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Debate: Needle exchanges

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====Yes==== ====Yes====
 +*'''Evidences show no change or decreased drug use''' [http://consensus.nih.gov/1997/1997PreventHIVRisk104html.htm "Interventions To Prevent HIV Risk Behaviors" National Institutes of Health,Consensus Development Conference Statement;February 11-13, 1997]:"
 +A preponderance of evidence shows either no change or decreased drug use. The scattered cases showing increased drug use should be investigated to discover the conditions under which negative effects might occur, but these can in no way detract from the importance of needle exchange programs. Additionally, individuals in areas with needle exchange programs have increased likelihood of entering drug treatment programs.On the basis of such measures as hospitalizations for drug overdoses, there is no evidence that community norms change in favor of drug use or that more people begin using drugs. In Amsterdam and New Haven, for example, no increases in new drug users were reported after introduction of a needle exchange program."
 +
*'''[[Argument: Needle exchanges do not increase drug use| Needle exchanges do not increase drug use]]''' [http://claremontportside.com/index.php?/20071025129/Politics/The-Case-for-Needle-Exchange.html#josc266 Karthik Reddy. "The Case for Needle Exchange". October 25, 2007]: "The opposition to needle exchange programs would have us believe that such programs encourage drug use. Studies of the Amsterdam program, however, demonstrate that drug use does not increase; the programs generally only attract those who have already become intravenous drug users. The implementation of the San Francisco program actually resulted in decreased drug use, as the program established much-needed links with the drug-using community." *'''[[Argument: Needle exchanges do not increase drug use| Needle exchanges do not increase drug use]]''' [http://claremontportside.com/index.php?/20071025129/Politics/The-Case-for-Needle-Exchange.html#josc266 Karthik Reddy. "The Case for Needle Exchange". October 25, 2007]: "The opposition to needle exchange programs would have us believe that such programs encourage drug use. Studies of the Amsterdam program, however, demonstrate that drug use does not increase; the programs generally only attract those who have already become intravenous drug users. The implementation of the San Francisco program actually resulted in decreased drug use, as the program established much-needed links with the drug-using community."

Revision as of 05:03, 4 July 2009

Are needle exchanges a good idea? Do they improve public health/safety?

Background and context

Many illicit drug abusers inject drugs such as heroine directly into the blood stream with syringes or needles. For many users, sterile syringes are not readily available and drug paraphernalia laws in some countries make it an offense to distribute or possess syringes for non-medical purposes.
As a result, many drug users share needles, which contributes to the spread of diseases such HIV and Hepatitis C, which have become near pandemics in countries and communities around the world. The spread of these diseases among drug users has become so concerning that, starting in the 80s, some activists and cities began opening needle exchanges. These government funded programs supply clean needles to drug addicts, so that they are at a lower risk of sharing needles and spreading diseases. Opponents argue that needle exchange programs condone illicit and immoral behavior and that governments should focus on punishing drug users, discouraging drug-use, and providing treatment for quiting. Several questions arise surrounding this debate: Do needle exchanges significantly reduce the spread of diseases? Do they save lives? Or, do they decrease or increase drug-use, and possibly put more lives at risk? Should governments be involved in distributing drug paraphernalia? Does this send the wrong message about drug-use? Are needle exchanges a more economic measure than treating those who are already affected with such diseases? Do needle exchanges help tie drug addicts into treatment programs? Is halting the use of drugs the only way to halt the spread of disease among drug users? Do needle exchanges harm communities? Do they deter prospective residents? Do they discourage customers and harm businesses? What is the overall balance of pros and cons? Are needle exchanges good public policy?

Fighting HIV/AIDS: Do needle exchanges help fight HIV/AIDS?

