THE TIP OF THE NEEDLE

New Mexico has been more progressive in tackling some aspects of drug
reform than virtually all other states, today's author reports, but further
progress will depend mostly on the next governor.

Although he's never used it himself, Kevin Santry can teach you how to
shoot up heroin. Packed into his SUV, Santry has everything you need (well,
almost) to do the job: the little round metal cups you use for cooking the
drug, dental cottons to strain out the gunk, alcohol swabs, rubber
tourniquets for tying around your arm and, of course, needles.

Santry will give you these things for free; he'll even deliver them
straight to your door. While he's there, he might give you a pamphlet
advising what to do if a friend overdoses while you're shooting up together
and you're scared of the cops ("Stay until you hear the sirens get really
close, then split").

Santry is director of the state-funded syringe exchange program operated
out of Youth Development Inc., a 30-year-old community organization in
Albuquerque's South Valley. He's a foot soldier in the battle to keep New
Mexico's drug users, and ultimately the rest of the population, healthy. He
teaches heroin users to shoot up correctly because those who don't know how
to inject into a vein get infections that can spread to the heart and
become fatal. He hands out complete drug kits because infectious diseases,
such as Hepatitis C and HIV, can be spread through contaminated works.

Besides drug paraphernalia, he dispenses vaccinations against Hepatitis A
and B, soap, razor blades and Pampers, as well as referrals to a host of
services, including drug and alcohol programs. He delivers syringes
door-to-door to avoid conflicts with neighborhood associations that don't
want bunches of drug users near their homes and because it gives him a
chance to interact with his clients.

Today, the clients include a man and woman who meet Santry outside their
West Side apartment with a red plastic "bio bucket" full of used needles.
Both are extremely skinny. The man has had Hepatitis C for 14 years.

"I guess I've got it by now, too," says the woman with a shrug. They like
the needle exchange program just fine. "We used to sharpen 'em on the
floor," the man says.

This needle exchange work is not for the faint-hearted, but then again,
public health work never was. In 1902, New York City health officials
arrested an Irish immigrant cook named Mary Mallon whom they had determined
was spreading typhoid fever to the people she cooked for. After Mallon was
released and went back to work as a cook using a false name, public health
officials re-arrested her and exiled her to an island in the East River for
the rest of her life. She went down in history as Typhoid Mary.

A hundred years later, it's hard to imagine public health officials
wielding such power. As Laurie Garrett recounts in her masterful tome,
"Betrayal of Trust," public health has been losing ground ever since its
glory days at the turn of the last century, when zealous sanitarians could
order diseased people into quarantine. Privatization of health care,
erosion of federal funding, morality, politics and even civil liberties, as
in the case of Typhoid Mary, can be at odds with public health goals.

But New Mexico, at or near the bottom of just about all of those health and
well-being indicator lists, appears to be a leader in the public health
arena, especially on issues related to drugs. New Mexico is one of two
states that funds needle exchange (Hawaii is the other).

Last year, New Mexico was the first state to distribute Narcan, an antidote
to overdoses, which state health officials say is responsible for nine
"saves" so far.

Since 2001, pharmacists can legally sell syringes to drug users without
fear of prosecution. Health officials are currently negotiating to get
methadone treatment into jails.

"The other states see us as treading new ground," says Don Torres, a
16-year veteran of the department who heads the Hepatitis, HIV and AIDS
programs. Some credit for these changes is due to our fearless leader, Gary
Johnson (Puff Daddy to his dueling partner, former federal drug czar Barry
McCaffrey), though the political story is more complicated than that.

The sheer number of injection drug users and their obvious impact on the
state is probably another factor. (The Office of Epidemiology estimates the
numbers at 14,000, but Torres believes the real number is at least double
that).

Not An Election Issue

How the Johnson-era programs and any further reform proposals will fare
under a new governor is a subject of speculation.

"Keeping Injection Drug Users Free of HIV and Hepatitis" is not a campaign
message you're likely to see on billboards this election season. Given
Johnson's almost single-minded pursuit of the drug issue, the gubernatorial
candidates, unsurprisingly, just don't want to talk about it.

"I can guarantee you that whatever they feel about it personally, drug
reform is not going to be a central campaign platform," says Sen. Cisco
McSorley, an Albuquerque Democrat, a member of Johnson's drug task force.
"This is not going to be the dummy distracter issue of the season."

If public health crusaders of yesteryear were Victorians bent on bringing
hygiene to the masses in order to prevent disease from spreading into their
own middle-class neighborhoods, today's crusaders are from a decidedly
different subculture. Some are former or current drug users, and many, like
Santry, distributed needles when doing so was still illegal.

About 15 years ago, supplying clean needles was illegal just about
everywhere. That didn't stop Santry, then living in his native Jersey City.
Heroin use was rampant, and for a time the city had the highest AIDS rate
in the country.

