Needle Exchange in the USA

August 16, 2009 1:37 PM

The history of needle exchanges in the United States starts in 1986 with Jon Parker, a dyslexic Yale medical student and former IDU (intravenous drug user), who was arrested time and time again for providing sterile needles and supplies to drug users, to prevent infection and spread of disease. David Purchase started the first organized (and illegal) needle exchange in Tacoma Washington in 1988, which still exists 21 years later.

Needle Exchanges fit into a harm reduction model of public health policy and drug treatment. Harm reduction approaches are being embraced by religious groups as a moral imperative, and are even recommended for jail administrators, showing that this evidence-based practice is gaining traction.

Despite scientific evidence and support demonstrating utility and cost [pdf] effectiveness, there has been no federal funding for clean needle exchanges because of this text, in every House Appropriations funding act for the fiscal year, for the last 20 years:

Notwithstanding any other provision of this Act, no funds appropriated in this Act shall be used to carry out any program of distributing sterile needles or syringes for the hypodermic injection of any illegal drug.

One of President Obama's campaign promises has been to remove this text from the apropriations bill: however, the initial 2010 bill maintained the original language preventing needle exchanges from receiving federal funding. This language was then repealed, allowing federal money to go to needle exchange and disease prevention programs for the first time in 20 years. Days later, a highly restrictive amendment was added to the House Appropriations bill, which may jeopardize funding in urban areas, particularly the DC metro area. This amendment prohibits funding of needle exchanges in any area within 1,000 feet of almost any location where children gather.

posted by circle_b (42 comments total)

*Sigh*
posted by Saxon Kane at 1:55 PM on August 16, 2009

It makes perfect sense from a public health point of view, but the fear whipped up by the Drug War makes a needle exchange look like a crack house to the general public, even though it's really a necessary means to reduce disease (which can and does affect people who are not junkies). And, to be clear, it has to be managed right. You can't have people dealing or shooting anywhere near it, or it becomes a different problem. Sometimes the only way to do it is to have mobile units, like vans that show up in the same spot once a week with the appropriate needles and means of disposal. It's highly controversial, and it wouldn't surprise me if Obama tried to make needle exchange possible as quiet as he can, or otherwise he'll make it go away if anyone notices.

I would be very happy if something could be done about this, but it's such a difficult issue that I wouldn't begrudge Obama dropping his support for it, as there is no reason for him to get majorly pilloried on this one, and, considering the general atmosphere and political tactics in play by the opposition, I fear that will happen. I am afraid this is one of those issues for which only the devoutly religious will have any sway with most of the general public, at least at first. After all, it's also how leper colonies were started. And maybe we really need the humility of religious sacrifice in our culture in order to practice certain forms of necessary but ugly public health policy, because what politician wants to do this sort of thing and easily risk becoming a pariah? Unfortunately, it doesn't allow for public input and accountability, but I do think someone working as a "servant of god" would be granted some immunity from society's scorn, and at least it's a way to get it started.
posted by krinklyfig at 2:10 PM on August 16, 2009

"Harm reduction approaches are being embraced by religious groups..."

"The five leaders presented official resolutions (actually dating back to 1994) from several denominations, including the House of Bishops of the Episcopal Church, the Central Conference of American Rabbis, the Presbyterian Church, and the Society of Christian Ethics,"

It should be noted that these are very, very liberal religious groups.

I would imagine that most Southern Baptists (the largest denomination in America) would take the same tack that my church-folk did when I was younger: drug users are sinners and to give them clean needles would be to encourage them in their sin.

I mean, they already think AIDS is the "natural consequence" of being gay, so why not?
posted by Avenger at 2:10 PM on August 16, 2009 [1 favorite]

Jon Parker is featured in FRONTLINE's "Age of AIDS".
posted by Mayor Curley at 2:15 PM on August 16, 2009

This has been an encouraging and exciting year for syringe access programs - the progress made towards lifting the federal ban is the first positive movement we've had on this in years. Advocates are still working hard to get the 1,000 foot restrictions lifted, and
I'm hopeful that we may yet get something good out of this yet.

If you want to encourage your congresscritter to do the right thing here, please please send them an email! There's still time to get your voice heard. Here are a couple of ways to do that.

Thanks for this post. As a syringe exchange volunteer for the last twelve years, this is an issue near and dear to my heart.
posted by gingerbeer at 2:16 PM on August 16, 2009

Great post; thank you.
posted by rtha at 2:46 PM on August 16, 2009

drug users are sinners and to give them clean needles would be to encourage them in their sin.