Yes

  • Needle exchanges are key to fighting HIV/AIDS, saving lives Debra L. O’Neill. "Needle Exchange Programs: A Review of the Issues". Missouri Institute of Mental Health. September 27, 2004: "Research has shown needle exchange programs (NEPs) offer a number of public health benefits in the prevention and reduction of IDUs’ exposure to HIV, HBV, HCV and other diseases. For example: 􀂃 New Haven, Connecticut found a one-third reduction in HIV prevalence after its NEP had been in operation for only 4 months. 􀂃 Researchers found an 18.6% average annual decrease in HIV seroprevalence in cities that had introduced an NEP, compared to an 8.1% annual increase in HIV seroprevalence in cities that had never introduced NEPs. 􀂃 HIV prevalence among NEP attenders in a Canadian city was low, even though high-risk behaviors were common. 􀂃 IDUs in Seattle who had formerly attended an NEP were found to be more likely than non-exchangers to reduce the frequency of injection, to stop injecting altogether, and to remain in drug treatment, while new users of the NEP were five times more likely to enter drug treatment than never-exchangers."
  • HIV epidemic justifies dramatic efforts such as needle exchanges. "With over a 100 people in the United States becoming infected with HIV, HCV, or HBV every day as a result of injection drug use, it is clear that we must do more. We must continue to educate people about the harms of drug use, particularly injection drug use. We must pay attention to the expertise and knowledge of public health officials and scientists who urge that sterile syringes be made legally available to people who inject drugs."
  • Drug addicts cannot make recovery if they acquire HIV. David Lewis. "Should needle exchange be publicly funded?". PBS: "Many intravenous drug users eventually overcome their habit and become productive members of society -- but not if they are afflicted with AIDS. Needle exchange programs are an effective and obvious strategy to prevent the spread of this devastating disease."
  • Needle exchanges help fight the spread of many different diseases. Mark Cichocki. "Why Do We Need Needle Exchange?". About.com. September 3, 2007: "Needle exchange programs have also achieved reductions in the rate of hepatitis infection, which can also be spread through sharing needles. In Tacoma, WA, clients of a needle exchange program were up to eight times less likely to contract Hepatitis B or C than non-client IVDUs."


No

  • Drug addicts transfer HIV in many ways other than by needles. There are many ways by which drug-addicts can transfer bodily fluids between one-another. Needles are only one of many pathways. Sharing of mixing water for heroin another significant problem, and needle exchanges do not necessarily address this issue.
  • Needle exchanges fight disease at expense of bigger drug problem. Aaron Lawrence. "Why a Needle-Exchange Program is a Bad Idea". Record. August 26, 2005: "The drug problem is arguably bigger and more threatening to public health and stability than disease problems. And, yet, needle exchanges seem to place the interests of fighting diseases over the interests of fighting drugs, in so far as needle exchanges actually enable drug-use, in order to reduce the spread of disease."
  • General statements against needle exchanges Dr. David Murray, chief scientist at the Office of National Drug Control Policy: "Needles are not the magic bullet. We are being politically pressured to make this decision (in favor of needle exchange). But it's time to rethink if there's a more humane, effective public health response than continuing to support injection drug use."[1]



Principles: What are the main pro/con arguments on "principles"?

Pro

  • Needle exchanges do not condone drugs; they offer care. David Lewis. "Should needle exchange be publicly funded?". PBS: "Providing clean syringes and needles to intravenous drug users does not say that we condone their behavior: it says that we still care about them and that we want them and their partners to be healthy as a first step in becoming a productive member of society again."
  • Needle exchanges protect public, not just drug addicts. While opponents may argue that drug-abusers must live with the consequences of their decisions to use dirty needles, the issue is not just about helping drug-addicts avoid diseases. It is also about protecting the public from the consequences of the spread of these diseases. The consequences include higher risks of infection as well as higher taxpayer costs in providing the health care for more sick people. Also, needle exchanges help protect the families of drug-addicts from the possibility of their loved-one acquiring a potentially fatal disease such as HIV.


Con

  • Needle exchange harm-reduction puts expediency over principle. There are certain principles that should not be sacrificed to expediency. The individual choice to do drugs should be met sternly with the principle that it is wrong and that an individual that chooses to do drugs should suffer the consequences on their own, without burdening other taxpayers. The idea of needle exchange harm reduction sacrifices these principles to the expediency of reducing harm to the individuals involved. Such infractions on principle fore expediency's sake are inappropriate.
  • Needle exchanges involve state in drug paraphernalia distribution Atlantic City judges ruled in 2005 against Needle Exchanges on the basis that: "Atlantic City and its employees are not exempt from the (criminal) code provisions prohibiting the possession, use and distribution of drugs and drug paraphernalia simply because they adopted a needle-exchange program for beneficent reasons."[2]
  • Addicts choose to take drugs; must live with disease risks. While it is true that individuals that do drugs and share unclean needles face a greater risk of HIV/AIDS.


