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Giving clean needles to IV drug addicts saves lives – and money. That’s why the federal government should be spending your tax dollars to keep drug users -– and the people who have sex with them -- from getting AIDS and hepatitis.
But Republicans in Congress have decided that despite a veritable mountain of scientific evidence showing that needle-exchange work, they are not going to pay for this sort of program any more.
They just yanked it out of the end-of-year spending package.
Shouldn’t public health policy be guided by the best evidence we have about what reduces the dangers and costs of AIDS and hepatitis?
Studies done over more than 15 years across the U.S. and in Australia, Hungary, Holland, Ukraine, Canada, Portugal, Switzerland, Brazil, Belgium and Germany show that there is no doubt that needle- exchange programs lower infection rates for HIV and hepatitis C.
Less infection not only means fewer deaths, but lower costs associated with caring for infected people.
So what reason might Congressional Republicans or anyone else have for deciding to ignore the evidence and let people die, increase the infection rate and add to the cost of your medical insurance?
It’s not about the money. These programs are inexpensive for such a highly effective public health measure.
The reason is a belief that simply won’t go away: Giving out free clean needles sends the message that injecting drugs is OK. That belief just happens to be completely unsupported by any evidence at all.
Whatever leads people to decide to ruin their lives by becoming injection drug users, it is certainly not the chance to get free needles.
Policy involves more than scientific evidence when it comes to touchy subjects like drug addiction. However, morality cannot ignore the facts.
If needle-exchange programs do reduce risk, suffering, deaths and costs and it is beyond dispute that they do then it is bad ethics to insist on a moral message that is utterly disconnected from the harsh realities of drug abuse.
Art Caplan, Ph.D., is the director for the Center for Bioethics at the University of Pennsylvania. Follow him on Twitter @ArthurCaplan.
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Why shouldn't they have to buy their own needles for goodness sake! It's not a choice between clean or dirty, how bout they buy clean ones! They are cheap, it's the drugs themselves that are expensive.
Normally, you have to have a prescription to buy needles up front at a pharmacy. The programs vary from state to state.
I buy needles from Amazon (for shots my older dog has to take weekly). You can get them w/o a prescription; however, for drug addicts...money spent on anything but drugs is money wasted. If it came down to being able to score another shot of dope or buy clean needles, what do you think an addict would choose. Needle exchange programs are vital to keeping people healthy.
To buy on Amazon you need wither a bank account or a credit card - you also need an address. Needle exchanges save lives and are relatively cheep and effective. I hope congress wises up.
I was simply commenting that you do NOT need a prescription for purchasing syringes. I am all for needle exchange programs and am happy to support them with my tax dollars.
Everything the GOP touches turns to sh*t.
They have absolutely ZERO clue about anything. They are all anti-science, anti-intelligence, anti-education, anti-society.
These GOP neanderthals need to be relegated to the waste bin of history.
.
Again, we have religion versus science. In my book, ignoring the facts is extremism.
You need a prescritpion to get needles. You can manufacture these drugs but they don't manufacture the needles. Which leads to reuse of the needles they can lay their hands on.
How about the druggies just stop using drugs and having sex? But we can't expect people to have any self responsibility in the new liberal socialist USofA! The government must take care of everybody even when they are using illegal substances.
If people want to kill themselves taking drugs maybe there ought to be a government program to help them do it quicker.
It must suck to be you.
Less HIV from IV drug users translates into less infected individuals in the wider population. HIV drugs cost several thousand dollars per month. Would you rather taxes for a few dollars' worth of clean needles or thousands for AIDS treatment? That one isn't too hard for me to figure out. (It's like paying a few bucks for contraceptives and saving on child welfare costs.) Prevention is always cheaper and more effective, people!
Agreed that's all, needle exchange is cost effective, not to mention more humane. It's hard for me to stomach that some people would rather a drug addict die then not. Yes they made some bad choices but I don't wish aids on them and certainly not on the wider population.
Emily, it is nice to see others with compassion. Drug abuse is horrible and certainly, I wish no one chose that life but the fact of the matter is people do and ignoring them or trying to shame them into quitting does not work. The best we can hope for is to provide ways for them to adopt safer habits which in turn keeps the winder population safer. People seem to think that we can simply "make" addicts stop using...you know, if it was that easy, there would be no addicts.
I'm sorry, but Dr. Caplan is speaking from HIS perspective on morals and ethics. He says it isn't about the costs for free clean needles which he points out (correctly) saves vast amounts of money for then treating the illnesses such as AIDS and hepatitis that at times result from the use of contaminated needles. What he doesn't address, but rather implies, is society's obligation to care for/treat those who engage in this stupid practice (drug use and needle sharing). Further, those who choose to cohabit, etc. with these dregs of society are sharing in this risky business. There are, of course, some innocents; but allowances for these can be accommodated. Homo Sapiens are NOT an endangered species; and I, for one, would rather see cessation of empathetic tolerance for grossly bad behavior (and its potential consequences). Our resouces ARE LIMITED, and it is time for a more dispassionate allocation of same.
and then we can eat any infected children they might produce as an economical way to dispose of them - win-win
Now that's not fair Emily. When we TELL them to stop using drugs, we will also TELL THEM not to have babies. Duh.
