Harm reduction

dharris By dharris The Star-Ledger
on July 30, 2007 at 9:28 AM, updated August 16, 2007 at 10:13 AM

New Jersey's debate over needle exchange has been raging for more than a decade. Finally, in December, Governor Corzine signed the Bloodborne Disease Harm Reduction Act that allowed for the establishment of needle exchange "demonstration" programs. Unfortunately, there's no actual funding in the law for the cities interested in starting a program to prevent the sharing of syringes.

Where you stand on this issue depends on whether you believe exchanging dirty syringes for clean ones condones and encourages drug abuse or that it's a social policy that helps keep addicts from catching and spreading diseases like AIDS and Hepatitis.

Fortunately, we don't have to rely on belief. The facts are clear: Injection drug users in needle (or more properly, "syringe") exchange programs are less likely to share syringes, nor do these programs encourage increased drug use. The Institute of Medicine has undertaken a comprehensive review of the evidence and reached the same conclusions.

The legislature's unwillingness to actually pay for the needle exchange programs doesn't make moral or economic sense. Why put the burden on underfunded city health departments when this is a state problem? Forty percent of New Jersey's HIV/AIDS cases result from injection-drug use and an additional 8% are associated with having sex with an injection-drug user. A study from 2001 estimated that it cost $20,947 to prevent one AIDS infection that otherwise would have cost $195,188 to treat.

Health care costs have risen significantly since then, so preventing just a handful of infections could pay for the entire cost of the program. Since the state pays most of the cost of this care through Medicaid and the hospital charity care program, why not spend a little money to save a lot of money?

Some people object to syringe exchange on moral grounds, as if the noble act of keeping people from getting sick encourages bad behavior. Whatever happened to "hate the sin, love the sinner?"

As I said, there is no evidence that these programs result in more people injecting more poison into their veins. In fact, they can be a gateway to treatment, a first step in getting them to stop--provided we have drug treatment on demand.

A small group of people think HIV/AIDS is punishment for immoral behavior. Even if you believe that the "wages of sin is death," there are others who suffer as well: the family and friends of the injection-drug user, their sexual partners and their babies. Do they deserve punishment for the "sins" of their fathers and mothers when we have the means to prevent it?

With this legislation, we've come a long way since the Whitman Administration when "needle exchange" was the act that dare not speaks it's name. At that time, some New Jersey Department of Health staff were ordered not to sponsor or associate with HIV/AIDS education conferences at which needle exchange was part of the discussion. They had to leave the room when the New Jersey Public Health Association executive board discussed the issue. It was a time when belief and political expediency trumped facts and legitimate scientific discussion.

Syringe exchange is not the answer to everything. It's part of a comprehensive program designed to get the addicts into treatment and avoid the harm that comes with their behavior; no different than all the other disease prevention programs we've been promoting. And it's a start. Now, the state needs to put some money behind its rhetoric.