Drug-use: Do needle exchanges decrease or increase drug-use?

Yes

A preponderance of evidence shows either no change or decreased drug use. The scattered cases showing increased drug use should be investigated to discover the conditions under which negative effects might occur, but these can in no way detract from the importance of needle exchange programs. Additionally, individuals in areas with needle exchange programs have increased likelihood of entering drug treatment programs.On the basis of such measures as hospitalizations for drug overdoses, there is no evidence that community norms change in favor of drug use or that more people begin using drugs. In Amsterdam and New Haven, for example, no increases in new drug users were reported after introduction of a needle exchange program."

  • Needle exchanges do not increase drug use Karthik Reddy. "The Case for Needle Exchange". October 25, 2007: "The opposition to needle exchange programs would have us believe that such programs encourage drug use. Studies of the Amsterdam program, however, demonstrate that drug use does not increase; the programs generally only attract those who have already become intravenous drug users. The implementation of the San Francisco program actually resulted in decreased drug use, as the program established much-needed links with the drug-using community."



No


Community: Do needle exchanges improve or damage communities, business, etc.?

Pro

  • Needle exchanges help protect families of drug-abusers. Alan Franciscus. "Needle Exchange - A Matter of Public Health". Hepatitis. April/June 2003: Dawn Day, a Catholic priest and member of the New Jersey Governor's Advisory Council on AIDS: "I believe we have an obligation to permit people who inject drugs to have access to sterile needles so they can protect their health. Injection drug users are also God's children. And, like the reckless driver in the example above, people who inject drugs have wives, husbands, and babies. When we abandon the person who injects drugs to HIV/AIDS, we are abandoning their non-drug injecting partners and babies as well. God has given us knowledge with which to slow the spread of HIV/AIDS to all these people. Let us use it."[4]


Con

  • Needle exchanges create the open injection of drugs surrounding NEPs. Toni Meyer. "Making the case for opposing needle exchange". New Jersey Family Policy Council. November 16, 2007: "Increased, Open, Injection drug Use in Areas surrounding NEP’s due to influx of users. In Downtown Eastside (Vancouver BC), police estimate there are 7,500 to 8,000 addicts, and users shoot up on the streets because the injection site has waits of up to 45 minutes5. More police had to be assigned to the area to try and minimize the number of users who were shooting up outside the NEP area."
  • Needle exchanges create undesirable communities. The mere idea of having a needle exchange in one's community is off-putting. This is for a variety the many reasons described here, all of which discourage new residence, particularly those with families.
  • Needle exchanges increase discarded needles on streets. Toni Meyer. "Making the case for opposing needle exchange". New Jersey Family Policy Council. November 16, 2007: "Discarded Needles: Reports of discarded needles in public places outside of NEP sites abound from cities with NEP’s. Here is just one example. In Cairns Australia, City Place has been revealed as Cairn’s biggest drug shooting gallery with 1000 syringes discarded since January in toilets and streets surrounding the inner city mall. Addicts are also dumping hundreds of used syringes at many of the city's other popular public places, including the Esplanade near Muddy's playground, the city library, in gardens and in various other public places. The figures were released by Cairns City Council after a recent audit of its sharps disposal bin program7."
  • Needle exchanges generally degrade community cleanliness. Needle exchanges bring in drug-addicts, who are generally less clean than other individuals. Aside from discarding needles in the street and in parks, they are generally much more prone to leaving trash around, deficating outside, and spreading illnesses and even diseases in a community.
  • Needle exchanges generally degrade community safety. Drug-addicts are unstable and prone to crime. By bringing more drug-addicts into a community area, needle exchanges can jeopardize the safety of a community.

Treatment: Do needle exchanges help drug-addict treatment?

