Tuesday, 20 October 2009

Syringe Exchange Programs Are Saving Lives

Syringe Exchange Programs (SEPs) have been controversial since they were first officially introduced in the Netherlands in 1984. Since then, the issue of giving out clean syringes to inject illicit drugs has plagued politicians worldwide. They were faced with opposition from vocal moral crusaders, an ignorant public and attacks from other politicians while there was growing scientific evidence that SEPs prevented many deaths. It was a case of losing voters or losing lives. While most of Europe, Australia, New Zealand etc. worried about losing lives to HIV/AIDS, the US worried more about losing votes. As cases of HIV/AIDS and Hep C. rocketed up in the US, early adopters of SEPs, especially Australia had much better success at minimising the spread of blood borne diseases.

Giving out clean syringes to drug users existed long before SEPs was made official. In 1970, the San Francisco State University unofficially gave away clean syringes as a way to deal with yellow jaundice and abscesses from shooting heroin. This practice spread to the San Francisco General Hospital and in the early days of the HIV epidemic, some doctors and nurses would leave unopened packets of syringes in clear view of drug users then leave the room expecting the packets to be gone when they returned. Looking back now, it really hits home how draconian we can be in this so called modern civilisation.

United States
Regardless of this evidence, the use of federal funds for needle-exchange programs was banned in the United States of America in 1988. Most U.S. states criminalize the possession of needles without a prescription, even going so far as to arrest people as they leave private needle-exchange facilities. Nonetheless, every state in the United States has a program that supports needle exchange in some form or the purchase of new needles without a prescription at pharmacies.These programs were introduced during the Clinton Administration but were disbanded following negative public reactions to the initiatives. Covert programs still exist within the United States.

Although the evidence has been conclusive for decades from dozens of well established studies, the US remained defiant. At least 7 attempts to introduce federal recognition and funding for SEPs have been over turned by the reigning president of the time. President Bill Clinton promised to change the federal position but his drug czar, William Mcafferey convinced him that allowing SEPs would “send the wrong message” in their fight against drugs. it is estimated that 10,000 lives and 500 million dollars in health care could have been saved during his 8 year presidency if Bill Clinton removed the ban on federal funding.

By 2000, 36% of all AIDS cases and approximately 50% of new HIV infections had occurred among injecting drug users and their partners.
I do not favor needle exchange programs and other so-called harm reduction strategies to combat drug use. I support a comprehensive mix of prevention, education, treatment, law enforcement and supply interdiction to curb drug use and promote a healthy drug free America, not misguided efforts to weaken drug laws and needle exchange programs signal nothing but abdication, that these dangers are here to stay. America needs a president who will aim not just for risk reduction, but for risk elimination that offers people hope and recovery, not a dead end approach that offers despair and addiction.
-President G.W. Bush. Annual meeting of the AIDS foundation of Chicago. 2000

The ban on federal funding remains. In the run up to the 2008 election, Barrack Obama made a key campaign pledge to remove the ban on federal funding for SEPs. In May 2009 after being elected president, the pledge disappeared off the Obama website and when his health budget appeared shortly afterwards, the ban remained, buried deep on page 795.

It started in 1986 with a group of Sydney users who illegally distributed clean syringes at St. Vincent’s hospital under the watch of Dr. Alex Wodak. Since then, Australia has become an international leader in harm reduction with one of lowest rates of HIV/AIDS infections. Unfortunately though, with over a decade of conservative governments and strong criticism of harm reduction from the media, Australia has started to stagnate, losing it’s once impeccable reputation. While SEPs remain a major part of our health system, more recent Harm Reduction strategies are being ignored or opposed by the federal and state governments. The only major exception is the Medically Supervised Injecting Centre in Kings Cross.

In the early years of HIV/AIDS before condoms and clean needles were standard fare, the government took a pragmatic approach and spent $150 million dollars between 1988 and 2000. This prevented intravenous drug users from an estimated 25,000 cases of HIV and 21,000 cases of hepatitis C. A saving for taxpayers of up to $7.7 billion dollars.