No, drug users are sinners and preventing transmission of blood borne pathogens keeps them from receiving their just punishment. We may no longer throw Jews down wells to prevent the plague, but the religious have yet to lose their taste in cruelty.
posted by geoff. at 3:00 PM on August 16, 2009 [2 favorites]

However in last 30 years it has been invented that children are great weapons to beat sinners with. Somehow they also can absorb any sin that the wielder would be otherwise doing. Theology and ethics are flummoxed by this practice, but it seems to work fine in real life.
posted by Free word order! at 3:18 PM on August 16, 2009

I went out with Jon Parker a couple of times in the late 80's -- around the Lower East Side, Williamsburg (in the pre-hipster period) and around Boston.

At the time, I was working with Allan Parry at the Liverpool Needle Exchange (one of the first of the British Needle Exchanges) and we had data, so we were over to testify at one of his trials on how Needle Exchange prevented HIV and saved lives.

Stuff that I remember most: how goddam grateful American IV drug users were that anyone gave a shit about them. I recall going into a park in Williamsburg or Bed-Sty with him -- and it just looked like a regular park to me -- but people who were old enough to be my father were in tears about the fact that someone cared enough to supply sterile injecting equipment.

The other weird thing was that he seemed to have the support of both the Mayor of Boston, and the Director of Public Health. He certainly had their ear, because I recall going along to meet both Ray Flynn and Sandy Lamb with him. But that didn't seem to be enough to keep him from getting arrested.

I often wonder how he's doing these days.
posted by PeterMcDermott at 3:45 PM on August 16, 2009 [8 favorites]

Nice history; thanks so much.
posted by l33tpolicywonk at 3:46 PM on August 16, 2009

Needle exchanges should be mobile units. Drug dealers love to hang around outside the needle exchanges I'm familiar with, and sell drugs to the exchanges' clients, which makes it harder and harder to keep the exchange open as NIMBY kicks in amongst their neighbours (and I don't blame people for not wanting a drug-dealer-magnet on their street). I think they should have a van and a 1-800 number instead.
posted by joannemerriam at 3:48 PM on August 16, 2009

Some exchanges in some communities work better as mobile programs, other ones work better at stable sites. The ones I volunteer with are very responsive to community concerns, and don't have those sorts of issues with drug dealers. You have to meet the community and the exchangers where they are, right?
posted by gingerbeer at 3:54 PM on August 16, 2009

Needle exchanges should be mobile units.

it makes a bit of sense in theory, but it doesn't seem to have turned out well in victoria. nimbyism is the enemy of humanity, where needle exchanges are concerned (understandably, to a degree). having a stable, brick-and-mortar place to go seems to be the best option.
posted by klanawa at 4:04 PM on August 16, 2009

Oh, btw. That bit in the 1986 link about how Harm Reduction originated on Merseyside?

That's me, that is. :-)
posted by PeterMcDermott at 4:07 PM on August 16, 2009 [31 favorites]

Peter's being his usual self-effacing Englishman self, he was actually one of the key activists in the harm reduction movement, an early editor of the International Journal of Drug Policy and one of those who really made harm reduction in the UK happen (long before it did in the U.S.).

Although Liverpool did not have the world's first needlex (that was in Holland, founded by the Junkie Union, to prevent Hep B, pre-AIDS in the early 80's), it had one of the first and the message coming from Liverpool via Peter and a few of his colleagues would soon reach the world and would have done so far less effectively without him.

Someone recently told me they'd talked with Jon and that he is OK. My experience was similar to Peter's; I was one of those grateful IDU's in 1986 in NYC when a friend visiting from San Francisco told me how to protect myself. I started trying to spread the message at my methadone program and in bathrooms via grafiti on the lower east side when I got high. 50% of our addicts--including some of my friends, including those I likely would have shared with if I hadn't learned when I did-- were already infected.

Self-promoting American section: When I stopped using (part of my time at a halfway house in Arizona financed by a check from High Times for an article I'd written), I graduated to larger platforms: my article for the Village Voice in 1990, is, as far as I know, the first in the major media to argue for needlex from the addict's perspective in the U.S. (Pat Califia and I both wrote earlier stuff for High Times, but I don't think that counted as major media at that point).

I have since written extensively on this and I can't tell you how sickened I am by the fact that we are still having this fight.
posted by Maias at 4:07 PM on August 16, 2009 [45 favorites]

Oops, I just see you got the self promotion in there yourself, Peter: perhaps something has rubbed off on you after all...
posted by Maias at 4:08 PM on August 16, 2009 [2 favorites]

Can't find the stats now, but I've heard that if a local needle exchange program prevents just one case of Hepatitis, then it's paid for itself (assuming the sick person will seek publicly funded treatment) for many years over. It's just good business sense.
posted by Burhanistan at 4:41 PM on August 16, 2009

It is absurd, at best, and criminal at worst that we are still having this conversation, but the tenor of the discussions has changed so much in the last few months. I feel like we've gone from "if" the federal ban is lifted to "when." The flip side, of course, is that just as we're getting traction on lifting the federal ban, our hard work to get the State of California to use its funds to support syringe access has been undone by the Governator's illegal and short-sighted vetoes of all HIV prevention dollars. Win some, lose some...

