HOW NEEDLE BILL COULD CHANGE HEROIN ADDICTION

Heroin addicts learn to make do. Former addict Scott McDonald
did.

When the St. Charles man needed syringes, he found them along the
streets or he borrowed from friends, rinsed them in bleach and prayed
he wouldn't catch a disease like HIV or hepatitis.

He made do until a friend told him about the Chicago Recovery
Alliance, an outreach and syringe exchange program operating from two
Chicago storefronts, a cell phone and one large silver van that
traverses Chicago and some nearby suburbs.

When McDonald wanted clean syringes, the CRA staff gave them to him
for free, along with information and offers of treatment for his addiction.

McDonald quit drugs three years ago, but thousands of other drug users
get syringes from CRA or the Community Outreach Intervention Project,
sponsored by the University of Illinois School of Public Health in
Chicago.

Now, the issue of whether it does more harm or good to make needles
easily available has been brought into sharp focus with the approval
of a new law by the Illinois General Assembly.

If Gov. Rod Blagojevich signs the bill on his desk, clean syringes
will be available even closer to home - as close as the nearest
pharmacy. Senate Bill 880 would allow people 18 and older to buy new,
sterile syringes without prescriptions.

The bill, if signed into law, would siphon some people away from the
needle exchange programs. Suburban residents, lacking convenient
access to needle exchanges, probably would buy syringes at pharmacies,
said Larry Ouellet, director of the U of I exchange program.

And that's the problem, say opponents of the bill who argue that
easier access to syringes would translate to increased drug use.

Making use too easy?

"You don't want to make (drug use) any easier than it already is,"
said Judy Kreamer, founding member of the Naperville Task Force for
Drug Free Youth and president of Educating Voices Inc., a drug abuse
prevention organization.

Supporters counter that better access to syringes translates to
decreased needle sharing, reducing the likelihood injectors will
contract diseases from infected blood.

CRA Executive Director Dan Bigg backs pharmacy sales even if it means
fewer clients for CRA, which gets 41 percent of its participants from
the suburbs and spends $250,000 a year on syringe giveaways. Sharing
syringes is more common among young suburban drug users than for any
other Chicago-area group, putting them at higher risk for disease,
according to a 2001 study in the Journal of Acquired Immune Deficiency
Syndromes.

"If access prevents disease transmission and keeps someone alive,
that's a great thing," said Karen Reitan , state affairs director for
the AIDS Foundation of Chicago. "It's not hypocritical to say, 'We
don't want you to use drugs, but we do want you to use sterile
syringes.'ae"

That's the premise behind needle exchange programs, which began 17
years ago in Chicago and receive funds from public and private sources.

Within minutes of the CRA van's arrival on streets from Uptown to the
South Side, people walk up carrying bags filled with used syringes.
They leave carrying bags filled with clean ones.

Some addicts pick up the cotton balls, cookers and sterile water they
use to inject. Others get free condoms. Volunteers test for HIV, treat
abscesses resulting from dull or dirty needles, teach addicts to
inject safely and direct anyone interested to treatment programs.

At one stop, a pregnant drug user gets linked up with a methadone
treatment program that could help prevent the state from taking her
baby after it's born.

On a different day, a young woman trades her old syringes for new and
fills out a survey, for which she collects $15. She takes the money,
places an order with her drug supplier and shoots up with a clean
syringe in a nearby McDonald's parking lot.

Reitan calls both of them victories.

"We take our victories big and small," she said. "If someone uses a
clean syringe or a condom, we take them all, and celebrate them all."

"Every time a syringe exchange program participant enters a treatment
program that's a victory. Rates of HIV among IV users over the last 20
years have dropped. That's a huge victory," she said.

Drug use and disease

Injection drug users account for one-third of all AIDS cases, and
one-half of hepatitis C cases, according to the Centers for Disease
Control and Prevention. Illinois ranks seventh nationwide in the
number of cumulative AIDS cases. Chicago ranks sixth in cumulative
AIDS cases among major metropolitan areas.

The CDC, U.S. Department of Health and Human Services and National
Institute on Drug Abuse recommend sterile syringes to reduce the
spread of AIDS and other diseases. For years, groups like the AIDS
Foundation of Chicago and CRA lobbied for a law allowing their
purchase without a prescription. Only in Illinois, California,
Delaware, New Jersey and Massachusetts must people have a prescription
to purchase syringes.

They found a champion in Sen. Donne E. Trotter, who introduced a bill
legalizing syringe purchase in 1992.

"To address this insidious disease, which is still running rampant in
poor communities, you had to address the needle question," says the
Chicago Democrat who had bipartisan support, including Senate
co-sponsor Stephen Rauschenberger, an Elgin Republican and possible
Senate candidate.

The bill, one of more than 700 awaiting the governor's signature, also
requires pharmacies to provide people buying syringes with educational
materials on safe injection, HIV prevention, syringe disposal and
treatment options.

"Once you get past the emotion, it's good public policy,"
Rauschenberger said.

"In states where people can obtain clean needles, there is a high use
rate and a substantial decline in the transmission of AIDS," he said.
"In states where there is legalized access, (public health officials)
have not seen any increase in drug addiction or drug use."

A spokesman for Deerfield-based Walgreens said stores will sell
syringes over the counter if the bill becomes law. Representatives for
Jewel-Osco did not return phone calls asking for comment.

Seeing the trade-offs

Even some proponents of over-the-counter syringe sales point to some
flaws in the bill before the governor.

For one thing, drug users wouldn't get face-to-face counseling and
wouldn't have to return their old syringes, like they do in the needle
exchange programs.

Trotter said the cost was prohibitive. He'd prefer Illinois to follow
Baltimore's lead and place syringe disposal boxes on some street corners.

"In a better economic climate, we'd add that to the bill," he
said.

Illinois House Rep. Mary Flowers, a leading opponent, said if the
governor supports the bill, it will be inconsistent with a law he
signed prohibiting the use of the drug ephedrine, which had been legal.

"How many people in this state know that heroin is on the rise?" asked
the Chicago Democrat. "Why would we contribute to something so
negative? Do we want to give people guns and more bullets, too? That's
exactly what they're doing."

Kreamer disputes the argument that clean needles reduce the spread of
disease. She said sharing needles is such a part of the drug culture
that making clean syringes available won't be a deterrent.

"People under the influence of drugs do not act responsibly," she
says. "They don't take precautions to dispose of (syringes)
responsibly. They simply get tossed."

McDonald agrees. He favors needle exchange programs but doesn't
support pharmacy sales because easy access will lead people to
escalate their addiction, he said.

"Some people stick to snorting and don't use intravenously because
they don't know how to find needles," he said.

Whatever happens with Senate Bill 880 probably wouldn't affect
Chicago's $700,000-a-year contribution to the two needle exchange
programs, said Fikirte Wagaw of the Chicago Department of Public
Health's division of STD, HIV and AIDS.

"For all HIV interventions, we would like to give a lot more," she
said. "Access to sterile syringes at pharmacies is just another tool."

Currently, syringe exchange programs reach only 5 percent to 8 percent
of the injectors, said Reitan, which translates to a lot of unmet need.

If pharmacy sales cut into their giveaways, CRA would spend less money
on syringes and more on expanded hours and additional sites.

"Our goal is to meet the demand," Bigg said.