Needle exchange programs, which make sterile needles available to intravenous drug users for free, have long been a controversial component of the war on drugs. Ever since AIDS and other diseases such as hepatitis began taking their toll on IV drug users, these programs have sprung up worldwide in an attempt to prevent the spread of disease. In some European nations, needle exchange programs are government sponsored, but in the United States, federal funds cannot be spent on such programs and are instead funded by private organizations.

Scientific evidence about the efficacy of needle exchange programs has been ambiguous. Proponents of needle exchanges point to studies that show reduced rates of HIV transmission among participants in the programs, while opponents cite other studies that indicate needle exchanges have no such effect. In March the Surgeon General released a report on the scientific research regarding the effects of syringe exchange programs. The report concluded that available research showed that needle exchange programs were effective in reducing transmission of HIV if they were part of a comprehensive HIV prevention strategy. The report also concluded that needle exchange programs did not contribute to increased drug use among participants. Another recent study, conducted by the Substance Abuse Policy Research Program, found that physicians can legally write prescriptions for syringes in 48 states in the U.S. Since the possession and sale of syringes in a criminal offense in most part of the country, a doctor's prescription would enable IV drug users to obtain clean needles legally.

On One Hand...

Until the flow of illegal drugs into the U.S. can be slowed or stopped, people will use them. Instead of denying that fact, the government should address how to stop some of the more serious side effects of drug use, which include the transmission of HIV, hepatitis and other blood borne viruses. Needle exchange programs not only stem the transmission of disease by providing addicts with otherwise difficult-to-obtain sterile needles, but these programs provide support and information that can lead addicts into treatment. An addict might visit a needle exchange just to get clean needles to use to inject drugs, but they might also pick up free condoms or talk to a drug counselor about treatment options. The government's refusal to fund needle exchange programs means that an opportunity to stop the spread of HIV has been lost.

On the Other Hand...

Giving needles to IV drug addicts is like giving matches to a pyromaniac. Needle exchange programs encourage addicts to continue, or even increase, their drug use. While the IV drug users may transmit disease through shared needles, they are also likely to engage in risky, unprotected sex that can also cause the spread of HIV and other diseases. The only way to halt the spread of disease among drug users is to halt their use of drugs. Needle exchange programs are not an effective way to achieve that goal, and the government is correct in its refusal to fund these counterproductive programs.

• As many as half of new HIV infections are caused by the sharing of injection equipment contaminated with HIV, either directly due to injection drug use, through unprotected sex with someone who acquired HIV infection through injection drug use, or birth to a mother who acquired HIV infection through these means.

• An estimated three out of four AIDS cases among women are due to injection drug use or heterosexual contact with someone infected with HIV through injection drug use, and over 75% of new infections in children result from the consequences of injection drug use in a parent.

• One study showed that HIV-1 can survive over 4 weeks in a contaminated syringe, remaining infectious to individuals who reuse that syringe over this prolonged period.

• Between 1991 and 1997, the U.S. government funded seven reports on clean needle programs for persons who inject drugs. The reports are unanimous in their conclusions that clean needle programs reduce HIV transmission, and none find that clean needle programs cause rates of drug use to increase.

• In 1998, nearly 40 percent of the 652,000 cases of AIDS reported in the United States had been linked to injection drug use. And more than 75% of babies diagnosed with HIV/AIDS were infected as a direct or indirect result of injection drug use by a parent.

• An article in the medical journal Lancet estimated that 4,400 to 10,000 HIV infections among U.S. intravenous drug users could have been avoided between 1987 and 1995 if the federal government had implemented syringe exchange nationally, saving over $500 million in health care costs. Action taken in early 1997 could have prevented an additional 11,000 infections by the year 2000, saving over $600 million.

Center for Disease Control, Common Sense for Drug Policy, U.S. Department of Health and Human Services; Lindesmith