From: Marnie Regen Subject: Chicago needle exchange Date: 1996/11/05 newsgroups: alt.drugs.hard Study: Needle Exchanges Reduce HIV Infection But City Health Department Threatens Drastic Cuts for Local Program "Windy City Times" (Chicago), October 31, 1996, p 16. By Louis Weisberg A landmark two-year study measuring the effectiveness of needle exchange programs in New York City has found that providing injection drug users with clean needles reduced their rate of HIV infection by two-thirds. The study's results confirm and closely parallel several others, including one currently in progress involving the Chicago Recovery Alliance. Reported in the Oct. 12 issue of the medical journal "Lancet", the American Foundation for AIDS Research (AmFAR) study was the first to track new infections in exchange program participants and compare them with those in drug users without legal access to clean syringes. Citing the study, Dr. Mathilda Krim, AmFAR co-founder and board chairman renewed her call on the federal government to lift its ban on funding for needle exchange programs. "We have called for the lifting of the ban before, but now there is incontrovertible evidence that needle exchange reduced the transmission of HIV by 60 percent," she said. According to Krim, ongoing questionnaires completed by study participants indicated that the exchange programs also discouraged participants from drug use, prompted them to become more health conscious and improved their self-esteem. "The needle exchange is symbolic to these drug users that somebody cares for their health and survival," Krim explained. "Once you get them to come in regularly, you can talk to them and advocate treatment for addiction, medical referrals, etc." Due to the federal funding ban, needle exchanges must be underwritten by local governments and private foundations. In Illinois, where only programs with research projects are allowed to operate legally, there is only one major multi-site program. And even its funding is in jeopardy, according to its director. Right now the future of the agency is up in the air," said Dan Bigg, head of the Chicago Recovery Alliance (CRA). CRA received $353,000 in 1996, but the city has promised the agency less than half that amount for 1997. "That does not even pay for the supplies we purchase," Bigg said. "We'd have to drastically cut back our services and our sites. We reach over 600 people per week and we'd have to cut that in half or stop operating in July 1997." Bigg estimates that his organization, which passes out needles to addicts at 15 locations in the city, has prevented more than 400 new infections since 1992. "Why the city does not value this massive HIV-prevention program is beyond me," he said. The answer could be that Bob Rybicki the assistant commissioner of health HIV/AIDS public policy and programs for the Chicago Department of Public Health does not believe CRA is emphasizing enough of what health experts call "wrap around services." We really want to put a comprehensive program in place," Rybicki said, explaining that he meant one containing a very strong prevention message" and including referrals to primary medical care, housing and drug treatment programs. "Over the last year we have referred 3,000 people to addiction treatment, primary medical care, HIV antibody testing, domestic violence protection, food, shelter, and legal assistance," Bigg countered. "We greatly exceed all the scopes of service required under our city grants." The city will make more funds available next year, Rybicki said, but CRA will have to complete for them against the University of Illinois at Chicago, which now operates only one needle exchange site in conjunction with its harm-reduction studies. ==================================================================== From: Marnie Regen Subject: More: Denver NEP debate Date: 1997/02/18 Newsgroups: alt.drugs.hard [...] The Denver Post, February 16, 1997 Page 1 Across the state, IV drug users are becoming a larger percentage of those contracting HIV, the AIDS virus. This week, state legislators and health officials will debate the merit of allowing needle-exchange programs in Colorado in an effort to curb the spread of infectious diseases. STANCHING THE FLOW By Ann Schrader Denver Post Medical/Science Writer Every day in his private medical practice, Ken Lichtenstein treats people who have contracted HIV or are dying of AIDS. Even so, the Denver infectious-disease specialist admits his first reaction to needle exchange programs was negative. That was about two years ago when discussion in the Governor's AIDS Council, of which he is a member, turned to needle-exchange programs. "Why in the world would I want to help people who use drugs?" he recalled thinking. Then Lichtenstein began reviewing research on needle-exchange and became an advocate. "The science makes sense," he said. Needle-exchange programs are being considered by policy-makers in the Colorado statehouse and state board of health. The debate centers on the prevention of AIDS and other blood-borne diseases. The programs have sparked concerns about whether "legitimizing" drug hardware such as syringes encourages the use of illicit drugs, especially in attracting new and young addicts. Some law enforcement officers are concerned about the message that the programs send. But supporters say the object of the exchanges is a public health concern as much as a drug abuse concern. Exchanges