I'm also happy to promote Maias' writing as some of the clearest, most accurate reporting out there on drugs, drug users, and the war on drugs in the US.
posted by gingerbeer at 4:43 PM on August 16, 2009

Good post, though I don't see how it matters that he's "dyslexic." But since you bring it up, how does somebody who's dyslexic get into any medical school, never mind Yale?
posted by ethnomethodologist at 5:34 PM on August 16, 2009

Thanks gingerbeer!!! Ethno, he went to Yale School of Public Health, I believe (I think the post has it wrong) and dyslexia is something that many brilliant people overcome. I don't think he actually graduated, but I don't think that had much to do with dyslexia-- more to do with getting arrested in numerous states to legalize needle exchange.
posted by Maias at 5:41 PM on August 16, 2009

...his amendment prohibits funding of needle exchanges in any area within 1,000 feet of almost any location where children gather.

Because no-one under 18 uses IV drugs, of course. And the ones that do are too sensible to share.
posted by Jilder at 5:49 PM on August 16, 2009

One of my personal peeves is that, even today in the age of internetty info-goodness, articles about congressional proceedings are usually pretty vague and lack the information you'd need to investigate further. The WaPo article quotes numerous people in favor of needle-exchange programs but it's the second page before you get any clue as to who is opposing them— as in this MeFi post, the opposition is mostly cloaked in the passive voice. The WaPo at least has a bunch of links to related stories at the bottom of its page, though at first I didn't see them among the other margin clutter. (And twenty minutes with THOMAS did manage to find me budget bill in question, HR 3170 (sec 816), and some brief but impassioned debate over needle exchanges. Alas, THOMAS won't let me link to search results. Interestingly but not too surprisingly, the issue seems to be as much DC's right to self-governance as it is about needle exchanges. Some versions of the bill contain such gems as “(b) The Legalization of Marijuana for Medical Treatment Initiative of 1998, also known as Initiative 59, approved by the electors of the District of Columbia on November 3, 1998, shall not take effect.”.)
posted by hattifattener at 6:14 PM on August 16, 2009

i knew jon parker way back when, during my ACTUP days in boston. he did brilliant work.
posted by brandz at 7:04 PM on August 16, 2009

Part of the problem tracking down info, hattifattener, is that there are two bills in play at the moment. One is for the District of Columbia's budget, which is controlled in true colonial fashion by the US Congress, and the other is the annual Labor and Health & Human Services Appropriations bill. It's the DC bill which *also* includes the restriction that DC can't even use its own funds for any number of things, at one point including counting the votes on the medical marijuana initiative.

Here's an excerpt from the CQ Today article on the LaborH markup:

House Panel Approves Labor-HHS-Education Spending Bill

By Kathryn A. Wolfe, CQ Staff

A House Appropriations subcommittee endorsed a massive fiscal 2010 spending bill for labor, health and education programs Friday that omits a longstanding prohibition on funding for needle exchange programs as well as funding for abstinence-only sex education.

...

Tiahrt also said he was “very concerned” about elimination of the current ban on using federal funds in the bill for needle-exchange programs, which are designed to reduce the transmission of HIV and other diseases among drug users. He said the action would be tantamount to helping fund addicts’ drug habits.

Obey said science has shown that needle exchange programs, when coupled with comprehensive prevention strategies, can reduce the rate of HIV/AIDS infections and do not promote drug use.
posted by gingerbeer at 7:15 PM on August 16, 2009

The people who oppose them are the usual suspects: Jesse Helms wrote the amendment banning federal funding for them, Focus on the Family occasional makes some noises, Mark Souter. Basically, it's tacked on to their hatred of condoms: it's "enabling" addiction and is a "counsel of despair."

Unfortunately, early in the epidemic in the U.S., they were aided by the drug treatment community, the black community leadership (Charles Rangel, David Dinkins, the Black Leadership Commission on AIDS) and the prohibitionists. To his great discredit, "drug czar" Barry McCaffrey talked Clinton out of doing the right thing on needle exchange, claiming, without any evidence, that it encouraged drug use.
posted by Maias at 7:28 PM on August 16, 2009

he was actually one of the ...

