Harm minimisation advocates often claim that the distribution of clean syringes will help protect addicts from infectious diseases and protect the community at large. Thus they are often promoting things like heroin injecting rooms, needle-exchange programs, and the like. But are these strategies the proper way to proceed?
An article in today’s Herald Sun spoke of concern about yet another such plan to have “needle vending machines in city’s drug hot spots”. Most folks were not too thrilled with the prospect. “Needle vending machines in the city’s heroin hot spots will increase drug use and risk increasing the numbers of dangerous syringes discarded in the streets, residents and traders fear.
“The machines – which will allow addicts access to new syringes 24 hours a day – are planned for inner city suburbs like Richmond, Footscray, St Kilda and Braybrook. Richmond Asian Business Association spokesman Meca Ho said needle vending machines were not wanted by Victoria St traders and would only attract more addicts to the popular restaurant strip. ‘We are losing customers already because mums are afraid to take their kids here because of all the drug addicts and used syringes,’ he said. ‘It’s not a friendly environment to do your shopping’.”
An editorial in the same paper also warned against this: “Syringe vending machines on the streets of Melbourne are a shortsighted and misguided approach that defy law and order and make an existing public health risk worse. It comes as no surprise that the often confused councillors of Yarra City Council are partners in this flawed project. The vending machines are to be placed in heroin hot spots in Richmond, Abbotsford, Footscray, Sunshine and Braybrook.
“The gutters in these suburbs are already littered with syringes dumped by drug users and syringe vending machines will only add to the problem. Drug addicts are selfish. They care only about themselves. They will go to the nearest dark place to shoot up and throw away the syringe provided by the Yarra Drug and Health Forum.
“Blood-contaminated syringes are a public health issue. While the clean syringe program is designed to prevent the spread of diseases such as HIV and hepatitis C, the risk to anyone who might pick up these discarded needles would seem to have been overlooked.”
And all this is not new. Melbourne has previously discussed such plans. And they were roundly condemned back then, just as they should be now. Back then I discussed these proposals, and nothing has really changed. The arguments I used against them then are fully relevant for today.
Back in 2000 the City of Melbourne produced a Drug Action Plan which advocated that syringe vending machines be set up in Melbourne. One Councillor argued that this would ensure that “there’s after-hours access to clean needles”.
There are several problems with this strategy. First and foremost, whether using a clean needle or a dirty needle, every time an addict shoots up he or she is taking the risk of dying from a drug overdose. Thus, if we are concerned about the health and well-being of addicts, we should be doing all we can to free them from their addiction, not to perpetuate their bondage. Handing out clean needles is in fact a form of Russian Roulette. One day, one of the needles will be the addict’s last.
Second, when needle distribution programs are set up in a community, the “honeypot effect” sets in: drug users gravitate to these areas. But so do the drug dealers. As a result, as any policeman will attest to, crime rates go up, property values fall, and businesses close down or move out. Thus the whole community suffers.
For example, in one Melbourne suburb, police report that crime has noticeably increased after the establishment of a needle exchange centre. Indeed, most needle distribution centres are “no go” areas for police, because it is felt that if police are allowed to be in the area, drug users might be deterred from collecting their clean needles.
Third, communities become saturated with discarded needles. I prefer the term “needle distribution” to the standard term “needle exchange” to describe these programs for that is indeed what takes place. Needles are handed out by the truck-load full, while only a fraction are returned. The Melbourne City Council admits as much. Their Drug Action Plan cites a Melbourne study which found that the number of needles/syringes distributed in the Central Business District increased from around 3000 per month in 1997 to more than 12,000 per month by the end of 1998. And the number of needles/syringes collected within the city from July 1999 to June 2000 rose from 3,500 to 13,000. Many of these were found in parks and streets.
Consider some related figures. In 1998 there were 4.1 million syringes distributed by needle-exchange programs in Victoria. Yet less than half of them were returned. The situation has gotten so bad that one bayside council has had to use sand-raking machines every morning to clear its beaches.
One related problem with this deluge of needles is the marked increase in the use of syringes in assaults and robberies. Handing out free needles is increasing the supply of weapons our criminals are using against unprotected citizens. A recent study of crime in Victoria found that syringes are used as weapons in more than one in five of all robberies. This is a fivefold increase since 1996.
Fourth, there is no clear evidence that needle distribution slows the spread of HIV/AIDS or Hepatitis. While communities using needle exchanges report a drop in cases, the studies have been found to have numerous shortcomings, including the use of, and reliance upon, self-reporting for data collection, small sample sizes, and high drop-out rates, which makes follow-up impossible.
One expert, David Murray, director of research for the Statistical Assessment Service in Washington has reviewed the major needle exchange studies. He concludes with these words: “The stronger the studies have been methodologically, the weaker the conclusion has been that HIV is actually being reduced. That’s a real warning sign. The best and fairest that can be said is that the case that needle exchanges work has not been made”.
In fact, the evidence might point in the other direction – needle exchange programs may in fact increase the spread of HIV and Hepatitis. For example, while needle distribution in Victoria continues to climb steadily, so too have cases of HIV. Indeed, the number of HIV cases has jumped by 40 per cent in the year 2000.
A comparison of the rate of intravenous drug user deaths with the rate of the distribution of needles and syringes in Victoria shows a very close parallel. Dr Joseph Santamaria, who has worked in the field of drug and alcohol addiction for over thirty years, says that the “coincidence and timing are striking when the two are plotted one on top of the other. The degree of correlation is very high indeed and cannot be dismissed in cavalier fashion”. Moreover, a study of overseas needle exchange programs has found a similar rise in HIV/AIDS.
Of special concern is the rise in the number of cases of Hepatitis C. There seems to be a close correlation between the number of needles exchanged and the spread of Hepatitis C. In fact, with the introduction of needle distribution programs there has been an explosion in the rate of Hep C infections. In Frankfurt, for example, over 90 per cent of intravenous drug users involved in “safe injecting rooms” are Hep C positive.
Clearly then, the distribution (or selling, via vending machines) of syringes and needles is a bankrupt policy. And it is more than that – it is a policy of surrender. It is an abdication of our responsibility to help drug addicts in the most effective way that we can – by making them drug free. This counsel of despair needs to be rejected, and in its place we need to offer addicts hope – hope that they can be set free from the enslavement and degradation brought upon themselves by the drug menace.