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Darn Those Needles
Providing drug addicts with clean needles: a good or a bad idea? What do you all think? On the one hand it seems to me that this way the government may be able to prevent certain people from getting HIV, on the other hand I also worry that it may make it more easy for people to do drugs.
27 Responses to “Darn Those Needles”
In the U.S. alcohol and tobacco are quite legal and easily accessible, yet not everyone drinks or lights up.
Millions of prescriptions for pharmaceutically produced pain killers are filled every year, yet not everyone becomes an addict. The hospital admission rate for accidental overdose on prescription painkillers is actually greater than the rate for heroin overdoses.
If anything, all narcotic painkillers should have to be administered via needle. It would certainly cut down on the existing abuse of prescription painkillers because of the stigma attached to IV injection. Of course this won’t happen for a long time because the pharmaceutical industry pays lot and lots of money to make sure that their product remains on the shelves.
Painkillers. Pain is a very subjective thing. whether you are taking a medication to numb intense physical pain, say, recovering from a burn; or numbing the pain of a traumatic life. Many addicts are able to function very well in their society roles despite their need to take their medicine. Other addicts are whiny, good for nothing liars, manipulators and thieves.
If clean needles are part of the overall effort to help people receive education about addiction then I see no issue with programs like this.
I think even more than the concern that these programs encourage more drug use is the concern that they encourage careless disposal of used needles. That seems to be what is pointed out in the linked article; playgrounds and parks are being littered with used needles. That’s a hazard from the standpoint of sharp hazard, but also because some of those drug users are already HIV positive, there’s some risk of exposure there too (though not much since HIV isn’t long lived outside the body).
The point is, why would anyone assume that addicts are going to do the responsible thing and turn in their used needles? Its seems that the proponents of this program are trying to come up with all kinds of excuses for why the users may be behaving irresponsibly (trying to come up with all kinds of ways to make it easier for them to dispose of used needles properly), while ignoring the obvious reason that perhaps many of them just don’t care that they’re perpetuating a public health hazard.
I was once a die-hard supporter of needle programs, but now I am not so sure.
I once thought that this was one (of many) practical tools to help combat the spread of AIDS, but I can’t help wondering if this is simply another way to actually increase the transmission of any number of blood borne contagions (HIV or no) that may remain with the needles as they lie hidden in the blades of grass.
Truthfully, I don’t have any proof that our parks are more littered with syringes than they were before, but I am now a much more skeptical supporter of the program. I fear that the line between “the street” and a park for a picnic is becoming more blurred.
“A SONG of the good green grass!
A song no more of the city streets …” – Walt Whitman
Since I think stemming the spread of HIV/AIDS should be the top priority, I vote for distributing needles, reagrdless of other considerations.. Diseases are a terrible drain on the economy, so the cost consdious would do well to keep that in mind.
The lack of a clean needle, obviously, is not deterring the addicted from using drugs, or we wouldn’t be discussing the problem of used needles. I also don’t foresee that the sight of a needle will persuade non-users to start a new habit. Not many start smoking simply because they see a pack of cigarettes. Either you do or you don’t. A needle will not be the deciding factor, IMO
Needle disposal is only a problem if it’s ignored. I’m sure there are creative ways to encourage users to dispose of them safely. Recycling centers work well to reduce the number of discarded soda bottles and cans littering lidewalks. Something along those lines culd work for needles, as well.Those dispensing new needles could collect used ones at the same time, perhpas. Creative minds, I’m sure, could come up with ways to deal with the problem, if the will is there.
Now that I think about it, I wonder why the problem of used needles scattered here and there hasn’t been a top issue, even separate from the dispensal of clean needles. Like so many things, problems fester when ignored.
Not to be overlooked is the very pragmatic obstacle of even floating such a conversation outside of a few liberal metropoleses (sp?).
It is clearly hard enough to get some tacit, albeit reluctant, general public acceptance of individual freedoms for non-threatening deviations like marijuana-smoking or escort patronizing behind closed doors.
Now, you’re going to suggest to the average American that he/she fund a program so that mainliners in the park don’t get HIV?…….Good luck, but your campaign for mayor of Des Moines might get off to a bit of a rocky start.
Scenario A:
Joe the heroin addict borrows a used needle from a friend. He uses it to inject heroin. Joe goes home and sleeps with his girlfriend. It turns out the friend is HIV positive and didn’t know it (how many addicts do you think are conscientious enough to get tested?). The dirty needle infects Joe and he in turn infects his girlfriend. None of them are aware that they are carrying the disease. The girlfriend dumps Joe and moves on with her life for a while. She has other boyfriends who she unknowingly puts at risk. When she gets married or pregnant, she puts her potential husband and children at risk. Eventually she starts to get sick and realizes she has AIDS, but she’s already potentially spread the disease to several people, who may have spread it to even more people.