It is proven that crime and disease is lessened in places where needle exchange programs and "shooting galleries" (safe houses staffed by nurses where addicts use). We can't mandate morals. People are not going to stop shooting drugs because "we" make it harder for them to get clean needles. They will simply stop using clean needles.
Doesn't surprise me, this is the same "argument" used by the abstinence-only crowd for not wanting schools to teach kids about safe sex and not allowing them access to various forms of birth control.
Exactly!! And that whole abstinence thing is really working out, huh? People think they can just bully people into behaving the way they want. It never works but they still aren't willing to get behind proven alternatives. Soooo frustrating.
No! We don't bully them. We stop enabling them. Do drugs and you suffer the consequences. Fornicate and you suffer the consequences. If we quaranteened these people perhaps we wouldn't even be having this discussion! Everytime we pay for these people they go out and repeat the behaviors. Duh!
Hey! The problem only got worse when we starting the garbage called sex-ed. Grow up! Think!
What problem got worse when sex-ed started? You mean young people STARTED having sex when we started educating them? Are you freakin' kidding me? I can't even address that seriously with someone who used the word "fornicate" in a comment.
Good luck with your quarantine (I suppose that is what you were trying to say with that string of incoherent letters in your comment that started with a Q). And please make sure YOU stand by and watch the babies born addicted to drugs suffer and die because you don't want to enable druggies. Nitwit.
I'm encountering stories like these more and more these days, and on those days I consider withdrawing my consent from the government.
I've never done drugs but it makes sense to me that clean needles prevent a lot of expensive hospital visits! This seems like just another one of these right wing Christian knee jerk reactions that only end up hurting people and in the end costing the tax payer more money. So, let them have their needles and cut down on needless emergency room visits!
Thank you for being another voice of reason in the resounding din of nutballs here. I also have never done drugs and I certainly don't condone drug use but if providing clean needles and needle exchange can keep people safer (and its proven that it can), I'm all for it and happy to contribute my tax dollars to those programs.
Do drugs and you die. Why must money go to people who insist on living sinful, immoral lives? There are too many opportunities to stop the behaviors. Since these people do not want to stop, let's start quaranteening them. Let's stop enabling these behaviors!
Wake up America!
Why must people continue trying to mandate the morals of others? People ARE going to do drugs. Always. Why not make those people and, by extension, EVERYONE ELSE as safe as possible since this is going to happen whether we like it or not? You cannot force people to live by your moral code.
And giving addicts clean needles is not enabling anything...they are already shooting drugs, what part of that don't you understand? Its not as if addicts are at a loss as to how to find needs to inject drugs with...they will do it one way or the other so why not provide clean needles to keep people (all people!) safer? You and people like you are so closed minded that you can't see past your own disgust for people who don't believe what you believe to understand this helps EVERYONE, including YOU.
IMO - Instead of needles, give them a gun...
Then let them shoot-up and share with their friends...
Those that enable people to continue a destructive life-style are no better that the addicts...
Or do you think that giving a alcoholic easy access to alcohol is a solution???
Harm programs in the EU have resulted in 80% of the IDU have HIV...
Thailand ENFORCES their drug laws, and their HIV rates are FALLING...
Thailand tried their version of the HARM program, they gave out free needles. The POLICE were video-tapping the recipients, it made their job of arresting druggies easy... 555
Hmn. Perhaps you should move to Thailand where in addition to "enforcing" their drug laws (they sure don't do much with the Human Trafficking laws that allow young children to be sold for sex but anyway) the government runs every aspect of life...even for those NOT addicted to drugs.
JS, Baltimore,
I live in Thailand and have been since 2005...
A bad day in Thailand is better than any-day in the current USA...
I can and have walked the streets throughout BKK and the Thai country side, both night and day, alone & with my family. Try that in Washington DC, Detroit, El Cintro, etc...
BTY - We pay ZERO taxes and the Thai 'Universal health care' cost $1+USD a Doctor/Hospital visit...
Come to Isan and play with the children, I guarantee that you will not be using your return ticket...