And today I'm the UK drug policy establishment.

Booyah motherfuckers!
posted by PeterMcDermott at 12:53 AM on August 17, 2009 [5 favorites]

As an IV drug user I have to say that needle exchanges are the furthest thing from my (and my junkie friends') minds. Just outright buying "fresh ones" was near impossible in Dallas until about a month ago. My girlfriend has Hep C and we went to pharmacy after pharmacy (with the results of her blood tests in many cases) and were routinely turned away by pharmacists and pharmacy managers because, in Texas at least, they have the option whether or not to sell new needles to customers who do not have a Diabetic ID card. So we would do what we could do to get new ones from a dealer or fellow user (paying as much as $10 per) then use it over and over and over and over and over trying to go right back into the previous puncture mark once the point had dulled so badly that it could no longer pierce the skin. Everyone has there own trick to supposedly sharpen or at least flatten a barbed point, from running it through your hair to using the edge of a dime or quarter and rolling it down the tip but, naturally, they don't work. We tended to always be able to clean them with bleach and never had to share but we have friends who we have seen use points with the barrels just caked with god knows whose blood and not think twice. Then about a month ago, a strange thing happened. A new grocery store opened on the Bus line (which is crucial in some cases) that sells fresh new clean points to anyone no questions asked for $.13 each, $1.30 for a ten pack, or $13 for a box of 100. So I bought a box and a Hazardous Waste Hypodermic Needle disposal box thing like they have in hospitals ($2) and let my friends come and dispose of theirs and give them a couple of new ones. I know that a few of them end up getting sold but, its only $.13 to me so no big deal. I don't really know what the motivation at that new WalMart is (although I have personally thanked the pharmacists and they seem genuinely concerned about the the people buying them), but, and i know its not cool or hipsterish or whatever to say this but, thank god for WalMart. That one at least is saving lives.
posted by holdkris99 at 3:50 AM on August 17, 2009 [11 favorites]

... a dyslexic Yale medical student and former IDU ...

He was actually trying to become an IUD...

(What? C'mon, it was just sitting there begging! If Prince Charles can dream, so can Jon Parker...

He's lucky he didn't become a DUI. We still hate them, don't we?))
posted by Pinback at 3:58 AM on August 17, 2009

in Texas at least, they have the option whether or not to sell new needles to customers who do not have a Diabetic ID card

Here in Austin, most of the pharmacies near the University (where a lot of homeless junkies live, or used to, I think there's a lot less around these days) would generally sell needles no questions asked. I've never used a needle (only because I'm deathly afraid of them, otherwise I surely would have gone down that road), but a lot of my friends have over the years, and they would always go down to that area to buy them.

If you're a pharmacist, man, just fucking sell people needles. It's not illegal. You're not doing anything wrong. You're doing something wrong by not selling them. You might erroneously think it's encouraging drug use, but what it's really doing is encouraging people to use dirty needles. The person you turned down is gonna find a way to inject drugs into himself, clean needle or not.
posted by DecemberBoy at 4:40 AM on August 17, 2009

This is a great post. Thanks for pulling it together.
posted by lunit at 6:18 AM on August 17, 2009

I'm new here and PeterMcDermott goaded me to contribute and lose my MeFi virginity, so this is a test as much as anything, but also an introduction as I dip my toe in.

So...I'm UK based and have only ever visited the USA once - a 3 day stopover on LA. Big mistake. I've never been able to get my partner to come back, even though I gather some of it is nicer than LA. But I digress.

I work in this territory as a kind of academic (let's see if that works and I manage to put in a link), within a service running a needle and syringe programme and, as an activist of sorts. To borrow a phrase, observing US drug policy from afar makes me feel like we are two countries divided by a common culture. I'm incredulous about your situation, but it just tells me I should not expect to comment too usefully because I am culturally incompetent and am better off listening and learning, which I'll mostly do.

But I'll offer an aside on dyslexic, intelligent people though, as I had a great insight into this when working on a scientific paper years ago with an academic I more or less worshipped. We sat down to write together for the first time. I talked. He typed. It was like watching a child in grade 6 write. More words were underlined in red than not, yet his list of published papers was like a telephone directory. Before that, and not knowing much, I had believed that dyslexia and intelligence were (at least) somewhat related. It was a wonderful object lesson in how wrong that view is. I'm sure there is some diagnostic messiness in it all, but some people evidently have a very bounded but profound disability in this area that is hard to believe until you see it for yourself.

Finally for now, something I think my mum may have taught me:

Putt knot yaw trussed inn spell cheque!
posted by Neil Hunt at 11:12 AM on August 17, 2009 [4 favorites]

Sadly, and ridiculously, in some states pharmacists are not allowed to sell syringes without a prescription.
posted by gingerbeer at 11:25 AM on August 17, 2009

> And today I'm the UK drug policy establishment.

