NEEDLE EXCHANGE GIVES ADDICTS TIME TO CHANGE

The RV arrived at a corner near Washington's Marvin Gaye Park, known
locally 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, 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, unnaturally bright or tired beyond exhaustion. Arms
that are ulcerated sticks or purple 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're also at the centre of a controversy. Needle exchange programs
have always been controversial, with opponents arguing they send a
mixed moral message about drug use. The House of Representatives
recently passed an amendment banning exchanges in the District of
Columbia within 300 metres of sites where children gather--which, if
approved by the Senate, would effectively put programs like
Prevention-Works! out of business: Staffers joke they could only work
in graveyards or the middle of the Potomac.

This might make sense if needle exchange programs increased the
number of addicts. But they don't. Dr. Anthony Fauci, the director of
the National Institute of Allergy and Infectious Diseases at the
National Institutes of Health, has reviewed the 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 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 older. 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 Reggie, the
supervisor of the mobile unit, is to keep people alive until they can
get clean, something that can take years.

Needle-sharing is the third-leading cause of HIV infection
Washington. It is also a major contributor to the spread of hepatitis
C, the main cause of liver transplants in the U. S. Reggie 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 of Prevention-Works! builds 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, Reggie signed up two addicts for detox.
Teefari 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 say needle programs create a moral hazard by legitimizing
drug abuse. But it does not legitimate drug abuse to help addicts
avoid deadly diseases until they are ready for help. Instead,
sacrificing their lives to send an "unmixed" moral message sends a
troubling moral message: The unwanted have no worth.

Street addicts are connected to the rest of us by only a few
invisible strands --people such as Hazel, Reggie and Teefari.

Those strands should not be severed.

mgerson@globalengage.org