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.

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But many advocates for syringe exchanges say that in allowing an outdated moral agenda to trump science, politicians like Rogers are launching a misguided attack on both drug users and taxpayers in general.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.

What's more, advocates reject the idea that syringe exchanges are immoral. The vast majority of syringe exchange programs are not just anonymous offices where drug users pick up equipment. These programs host support clubs, link people to housing and health care, and serve as meeting spaces for individuals to learn about their rights. For drug users accustomed to daily rejection by family, friends, and society, syringe exchanges are often the last outposts of acceptance, the only places where they can recover their dignity.

"This is where we learn to stop seeing ourselves as just a bunch of drug users," said Cindy G., 52, who spent decades sharing needles with others, sharpening dull ones on emery boards and taking them from diabetic friends. She now participates in the exchange program run by VOCAL-New York, where she helped start a woman's support group. "What's insane is that there are so many people that can't or won't be able to use them."

Indeed, many current and former drug users say that the saddest element of the funding ban is the lost opportunity for people to create new, productive lives. Take Owens: She was once "just a body walking around," sleeping in Washington Square Park, shooting up in apartments that reeked of dried blood and burning metal, watching one friend after another die of AIDS and overdose. Now, she's a peer educator with a New York City-based non-profit, and for a $100 weekly stipend she traverses the city, convincing drug users to seek help.

"I found a job that I can do that I know is helping the community," she said. "Imagine how many people who are out there that want to change, but don't know where to start."

Human Rights Watch estimates that just three percent of the estimated one billion illicit drug injections that take place each year are covered by syringe programs. Thanks to spending cuts, nearly all of the nation's approximately 220 syringe exchanges are crying for money; and the federal funding ban will only exacerbate the situation. The ban will hit hardest in the Southeast, where there are the "least number of programs and the greatest need for them," according to Dr. Don Des Jarlais, a leading researcher on drug-user issues.

Internationally, nearly all high-income countries support exchanges on a national scale. Even conservative politicians in other nations (think Margaret Thatcher in Britain) have thrown their weight behind them. Now, the challenge for syringe exchange advocates in the U.S. will be convincing the last holdouts -- like Rogers -- that supporting these programs doesn't just make sound economic sense -- but is the ethical move to make.

"It simply doesn't make sense to turn our backs on approaches that are working so well," said Chris Collins, vice president and director of public policy at amfAR, a research organization dedicated to ending AIDS. "If the moral agenda is advancing public health, taking needles off the street, protecting police officers, and helping people get the care they need, then syringe exchange programs make sense."