You can't be. You haven't sold out (as far as I can tell) and I believe that is a pretty rigid requirement.

If you check the small print in your contract, I guess you'll find it says your job title is something like 'Co-opted Maverick to the Drug Policy Establishment'.

One determining factor of whether you are the establishment is probably whether you manage a 7 digit budget or more. If I am wrong and you do...we should hang out more ;)
posted by Neil Hunt at 11:31 AM on August 17, 2009

Welcome, Neil. Come visit San Francisco next time you're in the States. We do our best here to pretend we're not in the US when it comes to harm reduction.

And maybe we should be planning a MeFi meet up for the IHRA conference in Liverpool at this rate.
posted by gingerbeer at 11:31 AM on August 17, 2009

> Sadly, and ridiculously, in some states pharmacists are not allowed to sell syringes without a prescription.

Surreal! This sort of information is why I know I should listen and learn, rather than rushing to tell you how to fix your country.

> Come visit San Francisco next time you're in the States.

Thanks gingerbeer...it was a tactical error not to do that the first time :/

> And maybe we should be planning a MeFi meet up for the IHRA conference in Liverpool at this rate.

I'll certainly be there. How much time I'll actually spend on MeFi remains to be seen. It looks like it could easily absorb the last 10% of my day that I don't use fooling about on Facebook, music nostalging on YouTube, running my kids around or otherwise goofing off.
posted by Neil Hunt at 11:44 AM on August 17, 2009

I'll certainly be there.

And I live here, so I don't have much choice -- though I've also agreed to do the Goodenough event and the SMNGP conferences on the previous week, so I'm hoping that I won't be 'all conferenced out' by that point.

A MeFi meetup would be fun, IMO.
posted by PeterMcDermott at 1:50 PM on August 17, 2009

> Sadly, and ridiculously, in some states pharmacists are not allowed to sell syringes without a prescription.

I'm a pharmacist in one of those states. Virginia. Of course, Virginia.

The law requires the person buying them to provide "written, legitimate purpose for which the controlled paraphernalia is being purchased." It seems to me that "don't want to contract HIV" is a legitimate purpose, but I do not pretend to understand the mind of the Virginia legislature. I think it's also illegal hear to wear low-rise pants that reveal your undies or buttcrack.
posted by selfmedicating at 6:26 PM on August 17, 2009

hear --> here
posted by selfmedicating at 6:32 PM on August 17, 2009

Kudos Peter McDermott - I didn't know that's what you did in real life. More power to you and yours.

This and the fact that you are connected to the great Irish Piper Seamus Ennis makes up for the Everton thing....

/Liverpool fan/
posted by Nick Verstayne at 3:56 PM on August 18, 2009

For anybody interested in the Australian perspective, we have free exchanges, vending machines in areas of high IV drug use (eg Kings Cross in Sydney), and just about every pharmacy (at least in areas where drug use is relatively high) will sell syringes, sterile water & swabs, no questions asked, for a minimal cost. Pharmacies also accept used paraphenalia for safe disposal.

I'm not sure about other States, but Sydney has at least one medically supervised injection clinic - again, in The Cross (I know one of the nurses who works there, coincidentally). It's prone to the expected controversy, but apparently local residents are happier to have it, rather than junkies shooting up in their doorways, occasionally ODing, and often leaving their needles behind.

This relatively enlightened harm minimisation approach may actually owe a debt of gratitude to Peter McDermott's work, so good onya, mate.
posted by UbuRoivas at 4:26 PM on August 18, 2009

Drug Consumption Rooms (DCRs) such as Sydney's are where evidence and practice go their separate ways here in the UK. Despite a series of reports urging evaluated pilots to clarify whether the benefits documented elsewhere would improve injectors' health and reduce public nuisance in the UK, the government is selective about where our drug policy should be evidence-based and maintains the view that DCRs would contravene the UN Conventions and, presumably, that countries including Canada, Australia, Spain, Norway, Switzerland, the Netherlands, Germany and Luxembourg are villainous convention breakers.

In the context of this thread, I probably ought not moan...but I do.
posted by Neil Hunt at 10:31 PM on August 18, 2009

A datapoint from Finland: Monday's newspaper reported that HIV infections from IV drug use dropped from 90 (1999) to 7 (2008) and only 2 for this year. AIDS support center states that needle exchange programs are the most probable cause for this development. From 2003, health counceling centres are legally required to provide needle exchange.
posted by Free word order! at 1:36 AM on August 19, 2009