are designed to reduce the transmission of HIV and hepatitis B and C among people who inject drugs. Addicts have a tendency to use the same needles over and over and share them with each other. Under current Colorado law, possessing syringes can mean arrest and a $100 fine. Sharing needles can trasmit disease, which in turn can be passed on to sexual partners and unborn children. "Needle exchanges are not a panacea," said Dr. Ellen Mangione, an epidemiologist with the Colorado Department of Public Health and Environment. "They won't eradicate HIV, they won't stop injecting drug use, but they are an important tool of a complete broad-based program to intervene." Colorado has an estimated 15,000 people who inject illicit drugs, such as heroin, cocaine or amphetamines, with about 11,000 of them in the metro area. The estimate probably is low, experts say. But the addicts' affect on the state's 5,600 AIDS cases is huge. A state health report published in September showed Coloradoans contracting the disease increasingly are women who shoot drugs or have sex with men who do, and those womens' unborn babies. The number of minorities with AIDS also is increasing in Colorado. "The face of the AIDS epidemic is changing," Mangione said. HIV is a virus that leads to AIDS, a chronic and fatal disease of the autoimmune system. HIV is transmitted through blood and sexual contact. With IV drug users, sharing syringes in which there is a residue of HIV-infected blood spreads the disease. --- Needle exchange programs are built around trading sterile syringes for contaminated ones. Many public health officials insist that in addition to fighting the spread of disease, needle exchanges are the missing component of comprehensive drug intervention programs that educate, counsel and assist injecting drug users into treatment. Five federal studies have found that needle exchange programs reduce HIV transmission and don't increase drug use. Four studies have recommended repeal of state drug paraphernalia laws to allow needle exchange. About 100 needle exchange programs exist throughout the country, including one set up in Boulder in 1989 when District Attorney Alex Hunter indicated to health officers that he wouldn't prosecute their employees who distributed syringes, despite the state law. Now there is a proposal to open the door to creating similar programs in Colorado. The state legislature is considering House Bill 1289, which would exempt a portion of the state drug paraphernalia law to allow communities to set up needle exchanges. The proposal, which may be heard this week in the full House, would exempt syringes obtained from recognized programs and the workers who distribute them. Also this week, the Colorado Board of Health is expected to vote on supporting the measure. While there isn't a public health emergency, exchange program supporters acknowledge, the statistics are alarming. In 1986, 3 percent of Colorado's AIDS cases were acquired through IV drug use. By 1990-1991, injecting drug use led to 7 percent of the AIDS cases in the state, and in 1995-96, 11 percent were IV drug-acquired. IV drug use was identified as the risk factor for 33 percent of female AIDS cases in Colorado. That number climbs to "at least 62 percent" when it includes women having sex with male intravenous drug users. For white women, IV drug use was the main exposure route, while heterosexual contact was the predominant exposure for black and Hispanic women. One in five black men and nearly one in three Hispanic men with AIDS contracted it through intravenous drug use. One in three Colorado children with AIDS was infected through the mother's drug use, state studies show. More than three-quarters of HIV-positive Colorado children were infected through their mothers. The pediatric HIV clinic at Children's Hospital treats 60-70 children, "a very difficult job because we have to watch them suffer," said the unit's clinical director, Dr. Betsy McFarland. --- An unpublished study by University of California researchers shows 50-100 HIV cases in Denver could have been prevented between 1987 and 2000 by a needle exchange, said state health's Mangione. Diseases other than HIV can be transmitted by sharing dirty needles. Some national studies have estimated 90 percent of injecting drug users are infected with hepatitis C, a chronic liver inflammation that can be deadly. Currently in Colorado, syringes may be purchased without a prescription but there are barriers to buying and using them. The present law states that a person possesses drug paraphernalia if he knows or "reasonably should know" that it could be used for illegal purposes. "I can walk into a drugstore and buy a syringe, but as soon as I walk out the door, I can be arrested," said Michael, who described himself as an active heroin and cocaine addict "for a lot of years." Val Kalnins, executive director of the 850-member Colorado Pharmacists Association, said "it's an individual decision" on whether to sell syringes if pharmacists believe the syringes will be used to inject illegal drugs. Some refuse. Others sell individual syringes from 15 cents to $1.25. Yet others insist on selling them in 10-packs for $15.95, a price addicts don't want to pay since it will leave them open to arrest for possessing extra syringes. But the addictions can be so strong that users will inject even if it means with a syringe tainted by someone else's blood, said