As a bioethicist the authors should go a bit deeper into the issues. With that overpopulated world is it an advantage to save any lives? Is it a particular advantage to save drug addicts lives? The same questions can be related to saving medical costs. Is it the government's duty to save all lives?, To provide any medical attention for anyone?, It seems that the author is merely expressing his opinion and adding a few questionable "facts." As is clearly shown in Book 4, On Human Values. in that free e-book series at http//andgulliverreturns.info, ethical questions need to be clearly related to: self-centered, God based, or society based assumptions, then the evidence presented to back up one's position needs to be critically examined.
Bioethicist? Who invented that one. How about not using drugs or engaging in unprotected sex
for prevention instead of subsidizing the drug addicts and gay/lesbian lifestyles?
Did that ever occur to this genius?
WOW!! Lots of different directions in these comments-Right wing christian idiots, don't give them needles, give them needles, let them get aids and die, etc. How about we mandate that the drug pushers give their clients needles? What the hell-if they're that cheap, maybe they can up their profit margin? Of course, that may mean legalizing the @!$%# and allowing open sales. But-just think of the tax revenue!?!?! Cigarettes are a no-no everywhere now and states are taxing them to make up for loss of revenue. Just think of the possibilities!!
There is abundance evidence supporting syringe exchange programs as a risk reduction strategy. There are approximately 221 programs in the U.S., District of Columbia, Puerto Rico and the Indian Nations (Foundation for AIDS Research). Many individuals seem to be unaware of the benefits of these programs:
Syringe exchange programs have been shown to decrease the transmission of blood-borne pathogens, such as HIV/AIDS and hepatitis. This can significantly decrease health care costs associated with progression of these diseases. Pharmacotherapy to treat individuals who contract these diseases can be tens of thousands of dollars (and often more). Not only do individuals who are already using drugs have access to clean supplies, according to research, behaviors are changed - they are less likely to share (give or receive) dirty needles.
These programs serve as a location for needles and syringes to be dropped off. Programs require that old syringes be brought in and disposed of before new ones are handed out. This has been shown to reduce the number of syringes found in public places, and subsequently lowers the risk of a needle stick by community members, law enforcement and health care professionals.
Syringe exchange programs provide an access point for providing other forms of health care to a population that generally does not seek routine care otherwise. This generally includes care by a registered health care professional, and may include immunizations, disease state testing, and education. In addition, it provides an opportunity for education and referral to other services (shelters, rehabilitation centers, etc). Syringe exchange programs have been shown to increase the number of individuals who go through drug treatment programs.
Evidenced-based risk reduction strategies, such as syringe exchange programs, are beneficial for both individuals and society as a whole. Helping to prevent the spread of disease does not mean condoning the behavior. These programs should be expanded.
The needle exchange is working real well in the 'District of Columbia' - AIDS rates are over 3% in the general population...
BTY - That is higher than Haiti & almost 3x higher than Thailand...
I would encourage you to look into this further. Even without reading all the published literature, you will find evidence to support the use of these programs. From one article:
According to October 2007, AIDS Action policy Brief, syringe sharing was reduced by two thirds in Washington D.C in a study conducted among 2000 users in 1992. Additionally, according to a study conducted in 2005 by American Foundation for AIDS Research, the rate of new AIDS cases by Intravenous Drug Use dropped by 73% when compared to 52% drop in overall AIDS cases in D.C. Furthermore, CDC calculated that each syringe costs only $0.97 and successful implementation of SEP to prevent HIV infection in a person/family costs $4,000 – 12, 000. But lifetime medical costs of someone who is HIV positive is $619,000. According to Dec 2005 CDC fact sheet, many research studies and positive results led the National Institutes of Health Consensus Panel on HIV Prevention, to conclude that: “An impressive body of evidence suggests powerful effects from needle exchange programs...Studies show reduction in risk behavior as high as 80%, with estimates of a 30% or greater reduction of HIV in IDUs.”
It goes on to talk about difficulties implementing these programs that may impact the effectiveness. The article is here http://targetpopulation.wordpress.com/2010/03/04/syringe-exchange-program-in-d-c/.
There is also quite a bit of primary literature available. A nice summary of 47 studies is following article. While it may be older, it provides a good overview. There is also more recent literature available that can be searched and read. Science should be relied upon when making policy decisions. Information about the effectiveness of syringe exchange programs has been available for more than two decades. This data should be acted upon.
Ksobiech K. A Meta-Analysis of Needle Sharing, Lending, and Borrowing Behaviors of Needle Exchange Program Attenders. AIDS Education and Prevention 2003;15(3):257-68.
Giving out free needles and supplying sanitary areas for the addicts to shoot-up. Have NOT lowered the numbers of the ADDICTS.
The ADDICTS are the problem...
The best health care in the world only lowers the amount of harm done. It doe not address the root problem...
Thailand has proven that 'strict drug laws' work and it lowers the numbers of ADDICTS and people becoming infected with HIV...
Hey, if it means the super rich can keep all their money I say do it. They deserve it after all they've done and are doing for us.