"I was watching all my high school friends die of AIDS, so I guess you
could say I got politically motivated," he says. But underground programs,
like the one in Jersey City, couldn't get enough needles to addicts.

"There were not enough syringes to go around," Santry recalls. "If we gave
out a syringe, we knew it was still going to get used many, many times. So
it was symbolic, a political statement more than anything else."

All that changed when Santry moved to New Mexico and took a job with an
above-ground needle exchange program here. New Mexico, compared with New
Jersey, was needle heaven. Registered users bearing laminated ID cards
could turn in dirty needles and get an equal number of clean ones.

"We give people all the syringes they need," Santry says. "That's the only
way you can ensure they use a clean one every time."

And, remarkably, given a program that uses taxpayer money to provide
addicts with beaucoup needles, complete drug kits ("Get your Kits on Route
66" was the slogan of a national syringe exchange conference held in
Albuquerque in April), information on how to avoid getting busted and
training in how to shoot up, New Mexicans, for the most part, have not
freaked out.

There have been conflicts, however, between syringe exchange programs and
their neighbors. As a result of an Albuquerque City Council vote last
December, syringe exchange programs in the Duke City are now restricted to
mobile units. However, the moral and political rhetoric of the type argued
nationally by conservative groups such as Concerned Women of America
("Needle exchange programs put government in the role of subsidizing bad
and addictive behavior") has been muted or absent.

Support Grows

Law enforcement, often an opponent, has also supported the program, or at
least not opposed it. "We're against legalization, but needle exchange
seems to help people get off drug use and maybe eventually to become
productive members of society again" was the mild comment of Albuquerque
police spokesman Jeff Arbogast. The state's district attorneys, who adopted
a wait-and-see attitude at the outset, according to Torres, have come
around to support the program.

Darren White, the former Department of Public Safety secretary who quit
because of his opposition to Johnson's drug reform proposals, says the
health department needs to prove that syringe exchange in New Mexico is
actually working.

"In theory, (needle exchange) is great. But what is this program doing? Is
it reducing diseases or is it just supplying clean needles to addicts?"
White asks. Now running as a Republican in the Bernalillo County Sheriff's
race, White is also concerned that needle exchange is adding to the overall
number of discarded dirty needles found on the street.

"It goes without saying that not everybody's going to be responsible,"
White says.

State Secretary of Health Alex Valdez says the generally positive response
can be explained in part because New Mexicans have gotten more
sophisticated about drug policy during the last four years. "People hear
the term `legalization' and that's incendiary. They hear the phrase `drug
reform' and that's kind of inflammatory. But talk about sound public health
principles and you can build a fair degree of consensus around that," says
Valdez, who says he's convinced that his programs will be supported by the
next governor.

But scientific evidence in favor of syringe exchange hasn't necessarily
translated into well-funded programs around the country. Syringe exchange
is supported by the American Medical Association, the U.S. Centers for
Disease Control and the National Academy of Sciences, all of which believe
it decreases disease transmission while not increasing drug use. But 48
states don't have legislation allowing for statewide funded programs. Many
of the 200 programs around the country operate without authorization and
face shortages, which undermine their effectiveness, according to a report
by the Ford Foundation.

Congress has renewed a ban on federal funding for needle exchange seven
times. President Clinton didn't act to lift the ban despite the urging of
his Secretary of Health and Human Services, Donna Shalala. President Bush
is even less likely to do so.

Perhaps New Mexico has been more accepting of needle exchange because,
Torres says, "It seems like everybody knows someone who is affected by this."

Wasn't Always So

After four years of watching Johnson dueling drug czars on national
television, it may be difficult to recall a time when the governor's
position on drugs was unknown. But that was the case in 1997 when Steve
Jenison, the physician administrator for the infectious diseases bureau,
testified before the Legislature on syringe exchange.

Jenison reported on a study he had directed on disease rates among
injection drug users. Jenison's study found that New Mexico is different
from New Jersey in another respect. At the time of the study, less than one
percent of injection drug users carried HIV, but 82 percent carried
Hepatitis C. That meant that drug users were clearly spreading Hepatitis C
through contaminated needles to other drug users.

But HIV, which is more easily spread to the general population through
sexual contact, hadn't appeared yet.

The state health office saw it had a window of opportunity to ward off an
increase in HIV. "(Syringe exchange) wasn't Johnson's baby in any way. It
came out of the Department of Health," says Katharine Huffman, director of
state-based projects for the Drug Policy Alliance, formerly the Lindesmith
Center.

But no one knew whether Johnson, who didn't come out in favor of drug
reform until after he was re-elected in 1998, would sign the bill. He did,
of course, and later went on to give keynote speeches at needle exchange
confabs.

Santry passionately believes that state drug users' access to clean needles
has forestalled an AIDS epidemic among users. "It hasn't happened here, and
it hasn't happened because of syringe exchange," he says, pounding the
steering wheel, as he drives to his next delivery.

But health officials know that proving a negative is a hard thing to do.