Scenario B:
Joe the heroin addict picks up a sterile, one-time-use needle from a clinic. He gets high and goes home to his girlfriend. The girlfriend eventually dumps him and moves on with her life. Or she could stay and help Joe get clean. Either way, they both avoid contracting HIV.
Personally, I would prefer to see a lot more of scenario B. That’s the point of the needle exchange program. It isn’t there to force addicts into rehab, it is there to protect the other people in their lives.
This is one I squarely come down on the side of helping protect not only the addicts, but all others they may come into contact, as Amanda says.
Does it cause a slight increase in drug addiction? I find that hard to believe. I don’t think there is an untapped pool of potential addicts going, ‘Man, if I could just KNOW there is a supply of clean needles available, I would shoot up in a heartbeat.’
I also don’t believe there is a statistically significant increase of needles abandoned in public places because of clean needle exchange/give-away. That is because it is only a very small subset of intravenous drug abusers who are shooting up in public in the first place.
All-in-all, it seems to me the good more than balances the potential bad.
Totally in agreement with AR for once. Anyone willing to shoot heroin in the first place, willing to obtain it and stick a needle in their arm to get high, has pretty much decided on that. Might as well protect a hugely at risk grp. As far as disposal is concerned not only needles but the large red plastic disposal containers can also be provided to the public, or something similar. Provide a drop off point as well for those, I’m sure any clinic would do.
Oh also, having a central point for distribution of needles allows healthcare workers to possibly reach some of these addicts. Hand out some pamplets, let em know some other options, you might pull a few back from the brink. Not many, but it couldn’t hurt.
Good idea – no downside.
Sam,
What I have a hard time seeing is why the guy or gal who has, as you put it, “decided on that” when it comes to shooting up, would use some other form of thinking when it comes time to dispose of a used needle. Let’s see, sit here and get high and drop the needle in the grass or mosey on over to the collection site to dispose of my used needle properly? Hmm….
Now I have to say, the article quoted reports a good return rate in a city that used a lot of drop boxes, so in fairness I’ll say that if that really is the case, if that works, then great. But pardon me for being a bit skeptical in theory, and not feeling that one anecdote will prove to be widely true in these programs.
Personally I think that if we’re going to do this, we have to go all the way and do it right. Set up centers where people can get needles for the short term, but they also have to agree to stay at the center and get clean. Would be costly, but in the end might be better than paying the costs that we incur for addicts and the public health problem of HIV transmission.
I’m not quite sure I see the motivation to stem HIV as particularly united to the motivation of keeping used needles out of our public spaces.
Certainly if you think it will stem HIV, go ahead. Someone shooting up heroin will very likely end up dead anyway, but might infect others in the meantime. Insofar as giving out clean needles is effective (the addicts actually take the time out for it) go ahead. I don’t think that by itself will prevent used needles from being discarded in parks. They might take the clean needles, but it’s quite something else to get a druggie to do the “responsible thing” and not throw it in the kiddie park when he’s done. Many probably don’t give a damn. You could give out clean needles on condition of the return of used ones, though that might reduce the number of takers. Another solution is creating spaces where they can not only get the needles, but shoot up if need be, leaving the needles there. That prevents them from throwing them in public spaces.
That’s basically what I’m getting at too, Lynx- but then too, if you’re going to create a sanitized shoot up ward, you might as well go a step further and try to detox them while they’re there.
And the needle giveaways actually have the great potential of exacerbating the needle litter, unless there’s another way of doing it like that. Every needle given out has the potential of ending up in public places, including parks and playgrounds. Apparently they had to close a playground in SF because it had become such a hazard.
LOL Michael You bring this up about a propoesd needle program in SF, well lets put it in perspective. Holland and the city of Amsterdam have been doing this since BEFORE YOU WERE BORN. I would hazard to guess that your Dutch country men have a large body of evidence about the effectiveness of “free needle programs”. Please inform the TMV audience of the needle programs in Amsterdam since 1984. I’m guessing you weren’t born in 1984.
http://www.aegis.com/law/journals/1993/HKFNE009.html
I’m totally with you, and I wasn’t assuming all junkies would be responsible about using disposal containers. But presumably these junkies are using needles and tossing them out anyways, so already they are a problem. Adding extra means of disposal couldn’t hurt.
Sam: Yes, I agree, it wouldn’t hurt to provide containers and there is some degree of needles tossed out without having needle distribution; but still, the needle distribution itself will increase the numbers of needles dropped (after all, what the program is doing is stopping the addicts from reusing- a desperate addict isn’t going to toss his last needle, he’s going to keep using it). So I just think that if needles are given out, somehow there has to be a corresponding way of getting them back after they’re used or you’re doing as much harm to public safety as you’re helping. And I think it’s naive to think that the reasons that the needles don’t always find their way back to the drop spots is because they’re not convenient or private enough- we can’t ignore the fact that a lot (not all) of the addicts truly don’t give a damn where they leave their used needles. If their addiction leads them toward self destruction, then there’s little reason to think that they care about saving others. (Again, I’m not presuming that there aren’t exceptions, people who function fairly normally and do care but haven’t been able to kick habits.)