Since then, the total lives saved and the amount of reduced costs is staggering. Surprisingly, there are still some groups who oppose SEPs and lobby the government not to increase the number of programs. The most recent controversial proposal is the introduction of SEPs into prisons but in terms of targeting susceptible groups, prisoners have the highest rate of blood borne diseases in our society. This is mostly because of a high number of intravenous drug users in prison who are also sharing hard to get needles. Those opposed to SEPs in prison use the same old reasoning that causes most of the current drug problems we have already. You have probably heard them before e.g. “it’s a prison, not a holiday camp” or “it sends the wrong message” or “we should be getting these people off drugs not encouraging them to use more” or “we should be trying to stop drugs getting into prison not making it easier for them to use drugs”. Of course, these arguments simply ignore the reality of drug use and places selfish ideology before the safety of others.
The issue is this — there are about 20,000 men and women being released every year. Many of them have got significant health problems, with blood-borne disease a major element of that. They are going in and out of the prison system and bringing those diseases to their families and their communities. Making clean needles accessible is one easy, relatively cheap way of dealing with that. It’s called public health.
-Gino Vumbaca. CEO of the Australian National Council on Drugs

Sterile injecting equipment in prisons is a no brainer just as a prison methadone program is. Access to these basic health resources is vital to tackling the spread of blood born disease especially in prison where the problem is most prevalent. Denying these services in prison is simply sentencing injecting drug users to a life of suffering or death. Each day that these programs are opposed, a few more fellow humans are tagged for an early grave.

Needle Program Success
The Age
By Julia Medew
October 2009

TAXI drivers, tradesmen and body builders are among the growing number of people using St Kilda's 24-hour needle and syringe exchange program - the only service that operates all night, every night in Victoria.

The manager of health services for the Salvation Army's Crisis Service, Sue White, said that since the Grey Street program started operating round the clock in late 2007, it had helped an extra 1000 people get clean equipment every month.

Aside from local sex workers, she said, tradesmen were using the after-hours service alongside truck drivers and a small number of taxi drivers.

Body builders who take steroids were also attending.

An evaluation of the 24-hour service by the Salvation Army and Monash University found it had contributed to a 51 per cent rise in the number of needles and syringes being distributed between August 2007 and September 2008. The number returned for safe disposal increased 26 per cent.

Ms White said the service had prevented people from sharing equipment - a practice known to spread viruses including HIV and hepatitis C. It had also exposed people to referrals for counselling, detox programs and other health-care services.

The evaluation found that since the service extended its hours, there had been little change in drug-related crime or complaints to the local council.

Ms White said other needle and syringe exchanges should consider expanding their hours, based on its success.

A Victorian Taxi Directorate spokeswoman said it was not aware of any drivers using drugs. She said it was working with police ''to identify drivers who may be under the influence of drugs or alcohol''.

A spokesman for the Victorian Taxi Association said he had also not heard of drivers using illicit drugs.

''It's very surprising and a bit concerning … It's something we will look at,'' he said.

I had to chuckle at the comments from the various taxi organisations. Both spokespeople claimed they had never, ever heard of a driver that used drugs.They sounded stunned!. Why wouldn’t taxi drivers be drug users? Are taxi drivers exempt from such evils in society? In my time, I have seen a taxi driver score heroin from a street dealer, had dozens of cabs drive me then wait while I score and I even purchased speed from one taxi driver. Over a 20 year period and you would expect it to happen sometime. Their responses appeared more like an instant reaction to protect their organisation than the truth. Regardless of their reasons, it had me smiling for a few minutes.


Kat D said...

Good post, Terry.

I used to work at the 24-hr NSP (SEP) in St Kilda. The politics involved in maintaining funding for the overnight service was incredible. There are vending machines services in other states which provide clean equipment; however, vending machines do not provide the other services that a staffed NSP can. Working in an NSP involves much more than provision and collection of syringes. I spent a lot of time teaching people safe injecting techniques; making referrals; providing a crisis response (instances of women who had been raped, especially in the overnight shifts) etc. The need for 24hr services seemed to me to be logical and economically advantageous in the longer term.

As for the issue of NSPs in prisons, it is absolutely apalling that this service isn't provided. If we follow the argument that drugs aren't allowed in prisons so there is no need for syringes; to be consisent, we woud need to be equally ignorant in the wider community and this would eliminate the existence of NSPs on the grounds that people shouldn't be using drugs anyhow. But as Michael Huemer has said:

' ...human beings are tempted more by immediate pleasures than by the long-term good. Until humans are replaced by angels, that problem will not be solved, and to declare "war" on it is to declare war on human nature'

We accept that NSPs are saving lives (and lots of money that would otherwise be spent of HIV and Hep C treatment); we should be saving the lives of the people in prisons too. And the lives of their partners and unborn children.

AAAH! Sorry about the long post, but it's just so frustrating!!!!

Terry Wright said...

Thanks Kat.
It's good to see that these issues make people angry. I can't believe that the carnage and suffering inflicted on those who catch these diseases is just a political or ideological issue to many. So much for an advanced society.

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