Common Sense on Needle Exchange

Two decades of paranoia on needle exchange took a welcome hit last week when a House subcommittee omitted the federal ban on needle exchange.

Since 1988, needle exchange programs have been prohibited from receiving federal funding. However, such programs have long been proven to dramatically reduce the spread of HIV/AIDS by allowing intravenous drug users more access to clean needles. The proof, domestically and globally, has been around for so long that in 1998, Health and Human Services Secretary Donna Shalala and Surgeon General David Satcher said it was time to lift the ban. "One of the worst things that can happen in this country is for us to say, if the science doesn't agree with our perspective, then we want to suppress the science,'' Satcher said.

But that's exactly what President Clinton did back then, a Democrat cowed by Republican moralizing about aiding and abetting drug users despite the science showing otherwise. No push to repeal the ban would come under Republican President Bush, of course.

Then came Obama, who said during the campaign, "We have to look at the drastic measures potentially, like needle exchange, in order to assure that drug users are not transmitting the disease to each other.'' Obama has surrounded himself with appointees who support needle exchange, such as drug policy director and former Seattle police chief Gil Kerlikowske, Food and Drug Administration Commissioner Margaret Hamburg, and Centers for Disease Control and Prevention Director Thomas Frieden.

But as for Obama himself, his FY 2010 budget contained the sentence banning needle exchange: "No funds appropriated in this Act shall be used to carry out any program of distributing sterile needles or syringes for the hypodermic injection of any illegal drug.''

In milquetoast responses to press inquiries, White House spokesmen said Obama needs time to "build support'' with Congress and the public to get rid of the ban.

Instead, it is Congress, or rather, courageous members of Congress, who are in the position of building support with Obama. The heavy lifting was left to David Obey, the Democrat from Wisconsin who chairs both the House Appropriations Committee and the Subcommittee on Labor, Education, Health and Human Services, which cut out the ban. Having decided that ideology has far too long ruled the day as US intravenous drug users have 11 times the HIV infection rate of such drug users in Australia, which has long had needle exchange, Obey made sure he highlighted the repeal in his public statement on the appropriations bill.

"Scientific studies have documented that needle exchange programs, when implemented as part of a comprehensive prevention strategy, are an effective public health intervention for reducing AIDS/HIV infections and do not promote drug use. The judgment we make in this bill is that it is time to lift this ban and let State and local jurisdictions determine if they want to pursue this approach.''

Aides to the Appropriations Committee said that some of the science that Obey relied on was a 2007 CDC review of 185 needle exchange programs in 36 states, the District of Columbia, and Puerto Rico. The review concluded that with just state and local funding, the programs "are helping protect IDUs [injection drug users] and their communities from the spread of bloodborne pathogens and are providing access to health services for a population at high risk.''

This is of little interest to some Republicans, such as Todd Tiahrt of Kansas, the ranking Republican of the House subcommittee, who said he was "very concerned'' about the elimination of the ban. He still clings to the disproved notion that clean needles promote drug use. It is time, with the House having taken the lead, for Obama to get out front and say once and for all that science takes the front seat to ideology. Some issues are too critical to the very lives of Americans to wait to "build support.''

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