I guess a better way to make my point is that needle distribution may not increase overall drug use, but it doesn’t have to do so to cause a problem. Even if the same number of injections occurs with or without needle distribution, there will be more needles used under the program than there were before the program. The provision of drop boxes may or may not take care of collection of those needles; I’m guessing probably not.
CS – You are injecting personal opinion, the point I tried to make above is that Amsterdam started NEP in Europe in 1984. This means that Amsterdam a birth place of said programs and a large body of evidence should point to the effectiveness of NEP. From another research paper/book:
Commenters bring up the strawman of “dirty needles in playgrounds” without looking at the actual programs. I don’t recall hearing about needles in “Dutch chocolate”
Getting back 86% of 720,000 needles doesn’t sound that great to me, Rudi. I’m glad that they are working on the exchange program to increase compliance with return of needles, but sounds like there’s still a lot of room for improvement.
BTW, Rudi, is there any data more current than 1987?? If their best efforts to improve compliance on needle return haven’t yielded better results than 86%, then I’d say we should call it quits because the problem that creates along with the costs of the program itself doesn’t seem to be offset by the return on the investment.
If they have eventually figured out a way to better that over the past 30 years, then I’d be happy to admit that my conjecture was proven wrong.
86% doesn’t sound bad to me. I think the numbers would be considerably better, though, if we did for needles what we did for aluminum cans: give a small amount of money to the person who brings them back. Maybe a penny a needle?
CS The publication I supplied came from a quick Google search. But reading between the lines show that the NEP “success” resulted in similar programs throughout Europe. MvdG brought up a recent SF program, Holland and Europe have done this for 20 years. If I find more recent studies or reports I will provide the links. But Europe has a long history, the US applies moralistic standards to what the EU treats as health issues. The death rates from prescription drug abuse far exceeds “illegal drugs”, yet we talk about “needles in playgrounds”. The heroin addict is a “junkie”, while a suburban housewife abusing “mommies little helpers” and alcohol doesn’t get the same negative description.
CS The US voter turnout isn’t 86%, should we abolish the Republic? The program is such a failure that India,Brazil and Vietnam have adopted similar programs.
http://www.prb.org/Articles/2001/BrazilsNeedleExchangeProgramsReduceHIVRisksforDrugUsers.aspx
http://physiciansforhumanrights.org/library/documents/reports/2007-report-aids-success-stories.pdf
Hmmm.. Mabey we should work harder on being enablers.
Let everyone carry guns to kindergarten. Because we know not all people who carry a gun will use it.
Let everyone drive 200 mph thru a school zone. We know that not all people who drive will go 200 mph thru a school zone.
Enablers are enablers. No matter how you cut it. ANYTHING to make it easier is enabling, and encouraging the behavior in question. While on the surface free needles seems the appropriate thing to do yet where do we stop with our enabling? When does this country say Jeeze shouldnt we have just a lil bit of personal responsibility?
Just a little? Or is it the position that life should be just one big “Animal House” and lets rock and be just like the main star. John Belusi….dead at a tender young age. Fat, addicted and overdosed.
Yet he did it his WAY. Frank Sinatra would be happy.
Giving needles isn’t letting 200MPH through a school zone, it’s detouring know speeders away from school zones. The US Puritanical impulse contributed to the AIDS epidemic. People haven’t been faithful or monogamous since the beginning of time. HIV is also a problem associated with prostitution in Brazil and India, they push condoms instead of abstinence. If NEP save lives and contributes to “community health” what is the problem? Dogmatic religious values don’t work, Iran has a drug problem, think the mullahs will go for NEP?
Back to my original thought, a NEP started in Amsterdam showed benefits to community health and spread throughout Europe and the third world. Guess what, Clenis and Barry McCafferty continued with the moralistic “War on Drugs”, we are losing that war too. They admitted to scientific data and joined into the NEP programs
Rudi,
The citizens of the US who don’t vote aren’t posing any hazard whatsoever to the rest of the population (in fact probably doing us a favor; if they aren’t motivated enough to get to the polls, they aren’t likely to be very informed either); the 14% of the people in Netherlands who take needles from the government, shoot them up into themselves and then discard them randomly, are posing a hazard to society.
These programs, if we’re to consider them at all, have to consider cost effectiveness as well as unintended negative consequences. I hardly think the comparison with having a needle program and having a democratic voting system is apt.
What alternative approach would you take other than a needle exchange? If the purpose is to prevent the spread of infectious diseases, what else can we do?
Arresting drug addicts and putting them in jail doesn’t help them get clean – most of them go through such horrific detox that the first thing they want when they get out is another fix. And rehab doesn’t always work, though it’s a much better option than jail time.