this article pisses me off, but i thought it was interesting.. not too relevant where i live though, considering my city just opened safe injection sites -------------------------------- "Clearly, drug using behavior is illogical and self-destructive. Intravenous drug use, in particular, has traditionally been viewed as irrational and dangerous. With the advent of escalating HIV infection as a factor in continued intravenous drug use, needle exchange programs (NEPs) have become a cause celebre among some well-meaning, albeit misguided, individuals and "drug legalizers." Many have advocated the concept of needle exchange as a supposed method of reducing the risks associated with needle-sharing. This is predicated on the theory that intravenous drug users will make a rational decision to delay fulfilling their need for their drug, while they seek out a clean needle to insure their safety. It is an act of extraordinary faith to believe that people engaged in such ultimately self-destructive behavior can or will make rational, healthy decisions while fighting the ravages of withdrawal. If intravenous drug users were this self-possessed, they might as likely choose not to use at all. The well-meaning activists for NEPs project their own thoughtful evaluation of the risk of needle-sharing onto the thought processes of intravenous drug users, a classic mistake. Needle exchange programs in Sweden and Switzerland have had poor to disastrous results. Sweden tried needle exchange in the 1970s resulting in increased use and health consequences, i.e. increased hepatitis infection. They had another recent experiment with a needle exchange program and found no change in the HIV transmission rate in cities with NEPs and in control cities. Between 1987 and 1992, Switzerland conducted a five year experiment of containment and drug decriminalization at Platzspitz Park in Zurich. There was no law enforcement intervention in the park and medical and drug treatment advice and assistance were provided on site. Full needle exchange was in effect and continues. The result of the experiment was a precipitous escalation in use, crime, violence, and HIV rates and that program was ended in 1992 (needle exchange has continued). During that time, Switzerland was reported to have experienced one of the highest rate of HIV deaths in Europe, a malady that still exists today despite having continued needle exchange without interruption. Italy and Spain have a 70% rate of HIV prevalence among its heroin addicts and needle sales have never been restricted in those countries. The "drug legalizers" proclaim European needle exchange programs a success. One wonders what they would consider a failure. In Canada, Montreal and Vancouver have large scale NEPs. Scientific studies, e.g., HIV testing upon entry and periodically during their participation in the programs showed higher HIV seroconversion rates for participants than for non-participating addicts. There are some extralegal needle exchange programs currently in effect in some U.S. cities. They make claims of success in reducing HIV rates. This appeals to the humanist in all of us; however, the scientific efficacy of these self-evaluations is well below normal standards of review and the findings are suspect at best. Further, needle use is not the only method of HIV transmission that affects drug users. HIV rates are also very high among crack users (no needle use). This is reflective of the aberrant, self-destructive pattern of behavior that is the pathology of substance abuse. Can we really expect distribution of needles to change the behavior of addicts/users? No! It would simply facilitate increased and continued use with society's blessing. Herb D. Kleber, M.D. and Lawrence S. Brown, Jr., M.D., the only two physicians on the committee of the Institute of Medicine that reviewed the issue of needle exchange, wrote in the October 25, 1995 issue of The Villager (New York) in regard to the efficacy of needle exchange programs, "NEPs are not the panacea their supporters hope for." They further stated that they believe "that the spread of HIV is better combated by the expansion and improvement of drug abuse treatment rather than NEPs, and any government funds should be used for that purpose." James L. Curtis, M.D., Director, Department of Psychiatry and Addiction Services at Harlem Hospital Center has issued similar warnings against NEPs. Though NEP advocates claim that NEPs do not contribute to increased drug use, intravenous heroin and methamphetamine use is increasing at an alarming rate. Are we to believe the knowledge that free clean needles are available is not a possible factor in the initial decision to use heroin intravenously? Before we permit expansion of NEPs, legitimate scientific studies with peer review must be undertaken to determine whether these programs have any beneficial use or simply portend an increase in use and the concomitant increases in health and social consequences as addicts are enabled to continue their drug use unabated." Published in Alcoholism & Drug Abuse Weekly on 10/13/97 ------------------ flame on.