrie Morse, remembers when he told her that he
was using heroin. It was in 2000, Ms. Morse says, and her brother was
suffering "horrible depression," using the drug to self-medicate. "I
was scared that something would happen to him," she says.

That year, Mr. Morse moved to California, following his longtime
girlfriend, who'd moved the year before. He saw a therapist and took
antidepressants, and continued working on his doctoral thesis. His
family says his heroin use stopped.

In 2000, the San Francisco health department adopted harm reduction
as a guiding principle. Mr. Morse continued his work on needle
exchanges, sometimes volunteering at one in San Francisco's
Tenderloin district, in a fetid alley behind a bar.

Volunteers like Mr. Morse set up tables there once a week to offer
syringes, first-aid kits and clean supplies like metal cups for
cooking heroin. They showed how to inject safely and instructed
people who wanted to quit how to access rehab.

Carrie Morse recalls asking her brother if this tempted him to use.
He told her that he needed to keep his head about him to help others,
and that his clients' situation reminded him of drug use's negative
effects. Mr. Morse said "it was his work in the harm-reduction field
that kept him from using heroin," his sister recalls.

Program managers don't take a unified approach to staff drug use.
Hilary McQuie, a San Francisco harm-reduction training administrator
who was Mr. Morse's last boss, says her organization trains workers
to develop a "personalized burnout prevention plan" that includes
taking time off work and doing a "self assessment" of whether their
own drug use is harmful.

Because harm-reduction programs don't force their clients to quit,
making employees do so would be "completely hypocritical," said Ms.
McQuie, the West Coast director of the Harm Reduction Coalition, a
New York-based nonprofit that trains workers to run needle exchanges
and other harm-reduction programs. She and others in the field say
drug use also is a problem among workers in abstinence-based
organizations, which require workers who use drugs to enter rehab or
leave their jobs.

Others believe that workers need more support services, including
access to therapy. San Francisco epidemiologist Dr. Kral, who sits on
Ms. McQuie's board, has for more than a decade paid a social worker
to conduct monthly group therapy for workers on his drug-user study.

Drugs continued to take a toll on Mr. Morse's peers. In 2002, Urban
Poole, an ex-convict who provided drug counseling for prisoners and
worked for San Francisco's Health Department, died of an overdose.
Three months later, Matthew McLeod, a local needle-exchange pioneer
and a musician known as Matty Luv, suffered a fatal opiate overdose,
according to a report by the San Francisco Medical Examiner. Mr.
McLeod had told people, including an interviewer from a punk music
publication, that he hadn't used heroin until he started the San
Francisco Needle Exchange in 1997.

Mr. McLeod's death shook Mr. Morse. He and a friend, a former heroin
user, discussed their own responsibilities and loved ones, and agreed
they didn't want to risk a similar fate.

Still, Mr. Morse never stopped identifying as a user. In counseling
with clients, the tattooed and dreadlocked Mr. Morse listened
silently and, based on his own use and drug knowledge, explained how
certain prescription drugs interact with heroin, recalls Kirk Read,
who worked with Mr. Morse gathering data for a drug-user study for
the University of California. "Your authority with clients is
sometimes measured by how much you've lived," Mr. Read says.

Stopping Overdoses

By 2003, needle exchanges had steady funding in San Francisco.
Harm-reduction advocates began expanding their scope. Mr. Morse
worked on the San Francisco health department's new Drug Overdose
Prevention and Education, or DOPE, project, training users to
administer naloxone, which cancels out the effects of an opiate overdose.

Participants in the naloxone program reported stopping almost 150
near-fatal overdoses over the next three years, says Josh Bamberger,
San Francisco's homeless-outreach coordinator, who ran the program.
Opiate-related fatalities in San Francisco dropped almost 50% from
2003 to 2005.

Mr. Morse stayed with DOPE after the Harm Reduction Coalition took it
over, with the help of city funding, in 2005. He started working full
time for the Harm Reduction Coalition the following year, providing
assistance to needle exchanges around the state.

By late 2006, Mr. Morse had also joined San Francisco's HIV
Prevention and Planning Council, and the board of San Francisco's
Homeless Youth Alliance, which runs a needle exchange. He finished
his Ph.D dissertation on the Wobblies.

Though his professional life bloomed in the last years of his life,
his depression was sometimes deep, his family says. His
paperwork-heavy job left him unsatisfied, his sister said. He was
also jarred by the death of his cat, who had nestled on his lap as he
wrote his thesis. He had its name, Otter, tattooed on his left biceps.

Then, three days before Christmas in 2006, his sister was diagnosed
with cancer. Carrie Morse says her brother was despondent. "Other
people's pain was Pete's pain," said Ms. Morse, who works in the
public-relations department of The Washington Post. The two spoke
daily for the next three weeks, she says.

Shortly before his sister's cancer surgery, late on the night of Jan.
12, 2007, Mr. Morse ended up drunk at a friend's house in San
Francisco's Mission District. He went to use the bathroom. The friend
discovered Mr. Morse unconscious on the floor, according to the
medical examiner's report. He was declared dead at 4:31 the next morning.

An autopsy found scar tissue on Mr. Morse's arm, and a needle
puncture in the crook of his elbow. The medical examiner said his
death was accidental and attributed it to alcohol, heroin and cocaine
in his system.

More than 300 mourners attended the funeral. Many paraded down a
palm-lined stretch of San Francisco's Market Street with drums and a
five-foot-tall photo of Mr. Morse.

Mr. Morse's parents blame his heroin use that night on his decision
to drink too much as he despaired over his sister's illness. They say
they're proud of their son's efforts to bring harm reduction into the
mainstream.

Since her cancer treatment, Carrie Morse has been volunteering at
Prevention Works, a needle exchange in Washington, D.C. Such
programs, she says, "save lives."

Mr. Morse's coworker, Mr. Read, learned another lesson from his
friend's death. "It punctured the illusion that knowledge can protect
you," he says.