University of Colorado cultural anthropologist Steve Koester, who has studied intravenous drug use for nine years. "I have never interviewed an injector who told me that they did not inject because they could not get access to a sterile syringe," Koester said. Paul, a member of a Denver regional users group, agreed. "People who are going to use are going to use anyway," he said. The 10- to 20-member group meets weekly to discuss HIV harm reduction and drug policy reform. The group is part of People Engaged in Education and Reduction Strategies, a nonprofit HIV reduction organization. Each year, about 100 people are arrested for carrying syringes under Denver's paraphernalia ordinance. Possession of drug paraphernalia is a class 2 petty offense, and conviction carries a fine of not more than $100. But it also can lead to some jail time if they don't pay the fine or appear in court. The next time they're stopped for carrying syringes, they go directly to jail for two to three days where they withdraw cold turkey. Two Adams County Democrats, state Rep. Alice Nichol and state Sen. Joan Johnson, proposed the paraphernalia exemption bill that passed the House Judiciary Committee on Feb. 6. Injection drug use is "hitting a critical mass" in transmitting blood-borne diseases, Nichol said, stressing that "this bill does not change criminal liability for drugs. It only deals with needles." Since the exchanges would be one clean syringe for each dirty one, Nichol said there would be no net increase of needles in the community. Johnson said she agreed to sponsor the bill in the Senate since she has served on the Governor's AIDS Council and feels "so strongly about this disease. I've lost too many friends to it...anything we can do to prevent the spread, particularly to children, we've got to try." Late last week, Nichol was retooling the bill to include a veto provision for communities that don't want the programs. The Colorado Association of Police, County Sheriffs of Colorado and Colorado District Attorneys Council have decided the proposal is a health issue and plan to take no stance -- for or against -- in the legislative process. "We're not opposed to the programs," said Jack Van Arsdale of the chief's group, but the members are concerned about how the programs would be set up and regulated. The 147-chief group favors an umbrella organization to oversee needle exchange programs' volunteer workers. --- The Colorado Health Officers Association's "major" concern about the House-committee approved version was its lack of local control, said its president, Weld County Health Director John Pickle. "There is every indication this is a successful strategy...but the counties could be in a position of paying for that," Pickle said. His Denver counterpart, Dr. Frank Judson, said there must be assurances that the exchanges don't operate "like an ice cream cart." As long as needle exchanges are illegal, Denver Mayor Wellington Webb "has felt he would not engage in a discussion on it," said his health policy adviser, Donna Good. If the bill is passsed, Good said there are Denver City Council members who would propose changing the city's paraphernalia ordinance to allow the programs. Revamped or not, opposition to HB 1289 is guaranteed. "I'm going to fight this with everything I've got," House Judiciary Chairwoman Jeanne Adkins vowed when her committee favored it 9-4. Beverly Kinard of Drug Watch Colorado, which "fights tooth and toenail against legalization of drugs," said the proposed exemption gives a mixed message. "Here we are fighting the illegal drug scene, the tremendous drug use among our young people, and here there are people giving out needles." She was involved in drafting the state drug paraphernalia law, which passed in 1980, and has been fighting drug use among youth for 18 years. Kinard knows first-hand what drugs can do: her son was brain-damaged by drug use and remains in 24-hour home care. Kinard referred to the ban on using federal funds for needle exchange programs "unless the Surgeon General...determines that such programs are effective in preventing the spread of HIV and do not encourage the use of illegal drugs." She doesn't think that standard has been reached. Dr. Peter Lurie of the University of California-San Francisco, in a study for the Centers for Disease Control and Prevention, visited 23 U.S. needle exchange programs, including the one in Boulder. "There's pretty clear evidence...that sharing of syringes goes down among people who attend needle exchange," he said. An indication, Lurie said, was a study of hepatitis B in a Tacoma, Wash., exchange program. People who used needle exchange were four times less likely to get hepatitis B than those who didn't. A key study conclusion was that "although the available data are not terrific, they provide no evidence that needle exchange programs increase the amount of drug use, either by clients in the programs or that they change the overall community levels of drug use." Lurie also estimated the cost-effectiveness of needle exchange programs. The study indicated it would cost $8,000 to $12,000 to prevent an HIV infection through needle exchange compared to at least $120,000 to treat a person with HIV over a lifetime. ==================================================================== From: news@petermc.demon.co.uk (Peter McDermott) Subject: AMA on Needle exchange Date: 1997/06/28 Newsgroups: alt.drugs.hard >The House