Pro

  • Social services for addicts can be centered around needle exchanges. "Needle exchange options; pros and cons". Canada.com. March 21, 2008: "Pros: The St. John Ambulance building on Pandora Avenue is only about two blocks away from the current Cormorant Street needle exchange, meaning drug addicts are already in the area. The St. John building is, however, considerably larger and beside the new Our Place, which offers transitional housing, outreach programs, social services, and amenities like washrooms for people living on the street. The new building will also house health professionals to diagnose, test and treat this sickly population. The building will house about 50 health care and social service providers including Assertive Community Treatment outreach teams, doctors, nurses, addiction counsellors, social workers and street nurses. Police would also have a presence inside and outside the building to maintain public order. More flexible hours of operation, and the possible use of a courtyard, mean drug users won't congregate all at once outside the building."
  • Needle exchanges can help create treatment awareness among addicts. "Are Needle Exchange Programs a Good Idea?" by Jenny Murphy, Bryan Knowles;Thursday, June 15, 2000: "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."

Con

  • Referrals to treatment are sometimes very low at needle exchanges. "Report: Needle Exchange Program Finds Mixed Success in Atlantic City". Join Together. January 22, 2009: "Atlantic City, N.J.'s needle-exchange program -- the state's first -- has succeeded in its primary mission of collecting dirty needles from drug addicts in exchange for clean ones but has had less success getting addicted individuals into drug treatment, a new report concludes. [...] the Atlantic City program ranked last among the state's four needle exchanges in terms of referrals to drug treatment, with only 74 referrals made. Program coordinator Therese Wilkerson said that staff must walk a fine line between wanted to get clients into treatment and scaring them off by pushing too hard."


Economics: Are needle exchanges cost-effective?

Pro

  • Needle exchanges are a cost-effective form of HIV prevention. "Does HIV Needle Exchange Work?". Center for AIDS prevention studies. November 1998: "Is needle exchange cost-effective? Yes. The median annual budget for running a program was $169,000 in 1992. Mathematical models based on those data predict that needle exchanges could prevent HIV infections among clients, their sex partners, and offspring at a cost of about $9,400 per infection averted. 16 This is far below the $195,188 lifetime cost of treating an HIV-infected person at present. 17 A national program of NEPs would have saved up to 10,000 lives by 1995."
  • By preventing infections, needle-exchanges cut health care costs. "Are Needle Exchange Programs a Good Idea?" by Jenny Murphy, Bryan Knowles;Thursday, June 15, 2000": "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."


Con

Crime: Do needle exchange program decrease/increase crime?

Pro

Con

  • Needle exchanges increase crime Toni Meyer. "Making the case for opposing needle exchange". New Jersey Family Policy Council. November 16, 2007: "Crime Increases in Area of Needle Exchanges: - Crimes Due to Drug Use: When a needle exchange program (NEP) moves in, associated crime and violence follows, including prostitution which contributes to the spread of AIDS. A spokesperson from the Coalition for a Better Community, a NY City based group opposed to NEPs, visited the Lower East Side Needle Exchange with a NY Times reporter. Their conclusion: “Since the NEP began we’ve seen an increase in dirty syringes on our streets, in schools yards, and in our parks…Brazen addicts shoplift, loot, and steal to buy drugs."


Public opinion: Where do publics stand?

Pro

  • Needle exchanges are favored by many publics. "Survey finds most voters favor needle exchanges." AIDS Policy Law. May 30, 1997: "AIDS: A poll conducted in April 1997 by the Human Rights Campaign indicates that a majority of Americans favor needle-exchange programs to curb the spread of HIV. Thirty-two percent of those interviewed strongly favor needle exchanges and 23 percent somewhat favor the strategy. Support for such programs was found in every region of the United States. Republicans were split but strong majorities of independents and Democrats were in favor of needle-exchange programs."


Con

  • Needle exchanges should not be forced on unwilling communities. David Noffs, Founder and Executive Director of the Life Education Center. "Should needle exchange be publicly funded?". PBS: "Lastly, many needle exchange programs have been introduced without the support of those communities where they set up shop. [...] Needle exchange program operators have arrogantly set up these illegal operations while self-righteously declaring that anyone who opposed them was either not compassionate to the plight of AIDS sufferers or homophobic. This condescending attitude has not helped their public relation efforts and has probably already determined their ultimate fate."


Pro/con sources

Yes

No

External links

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