"The onus is on us to show how effective the program has been," says Vivian
Amelunxen, HIV prevention program manager for the Department of Health.
"It's like asking how many people have not gotten HIV because you did this
particular outreach. And that's very difficult to answer."

A new study of infection rates among drug users could provide evidence that
the program is helping slow disease transmission. The department hasn't had
the money to do such a survey, though given the very high rates of
Hepatitis C and very low rates of HIV in 1996 Torres predicts there would
not be much change.

The health department is preparing a "transition statement" on syringe
exchange and other harm reduction in defense of the programs. "It's unknown
how a new governor is going to react to these programs, so we're trying to
anticipate that," Jenison says.

Says Torres, "We'll cross our fingers."

Ducking For Cover

"We're no Gary Johnson," says Dave Contarino, campaign manager for Bill
Richardson, a bit wearily. Contarino sounds like the last thing he wants to
talk about is heroin and needles. He will grant, however, that the would-be
Democratic governor wants to look at "creative and innovative ideas" for
dealing with drug abuse and wants to continue with programs that have
"proven to be effective."

Even if these programs are worthwhile, Johnson's single-minded devotion to
drug reform has been largely a waste of time in Contarino's view. "If all
that effort that went into drugs had been spent on education, on the
economy, we might be somewhere by now," he says.

All of which was more forthcoming than the John Sanchez campaign, which
didn't call back at all. (Richardson has said he would support medical use
of marijuana and Sanchez, while in the House, voted against it).

Green Party gubernatorial candidate David Bacon, who believes in expanding
treatment and decriminalizing "at least marijuana," says, "If we put that
money (spent on enforcement) into treatment and education then we wouldn't
solve the problem entirely, but we could get to a lot better place."

Johnson might have seemed a fumbling spokesman for the cause when in 1999
he first casually let it drop that he advocated the legalization of heroin.
But Huffman says that as Johnson refined his message, he, and the drug
reform movement, gained credibility.

"What sounded, because of the way it was first expressed, just sort of
extreme and impossible and ridiculous evolved into a nuanced debate over a
whole range of issues. He really did go out of his way to try to educate
himself," says Huffman, who set up an office across from the Roundhouse
expressly for that purpose.

She says the drug reform movement has gained enough momentum to continue
post-Johnson. "It's not going to be a high priority or high visibility
issue for the next governor," she says, but that may be better from a
policy standpoint."

For Democrat McSorley the big hole in Johnson's plan has been his lack of
support for funding a major drug treatment initiative.

"The issue that still needs to be faced is funds for rehabilitation,"
McSorley says. McSorley believes more legislators would have supported both
public health and sentencing reforms had Johnson been willing to spend more
money for drug treatment.

In the last session, legislators and the governor compromised on a $9
million increase in treatment spending, to be split between the Department
of Corrections and the Behavioral Health Services Division.

Valdez points out that the additional funds represented a 30 percent
increase in the treatment budget. But McSorley insists that is only a fifth
of what's needed to address the problem comprehensively.

"And he even balked at that amount," McSorley complains. "He wanted to
spend $5 million and take it out of the tobacco settlement money, which
would have created all kinds of problems for us. And this was in a year
when we still had surpluses."

Since Johnson avoided campaigning on the drug reform issues, and the
current round of candidates are, for the most part, avoiding talking about
it, McSorley says the state still hasn't had a real political debate about
drug reform.

"But what we've seen is that it doesn't seem to be a third rail issue
either way," he says. "It crosses all kinds of ideological lines."
Republicans who opposed Johnson on drug reform were re-elected, as were
Republicans who supported the governor.

Nevertheless, McSorley is pessimistic that the next governor will want to
take up the issue, given the perception that Johnson has been overly
devoted to it, and given the price tag. "This isn't something individual
legislators can do on their own. We need the full-on support of a governor."

Back On The Street

For the public health crusaders, Johnson's support has been amazing," in
the words of the state's harm reduction coordinator, Phillip Fiuty, who
distributed needles and even Narcan before it was legal. "It's having
someone in a position of authority who acknowledges what people do as
opposed to just denying that it's here."

Santry's next delivery stop is a shooting gallery outside a dilapidated
house. The woman who owns the house wants help fixing it up, but Santry
tells her she needs to deal with her addiction first and reminds her to
call the alcohol program he's already referred her to.

"The City Council wants to know `how many needles did you get in, how many
did you give out?'" Santry says, ducking under the open tailgate of his
truck to get out of the broiling sun. "They leave the people out of the
equation."

"At a certain point I figured out I was put on earth to limit suffering,"
he says with a Jersey accent and a shrug. "I guess I figure that's what
this is all about."

Ferry is a freelance writer based in Santa Fe. She previously was an
awarding-winning reporter at the Santa Fe New Mexican. She currently is
working on a public radio documentary about the Mexican border for
Homelands Productions. This article first appeared in the Santa Fe
Reporter. It also was published on the Internet at: www.alternet.org.