Why needle exchanges matter

The United States has a relationship with addiction and treatment that is simultaneously frustrating, narrow-minded, self-defeating, and regressive. Unlike almost every other nation in the West, we lack a comprehensive approach to handling addiction with respect and compassion, and it, along with the failing war on drugs, costs the nation millions a year. The United States destroys lives and communities because it’s so invested in demonising substance dependence, making drug addiction a moral failing instead of a complicated medical condition.

Drug addiction is usually the result of multiple confounding factors that stack on each other. Evidence strongly suggests that a genetic component is involved, with some people having a predisposition to developing drug dependency, but that’s not all. Some people take drugs as a form of self-medication to cope with mental illness or stressors like poverty and social isolation. Others, yes, take them recreationally, as is their right as human beings to make choices about their own lives and bodies, and some of those people develop a dependence on the substances they might have once used purely occasionally for recreation.

People who develop drug dependencies aren’t bad people. They aren’t moral failures who should be punished. They are just human beings with complicated mental health conditions that need to be addressed. The most functional way to help them is to actually help them, with programmes focused on helping them detox, develop skillsets to help them stop using, and to create opportunities that can get them out of swirling events that bring them back to drug use. For instance, mentally ill people using drugs as a coping mechanism can’t just go to rehab and be fine — they need long-term mental health care and may need supports like help getting into housing, finding jobs, and more until they can actually support themselves.

For those who opt to seek treatment, options are limited. Rehabilitation programmes are often extremely expensive and they can be demanding. People who need public assistance face severe restrictions when it comes to rehab. In communities where rehab through public services is available, it often comes with draconian rules and people will be kicked out for violating them, even if they’re minor — miss an appointment, show up late, or fail to perform to other standards, and you’ll be out. These ‘tough love’ rules demonstrably don’t work, yet they’re popular, and in some cases, funding remains contingent on them.

There are a lot of problems with drug policy in the United States, but one issue with the ‘drug war’ is the lack of access to clean needles, and, relatedly, the lack of safe disposal sites for used needles. The United States has adopted the tactic that the best way to fight the drug war is to limit access to drugs and equipment, even though this tactic also demonstrably doesn’t work; when access to forbidden things is limited, people just put themselves more at risk to access those things. When access is safe and readily available, people can make more informed health choices — and along the way, they may be more open to discussions about how to find help with substance dependence if that’s something they’re interested in.

Many needle exchanges are run by charitable organisations, as few cities sink resources into them, and when they do, it’s often on a short-term basis. Despite the fact that needle exchanges have a proved public health track record, cities are highly resistant to the idea — why provide tools for self destruction? These kinds of attitudes resist the basic principle of harm reduction, which notes that people are going to engage in given behaviours either way, so you might as well make them safe. It’s why we provide teens with condoms, and it’s why we should provide clean needles to injection drug users, no matter how much that upsets moralists.

People should be able to access clean needles in a clean, respectful, and comfortable environment where they aren’t marginalised and treated like garbage. They should also be provided with mechanisms for disposing of needles, including on-site sharps containers, collection containers at locations frequented by drug users, and sharps containers distributed for personal use; many companies make portable containers that are ideally suited to this kind of distribution, encouraging people to safely handle used needles until they can be brought back to an exchange for proper disposal.

Used needles pose a huge public health risk. People who can’t access safe disposal facilities are forced to trash them or just toss them — some might argue that these are the functions of a community that doesn’t care about public health or society at large, but this isn’t the case. When a community is marginalised, pushed to the fringe, and told that it lives under the constant threat of harassment and arrest, the members of that community have to be highly mobile, and they also don’t want to be caught with drug paraphernalia on their bodies. I’d rather have people carrying clean needles and injection equipment to prevent infections and the spread of blood-borne disease, personally, and I’d like those people to be able to ask for resources at offices maintained to help them dispose of medical waste.

Rather than trashing entire communities of people, treating them as problems to be solved rather than human beings, perhaps the better public health approach would be a commitment to harm reduction. A growing body of scientific evidence — and a number of agencies — seems to support this, but politics lags behind, because of the attitude that drug use is morally reprehensible and gross.

I don’t care what someone chooses to take or not take. I care that people can do it safely, because that’s what matters.

Photo: sriram bala, Flickr