Yes

by Martin Chandler

Created on: February 05, 2008

I feel compelled to write in support of government funding for needle exchange programs, especially in light of one of the "No" writers who, I feel, eloquently summarised most myths about on injecting drug use and needle exchange. Having worked in this field for several years I feel quite strongly that people should make their decisions about this issue based on genuine evidence rather than beliefs or scare stories.

Perhaps one of the most prevailing myths around needle exchange is the belief that it promotes or encourages drug use. Nothing could be further from the truth. There exists a significant body of research around this and, to date, there is no evidence for increases in injecting drug use in any area with a needle exchange. But let us put that in context; needle exchange began in the very early 1980's and has since spread to almost all westernised countries as well as countries such as Iran. Surely, given the very widespread nature of the scheme and the vast number of needle exchanges that now exist worldwide, we would have seen some evidence of this feared increase in drug use? But no, no such evidence exists. Indeed the fact that needle exchanges do not cause an increase in drug use has been ratified by former United States Surgeon General Dr. Davis Satcher, former Director of the National Institutes of Health Dr. Harold Varmus, and former Secretary of the Department of Health and Human Services, Donna Shalala. I sincerely doubt such individuals would make a colossal error of judgement in this matter.

The belief that free availability of needles will encourage people to inject, especially those who had not desired to do so previously, could be likened to increasing the likelihood of people drinking by providing pint glasses. Clearly, this is an unlikely scenario at best. People who feel a desire to experience certain types of drug will find a way to do so, the availability of paraphernalia to do so has never made the slightest difference to that desire. When young people first try drinking alcohol, do they look for glasses, or do they simply swig from the bottle? When people wish to smoke crack, do they buy a custom made crack pipe or do they make one from foil? The answer, more often than not, is that they make one.

The encouragement to take certain types of drug, especially those considered most addictive; such as heroin, crack cocaine and of course the most addictive drug of all; nicotine, is in the interaction between drug and user. The paraphernalia for taking the drug is wholly irrelevant in this process. Smoking heroin, arguably, leads to less of an addiction than injecting it, but it remains an addiction regardless of the manner in which the substance was ingested.

One writer has argued that many addicts are too far gone to worry about whether they reuse a needle, this suggests a lack of understanding or experience with such individuals. Whilst I have undoubtedly met many chaotic injecting drug users who may fit this description I would not, by any stretch of the imagination, categorise them as even a significant proportion, never mind the majority. Indeed, quite the reverse is often true. The problem is that making needles difficult to obtain increases the likelihood of injecting drug users reusing and sharing their equipment.

Allow me if you will, to paint a picture, in the hope that this clarifies the urgent need for well funded needle exchange programs. A young man has been dabbling in drug use for some time, his curiosity is especially piqued by more extreme experiences; much the same as some people find bungee jumping more to their taste than using a trampoline. Gradually, he becomes involved with ever more shady characters and eventually is offered heroin to smoke. His knowledge of drugs is limited, his understanding of the dangers based largely on misinformation from both his peers and the authorities. Let us make no mistake here, there are significant problems with drug education in both the US and the UK, with many so called "facts" being based on hearsay and circumstantial evidence. Young people know this and the "just say no" type messages are irrevocably damaged as a result. SO here we have one young man who believes his peers over the authorities; this is hardly unusual, after all who doesn't? After a while our young explorer feels the smoke is just not hitting the spot anymore, so he follows his peers advice and injects. Wow. What a ride! Clearly, he is unaware of the cost of this ride but for now it's the best experience he's had. But he's only just started injecting and he's sharing needles because they are hard to come by legally. He has a girlfriend who is getting worried about him and his occasional drug use. However the young lady loves him dearly and wants to help him. Indeed she is so in love with him that she agrees to sleep with him on several occasions. They are young, full of passion and not always as careful as they should be. They have unprotected sex. Eventually their relationship dies away and she moves on as he moves down. Neither at this stage is aware they are infected with Hepatitis C, by far the biggest blood borne virus problem in injecting dug use.

It does not take a genius to work out where this is going. Hepatitis C out in the community, away from drug users, expanding its influence dramatically and all because the drug users could not get clean needles.

Now let's jump forward five years and add HIV as another player in the game, can you imagine how many people could be infected from this original couple by now? Now count the cost of these infections. The argument that money from things like Medicare would be wasted on needle exchange is now ridiculous, because the money that treating these blood borne virus outbreaks costs is exponentially higher than the cost of a good needle exchange program. In the UK we calculate that for every 1 spent on needle exchange we save 10 in medical costs. Yes, we actually save money in the long run.

The arguments about cost are therefore completely nullified by the realities of the situation. The argument that giving people clean needles didn't stop the AIDS epidemic is also false, it most certainly did have a massive impact and continues to do so. The massive rise in the prevalence of AIDS came about through risky sexual practices not through injecting drug use.

Not providing harm reduction initiatives amounts to burying our head in the sand and supports only the prohibition stance. But let us bear in mind that, since the very earliest records we have available, human beings have taken mind altering substances. We always have and we always will. The US has spent well over a trillion dollars fighting the so called "war on drugs" and yet it is now easier to get them. The simple fact of the matter is this; not once, in any example of prohibition, in any country in the world, even when the death penalty is applied, has prohibition achieved anything of note. Nothing. The authorities can argue that they have locked up X number of drug dealers but the fact its, X+5 dealers have taken their place. We can argue that it's the only way to protect our children but in fact, education is the best way to do that. The evidence against a prohibitive stance is now completely overwhelming and it is only an ill-informed moral high ground that believes this to be a way forward. It is not, the evidence is there.

A writer has suggested we should use the money from needle exchange programs to help stop the use of drugs altogether. I would very much like to hear how. If over a trillion dollars and the 69 billion dollars that the US alone spends annually is not doing it then what is to be done? The simple fact is this; we have two choices. We can legalise all drugs across every country in the world, control them as we do tobacco and alcohol and certain prescription drugs and remove almost all of the personal and societal harms they lead to. Bear in mind that this will also seriously damage many of the worlds' largest criminal gangs. The alternative is that we criminalise alcohol and tobacco; after all they are the two most significant killers of all substances humans ingest. Indeed, alcohol is involved in almost all drug related deaths, most acts of random violence and a significant proportion of domestic violence and road traffic accidents. This is of course ignoring the deaths attributable directly to alcohol abuse. The situation as it stands is a blatant hypocrisy and young people are fully aware of this. We can choose to accept the truth that people have always and will always, take some kind of substance to feel different in some way; and work with that process for the benefit of all. Or we can choose to deny the drug addict the tools to save our society from further ills and pay for our approach through taxes used to pay for increased medical and judicial costs.

Simply put, needle exchanges and schemes like them save lives. Not just drug user but many more besides. Without them we will pay dearly for the cost of burying our head in the sand.

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