Should Cities Fund Needle Exchange Programs?

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One of the most potent negative images associated with drug use is the needle—the needle in the shaky hand of a junkie searching desperately among the tracks on his arm or leg for a vein healthy enough to receive one more injection; the needle hanging from the arm of an addict unconscious or dead from an overdose; the contaminated needle passing its deadly load of HIV or hepatitis to the next user and, through him, to his wife or lover and their unborn child. Small wonder that a prominent and persistent goal of U.S. drug policy, from the federal to the local level, has been to deny drug users easy access to needles and to punish them whenever they are found with one.

The illegal drugs that users most commonly inject are heroin, cocaine, and methamphetamines, although each of these can be taken by other means, such as snorting, smoking, or ingesting orally. Obviously, the use of these drugs, particularly in the corrupted state in which they typically reach the retail market, is risky business. This inherent risk is substantially increased when users share needles contaminated by blood-borne diseases, most notably HIV/AIDS and hepatitis A, B, and C. The actual result is stunning.

Informed estimates of the number of injecting drug users (IDUs) range from a quite conservative 1 million to a more common figure of approximately 1.4 million. By 2006, according to the Center for Disease Control and Prevention (CDC), 36 percent (270,721) of AIDS cases in the United States had occurred among IDUs, their sexual partners, and their offspring; 28 percent of new cases are traceable to IDUs.

Hepatitis C, the most dangerous variant of that disease, is also rampant among IDUs in this country; surveys consistently find that between half and 80 percent of injectors contract the virus within the first year of needle use and that it is found in the blood of even higher proportions (70-90 percent) of all adult IDUs.

A contaminated needle is an extremely efficient transmitter of a blood-borne disease, and the virus can live on a needle for as long as four days. Further, since the CDC estimates that at least a quarter of the people infected with HIV were unaware of it until they were diagnosed, and since the rapidity of infection with hepatitis C surely results in an even greater percentage of unsuspecting carriers, needle users are key agents in the spread of these deadly epidemics.