HELPING AMERICA'S LEAST WANTED

The RV arrived at a corner near D.C.'s Marvin Gaye Park, also known
to locals as "Needle Park." A steady procession of addicts came to
the door, mounted a few steps and sat down. One by one, they dropped
used needles into a container and received new needles in return,
along with alcohol wipes and the small, bottle-cap-like "cookers" in
which heroin is heated.

Reggie Jackson, Teefari Mallory and Hazel Smith -- staff members at
PreventionWorks, Washington's largest needle-exchange program -- are
at the park twice a week, offering clean needles to prevent disease
transmission, condoms, drug treatment referrals, HIV/AIDS testing and
a few kind words. "You still play the guitar?" "You'll have a swollen
hand if you keep going there." "Love you, baby."

It is the eyes and arms of addicts that draw your attention. Eyes
that are glassy, or unnaturally bright, or tired beyond exhaustion.
Arms that are ulcerated sticks or purpled parchment; with repeated
use, needles become blunt and tear the skin. Some addicts adopt a
defensive politeness -- "yes, sir" -- and quickly leave. Others want
to talk -- "I love plants, and I love kids" -- trying to provide
hints of their humanity. They are America's least wanted.

They are also at the center of a controversy. Needle-exchange
programs have always been politically controversial, with opponents
arguing that they send a mixed moral message about drug use. The
House of Representatives recently passed an amendment banning
exchanges in the District within 1,000 feet of places where children
gather -- which, if approved by the Senate, would effectively put
programs like PreventionWorks out of business. Staffers joke that
they could work only in graveyards and the middle of the Potomac.

This restriction might make sense if needle-exchange programs
increased the number of addicts. But they don't. Anthony Fauci,
director of the National Institute of Allergy and Infectious Diseases
at the National Institutes of Health, has comprehensively reviewed
the scientific studies on needle exchange. "It does not," he says,
"result in an increase in drug abuse, and it does decrease the
incidence of HIV. . . . The idea that kids are going to walk out of
school and start using drugs because clean needles are available is
ridiculous."

My experience in Washington was consistent with Fauci's view. Addicts
who came for needles were generally in their 40s and 50s. The
availability of clean needles no more caused their addiction than the
provision of clean shot glasses would cause alcoholism.

The main purpose of needle exchange, according to Jackson, the
supervisor of the mobile unit, is to keep people alive until they can
get clean -- a process that can take years, if it happens at all.
Needle-sharing is the third-leading cause of HIV infection in our
nation's capital. It is also a major contributor to the spread of
hepatitis C, the main cause of liver transplants in the United
States. Jackson is well acquainted with these facts because, while an
addict, he contracted both diseases. "If they had a truck like this
in the '60s, '70s and '80s," he told me, "maybe I wouldn't have
gotten infected."

The staff members of PreventionWorks build long-term relationships
with people no one else knows by name. Because of this, they have a
good feel for when addicts are ready for treatment. While I was in
the RV, Jackson signed up two addicts for detox. Mallory used her own
car to drive one addict, with whom she had been working for eight
years, to treatment. "He's ready, ready to go," she said, fighting tears.

Critics claim that needle-exchange programs create a moral hazard by
legitimizing drug abuse. But it does not legitimate drug abuse to
help people with the clinical disease of addiction avoid other deadly
diseases until they are ready for help. Sacrificing the lives of
addicts to send an "unmixed" moral message actually sends a troubling
moral message: that the unwanted have no worth.

As each addict leaves the RV, Smith -- who was an addict on the
street herself four years ago -- tells them, "I love you." When I
asked her why, she said: "If someone years ago had told me they loved
me, it might not have been so long."

Street addicts are connected to the rest of us by only a few
invisible strands -- people such as Smith, Jackson and Mallory -- and
those strands should not be severed.