of Delegates of the American Medical Association has taken >important actions in the area of access of injection drug users to sterile >syringes and treatment for opioid (primarily heroin) addiction. > >They have approved the following recommendations which are now AMA policy: > > - That the AMA encourage the expansion of opioid maintenance programs so >that opioid maintenance therapy can be available to any individual who >applies and for whom the treatment is suitable. Training must be available >so that an adequate number of physicians is prepared to provide treatment. > Program regulations should be strengthened so that treatment is driven by >patient needs, medical judgement and drug rehabilitation concerns. > Treatment goals should acknowledge the benefits of abstinence from drug >use, or degrees of relative use reduction. > > - That the AMA encourage the extensive application of needle and syringe >exchange and distribution programs and the modification of restrictive laws >and regulations concerning the sale and possession of needles and syringes >to maximize the availability of sterile syringes and needles, while ensuring >continued reimbursement for medically necessary needles and syringes. The >need for such programs and modification of laws and regulations is urgent, >considering the contribution of injection drug use to the epidemic of HIV >infection. > > - That the AMA initiate and support legislation revoking the 1988 federal >ban on funding for needle exchange programs for injecting drug users. > > - That the AMA encourage the undertaking of comprehensive research into the >potential effects, both positive and adverse, of relaxing existing drug >prohibitions and controls and, that, until the findings of such research can >be adequately assessed, the AMA reaffirm its opposition to drug >legalization, with a report back on the status of such research at the >Interim Meeting of 1998. > > - That the AMA strongly encourage state medical associations to initiate >state legislation modifying drug paraphernalia laws so that injection drug >users can purchase and possess needles and syringes without a prescription. > >[Please note that the final text of the recommendations of the House of >Delegates may be slightly different from what is included in this message.] > >These new recommendations are discussed in the attached summary from the >AIDS Daily Summary and an article from the June 27, 1997, issue of the New >York Times. > > >]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] > > AIDS Daily Summary > June 27, 1997 > >"A.M.A. Backs Drug-User Needle Exchanges" >New York Times (06.27/97) P. A15; Seelye, Katharine Q. > Citing an "urgent public health need," the American Medical >Association on Thursday called for a change in laws to allow >injection drug users to possess and have easy access to clean >hypodermic needles. Over a third of new HIV cases in the United >States are caused by use of contaminated needles or by sex with >drug addicts. Infection among drug users now represents the >highest rate of new HIV infection, almost two times that among >homosexual men. Although the AMA had previously "encouraged" the >needle-exchange programs, Thursday's decree was broader and more >pointed. The AMA's House of Delegates voted to work with >Congress to develop legislation revoking the nine-year-old ban on >federal funding for the programs and to urge state medical groups >to initiate state bills to relax drug paraphernalia laws. "There >is more and more evidence than the advantages of needle exchanges >outweigh the disadvantages," said Dr. Nancy Dickey, chair of the >AMA's board of trustees and president-elect of the medical >association. If the ban continues to the turn of the century, the >AMA noted, the United States would have failed to prevent 11,000 >cases of AIDS at a cost of $630 million for medical care. > >]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] > > June 27, 1997 - New York Times > > AMA Calls for Needle Exchanges > > By KATHARINE Q. SEELYE > > Lenon Wilson, a longtime heroin addict in Chicago with puffy >scars the size of leeches on his arms, climbed into an unmarked silver van >and unfurled a paper bag concealing 28 dirty hypodermic needles. > > "If the van wasn't here, I'd use the same needle three, four, five >times, even when it's dirty and has bacteria running through it, and then >I'd use somebody else's when I couldn't use mine anymore," said Wilson, >known as Smoky, as he scooped up 33 clean needles in exchange for his 28. >The volunteers for the Chicago Recovery Alliance at this mobile van in >Harvey, Ill., 25 miles from downtown Chicago, like to give out a bonus of >five to their regulars. > > "You get a better hit with a clean needle, and it leaves less of a >scar," Wilson said. "It's more hygienic all the way around." > > It was people like Wilson that the American Medical Association >had in mind Thursday when it joined a growing chorus of voices and called >for a change in laws to allow intravenous drug users easier access to clean >needles to help block the spread of HIV, the virus that causes AIDS. > > More than one-third of all new AIDS cases in the nation are caused >by contaminated needles or sex with drug users And drug users now account >for the highest rates of new HIV infection -- at nearly twice that of >homosexual men. > > The medical association had previously "encouraged" >needle-exchange programs, in