Answers to common questions about needle exchange 


1.  It’s dangerous.  It’s illegal.  It’s disgusting.  Why don’t they just stop injecting drugs?

For many decades now, and in the face of increasingly severe penalties, thousands of people continue to inject drugs.  So, the realistic question becomes: how are we going to reduce the harm that comes to people who inject drugs?

2.  Tough love works.  Why doesn’t it work here?

Learning from experience is as important for those who inject drugs as it is for the rest of us.  People who inject drugs may have experiences in many areas of their lives that can teach them that drug use is unwise.  There are the negative health consequences from putting illicit drugs into their bodies; the loss of their jobs, if they cannot perform their duties; the loss of friends, if the friends no longer want to be around them and their habit; and the loss of family, when family members find they cannot tolerate the behavior of the user.  These are serious consequences from which a person can learn and recover.

Infection with HIV is a different issue entirely.  Once someone is HIV positive, that person can give up injecting drugs, but the deadly virus is still there.   

One could say: they knew they were taking a risk; now they must suffer the consequences.  But that is not the approach our society usually takes toward those engaged in life-threatening activities.  For example, we have lifeguards at the shore to save the lives of those who swim out too far.  We send rescuers for skiers and climbers who have foolishly gone to dangerous areas and injured themselves.  As a society, we try hard to prevent serious injury and death even to people who are very reckless.

3.  Drug use is illegal.  Why should we protect people who do something illegal?

It is a question of having the punishment fit the crime.  Under state laws, we punish drug possession by probation, by commitment to treatment, and by prison sentences from a few months to several years.  Not one of our 50 states executes people for the crime of drug possession. Yet, when we deny persons who inject drugs access to clean needles, it is quite possible that we are sentencing them to death by AIDS.

4.  Drug use is like slavery.  By letting people have access to clean needles, aren’t we helping them continue to be slaves to drugs?

We want people to stop injecting drugs; we do not want them to die.  Consider the difference that access to sterile needles makes. Uninfected people who stop using drugs have their whole lives before them.  HIV-infected people who stop using drugs almost surely face serious, painful illnesses and premature death. 

5.  Is the spread of injection-related HIV part of a secret conspiracy?

The spread of injection-related HIV is caused by publicly supported and defended policies.  The following are causing the spread of injection-related HIV:

  • Policies that make illegal the possession of sterile needles

  • Policies that prevent pharmacies from selling syringes without prescriptions

  • Policies that prevent the establishment of needle exchange programs

  • Failure to make drug treatment available to all who desire it.

6.  Is the denial of access to clean needles, the denial of access to medical care?

When a person is suffering from an overdose, we rush that person to a hospital and provide the best medical care we can.  We do not say to the drug user's family and friends:  “Sorry, we cannot give your family member life-saving medical care because that would send the wrong message.”  

In our society, medical interventions go way beyond prescriptions and surgery.  In the name of public health were remove lead paint and asbestos.  We purify the water supply.  We limit the discharge of pollutants into the air.  Giving people access to sterile needles is a medical intervention necessary to avoid serious illness and perhaps death.

7.  People who work in clean-needle programs sometimes risk being arrested and imprisoned for their efforts.  Why do they do it?

The needle exchange worker’s answer is a simple one: needle exchange saves lives.  Some needle exchange workers are HIV positive themselves; others have a friend or family member who has HIV or has already died of AIDS.  But whatever their personal connections, all needle exchange workers hold to the simple conviction that the high value our society places on human life must extend to the lives of persons who inject illegal drugs.

8. Do needle exchange programs "send a message" that drug use is OK?

The question is, is this an empirical statement that can be proved or disproved, or is it a statement of belief which no amount of scientific evidence can refute?

The scientific evidence is clear.  It has been evaluated by the most distinguished research bodies in the United States and our leading medical associations, including the American Medical Association.  They have all concluded that needle exchange programs are effective in slowing the spread of HIV and do not increase drug use.(1)

So we are left with a question – can needle exchange programs be said to send a message that drug use is OK, when there is no scientific evidence that anyone hears that message?  

Footnote

(1) For information on scientific research concerning the effectiveness of needle exchange programs, click here.

For a list of other materials used on this website, see References.