The War on Drug Users: Are Syringe Exchanges Immoral?

Despite the data, some still struggle with the the idea of helping drug users inject, arguing that these programs encourage addiction.

A syringe exchange program. Gustau Nacarino/Reuters

For nearly four decades, Elizabeth Owens injected heroin in shooting galleries across New York City, handing over a bag of dope for the privilege to enter, and then a dollar or two for a needle that had been used, perhaps dozens of times, by other people.

Then, in 2008, a friend told her about a van on 149th Street that was dispensing clean syringes in exchange for dirty ones. Owens went to check it out, and her life changed. "I found people with resources, people that were caring," she said. The staff at the program didn't just give her clean syringes; they also told her who to contact to get help. She entered a rehabilitation program, and hasn't used drugs in over two years.

Programs like these, called syringe exchanges, are internationally credited with dramatically reducing HIV and hepatitis infections among injection drug users. They've also been proven to link addicted people to care (PDF), save taxpayers millions of dollars in health care costs, and help keep syringes off the streets, protecting both cops and kids.

Cindy G., 52, spent decades sharing needles with others, sharpening dull ones on emery boards and taking them from diabetic friends.

But amid the ruckus of the most recent culture-war battles -- over Planned Parenthood dollars and contraception coverage -- Congress quietly passed an amendment that prohibits the use of federal money for syringe exchanges. For 21 years, the United States had banned the use of federal funds for these programs. AIDS activists spent two decades fighting that ban, and in 2009, President Obama overturned it. Yet in a matter of months a few social conservatives managed to reinstate it. How did this happen?

In short: Politics. Despite the data, some still struggle with the idea of helping drug users inject, arguing that these programs hurt society by encouraging addiction and promoting a no-work, dependent-on-the system lifestyle. Congressman Hal Rogers (R-KY) is chair of the House appropriations committee and played a key role in the decision to reinstate the ban. "Chairman Rogers ... is concerned that needle exchange programs only encourage drug addicts to remain addicted to drugs and perpetuate the cycle of drug crime," Jennifer Hing, a spokeswoman, explained.

But many advocates for syringe exchanges say that in allowing an outdated moral agenda to trump science, politicians like Rogers are launching a misguided attack on both drug users and taxpayers in general. Eight federally-funded research reports have concluded that these programs reduce HIV transmission without increasing the use of illicit drugs. In New York City, the rate of new HIV infections among drug users fell 80 percent after the city implemented syringe exchanges. And the cost savings from such programs have been enormous: A clean syringe costs about $0.97 (PDF), according to Human Rights Watch. The average lifetime cost for treating HIV, in contrast, is around $300,000.

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Julie Turkewitz is a New York-based journalist. She also writes for the New York Times.

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