which addicts turn in dirty needles in exchange >for clean ones. But Thursday, citing an "urgent public health need," it was >broader and more emphatic. > > The association's policy-making House of Delegates, meeting in >Chicago, voted overwhelmingly to work with members of Congress to initiate >legislation revoking the 1988 ban on federal financing for needle-exchange >programs and to encourage state medical societies strongly to initiate state >legislation relaxing drug paraphernalia laws so users can legally buy and >possess needles. > > "There is more and more evidence that the advantages of needle >exchange outweigh the disadvantages," Dr. Nancy Dickey, chairwoman of the >board of trustees and president-elect of the medical association, which >represents half the nation's doctors, said in an interview. "We're >addressing a public health epidemic." > > The association said that if the ban continued to the year 2000, >the United States would have failed to prevent up to 11,000 cases of AIDS, >including those among heterosexual partners of drug users and their >children, at a cost of up to $630 million for medical treatment. > > Public health professionals applauded the association, saying that >its action, combined with a similar bipartisan resolution from the U.S. >Conference of Mayors earlier this week, could increase pressure on the >politically sensitive Clinton administration and a reluctant, conservative >Congress to reverse the federal ban on financing needle-exchange programs. > > In San Francisco, Roslyn Allen, project director at the AIDS >Foundation HIV Prevention Project, the nation's largest needle-exchange >program, said of the medical association's decision, "It sends a message to >other agencies that still view this as a dark and sinister practice." > > Outside, Allison, a 26-year-old prostitute with bruises on her >arm, said the clean needles were safer. Referring to the bad needles she >used until recently, she said: "Works would get clogged, broken and it was >pretty common for people to pass them around." > > Dr. Peter Lurie, a researcher at the University of Michigan who is >one of the world's foremost experts on needle exchange programs, said the >public health benefits of needle exchange had been evident for years. > > "If an infection is spread from person to person by an inanimate >object, you can prevent it by removing that object," he said. "This is not >rocket science." > > But what is obvious to public-health professionals is less >clear-cut for politicians. The medical group's action was greeted coolly in >Washington, which remains fearful of putting its official imprimatur on >something that many perceive as tantamount to promoting the use of drugs. > > Some critics see needle exchange as a foot in the door toward >legalizing drugs. They say that the exchange may help addicts avoid AIDS, >but that they may die instead of overdoses. Focusing on needle exchange, >they argue, takes attention away from treatment. > > Beyond that, while many programs offer condoms to those who arrive >for clean needles, critics say the needle exchange ignores the vast number >of cases of HIV infection that are transmitted through sex. And addicts >still need money for drugs, so clean needles do nothing to reduce robberies >or violent crime. One of the strongest critics of needle exchange is Rep. >Charles Rangel, D-N.Y., whose Harlem district is home to some of the worst >drug-infestations in urban America. > > "Needle exchange should never be a substitute for drug >rehabilitation," he said. "If the budget is just for clean needles, I don't >want it." > > When Congress prohibited the spending of federal money for needle >exchange, it said the ban could be lifted only when such programs met two >conditions: that they be shown to reduce transmission of HIV and not to >increase illegal drug use. The medical association came to just that >conclusion Thursday. > > Previously, numerous studies, including ones by the Federal >Centers for Disease Control and Prevention, the National Institutes of >Health, the General Accounting Office and the National Academy of Sciences, >have generally found that needle exchanges are effective in slowing the >spread of HIV and that they have not increased drug use. > > But no one in Congress has even tried to lift the ban, and signals >from the Clinton administration, which has the authority to lift the ban, >have been cautious. > > Dr. David Lewis, director of the Brown University Center for >Alcohol and Addiction Studies, said of the mood: "The administration is >scared. If they move to bring the issue up, Congress will be even more >strict and make it harder for addicts to obtain clean needles." > > Rep. Jesse Jackson Jr., D-Ill., who supports needle-exchange, said >the "demagoguing" on the issue "sometimes makes it hard for politicians to >vote or do the right or healthy thing." > > But Gary Bauer, president of the Family Research Council, a >conservative group, said the collective mind-set in Congress was so opposed >to needle exchange that conservatives felt no need to organize against the >issue. "It strikes the average voter in the gut as being against common >sense," he said. He said the matter was "untouchable" for Clinton because >drug use had gone up on his watch. "I don't see how this administration >could do anything on this that wouldn't blow up in their face," he said. > > Copyright 1997 The New York Times Company