Syringe-exchange programs can reduce the spread of HIV, AIDS and hepatitis among IV-drug users without increasing illegal drug use, many studies conclude, but a 21-year ban on federal funding has limited those programs from expanding nationwide.
States, cities, counties or private groups have had to find money to run them on their own because the federal Centers for Disease Control and Prevention can't. That created a patchwork network of programs that gives clean needles in exchange for used ones that may contain infected blood.
The number of syringe-exchange efforts could increase now that Congress and President Obama approved legislation in mid-December to end the ban, a move that would allow some CDC money to be spent on those programs.
"Science has shown these programs reduce HIV transmission and do not increase use of illegal drugs," said Nikki Kay, a CDC spokeswoman.
A syringe-exchange program, she and others said, gives health programs access to people who use IV drugs. They can link drug users to substance abuse treatment, education, behavioral intervention programs, HIV testing and, as needed, HIV treatment.
For Polk County to get a program up and running, however, it will require more than federal help. State legislators would need to allow a public health exemption to laws that target possession of drug paraphernalia.
"Chapter 893 of Florida statutes makes it unlawful to conduct a syringe exchange program," said Susan Smith, press secretary for the Florida Department of Health. "We implement policies set forth by the Legislature."
The law makes it a third-degree felony "to deliver, possess with intent to deliver, or manufacture with intent to deliver drug paraphernalia, knowing, or under circumstances where one reasonably should know" that it would be used to inject, ingest or inhale an illegal substance.
It remains to be seen whether the possibility of federal funds for fiscal year 2010 will spur Florida health officials to push for changing the law.
"You'd have to have that willingness," said Allan Clear, executive director of Harm Reduction Coalition in New York City. "One of the problems with Florida is it's not had that willingness. It's politically conservative."
The coalition advances policies and programs to address the adverse effects of drug use including overdose, HIV, hepatitis C, addiction and prison.
The Florida Department of Health is studying whether to recommend a change in the law. That would need to be in collaboration with the state's drug director, who takes the major role in drug policy, said Tom Liberti, chief of the department's Bureau of HIV/AIDS.
Bob Rihn, executive director of Tri-County Human Services in Lakeland, said he would support having an exemption for syringe-exchange programs if appropriate guidelines were in place.
"Anything that will reduce the rate of HIV, and that's one of the activities that can do that, should be considered," he said. "It can work as long as it's effectively planned out and strategically instituted."
Flashlight of Hope in Miami, the only syringe exchange in Florida listed with North American Syringe Exchange Network, is a semi-undercover operation. The Health Department can give the program director, George Gibson, condoms and brochures to distribute along with the clean syringes. It's up to him to get the combination to people who are using IV drugs.
"I'm pretty much a one-man show," Gibson said. "I pay for the other stuff on my own."
Law enforcement officers don't bother him about doing syringe exchange, he said. "When they see I have the condoms and brochures to hand out along with the syringes, they see I'm doing education."
The syringe-exchange network knows of 211 programs running syringe exchanges nationwide. As many as half operate outside the law.
The number of programs, while increasing, is nowhere near enough, said Dave Purchase, chairman of the exchange network based in Tacoma, Wash.
"When are we going to listen to the facts and act on them?" he said. "People's lives are at stake."
Preventing syringe-exchange programs also increases the cost of HIV treatment, Purchase said.
The cost of treating HIV infection for a lifetime averages at least $300,000 per person, he said. Money saved by preventing infections could go to drug treatment and prevention.
"You need people in the health departments to stand up and say, 'It's the right thing to do,' " Clear said. "It's such a proven method."
Former Florida Gov. Bob Martinez, in charge of federal drug policies in the early 1990s, opposed syringe-exchange programs.
In 1992, he said distributing needles "undercuts the credibility of society's message that drug use is illegal and morally wrong."
But he did call for further study of the controversial issue.
University of California researchers produced a 700-page report in 1993 that found no evidence needle-exchange programs increased the amount of drugs IV drug users took. They said "multiple lines of evidence" said it was likely the programs lowered the rate of new HIV infection.
They also recommended the federal government repeal the ban on funding needle exchange programs and states repeal paraphernalia laws as they applied to syringes.
Florida's paraphernalia law discourages IV drug users from making an effort to safely dispose of their used syringes, according to a state-by-state analysis of laws relating to syringes on Temple University's law school Web site.
Robin Williams Adams
January 17, 2010
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Proven Effective, Needle Exchange Banned in Florida