Opponents of needle exchange programs always make the same argument — especially now that the data overwhelmingly shows that they work. They claim that it “sends the wrong message” — today in Indiana, and even back in the 1980s, when clean needle programs saved my life in New York. But in fact, they’re wrong on both the science, and the symbolism.
From the outside, handing out clean needles does look like “enabling” drug use. It does appear to condone injection, saying “I don’t care if you kill yourself, so long as you don’t infect people with HIV.” It seems to say that drug use is OK.
But from the inside, the message is very different. To understand why, it’s important to recognize why people inject drugs and how the stigma of being identified as an addict can poison you.
In my case, I didn’t shoot drugs 40 times a day because I wanted extra pleasure; I did so because I was in emotional pain. As a child, I couldn’t connect with people and I only found lasting relief from this depression and anxiety in heroin.
This is even more true of people whose addiction takes them to the street, where trauma mixes with the mental illness that drives so much of addiction. At least two thirds of addicted people have had traumatic childhoods — and 50 percent have a pre-existing mental illness.
Consider a woman I interviewed recently, for a book I’m writing on learning and addiction. Raped by an uncle at three, she was later molested by a baby sitter for several years. Her mother often beat her severely. In her teens, she wound up homeless, addicted and sometimes prostituting herself to support her habit.
When you are in such a debased position, nearly every social interaction is humiliating. Customers look down on you — but so do service agencies and store owners. Most social contacts implicitly or explicitly require you to acknowledge your low status in some way, simply to get what you need — for example, by having to prove how poor you are when you seek benefits.
And many drug treatment programs are actually deliberately degrading. As an active addict, your humanity itself becomes contingent on your ability to imply that you want to be abstinent.
Needle exchange is different, however — particularly the illegal programs I first covered. When I went out in the street with Jon Parker, the ex-addict and Yale student who started the first one in America, he always rapidly attracted a crowd.
Most of these hardened, often homeless injectors couldn’t believe he was for real. And when they saw that this tall, ruggedly handsome blonde guy was actually risking arrest to try to help them save their own lives, they were touched. People whose faces bore the street mask of affectless despair lit up, if only momentarily — some even asked how they could help.
This was unlike their other interactions. Here, they were accepted exactly as they were. Here they were welcomed, not rejected. To addicts, then, the message of needle exchange is powerful. It says, “You are valuable and human, even if you do take drugs.” It says, “I know you want to do the right thing and I want to help you.”
When you come from a world where you are seen as the lowest of the low — where people literally cross the street to avoid you — such a message is stunning. And oddly, because it allows addicted people to feel accepted while still taking drugs, needle exchange often opens the door to considering recovery.
This happens in several ways. For one, altering your behavior by practicing safe injecting shows that change is possible. In my case, I was educated in safer injection practices before New York had needle exchanges, by an outreach worker who happened to be visiting from San Francisco in 1986. After I met her, I immediately changed how I shot up — but I didn’t stop using for another two years.
During that time, however, I began teaching others about safer practices like cleaning needles with bleach, and I think this was part of how I got on the road to recovery. It certainly helped protect me from joining the 50 percent of IV drug users who were HIV positive in New York at that time. (Needle exchange has brought this down to around 3% now, prompting New York state to label the programs, “the gold standard of HIV prevention.”)
Another way that needle exchange sends the right message is through the power of example. Many people who work at these programs are formerly addicted — and they offer living proof that recovery is real. I watched when I saw participants in exchange programs asking workers about their recovery and ultimately joining them in it, often volunteering at the exchange as well.
Finally, and most obviously, needle exchanges facilitate access to treatment, overcoming bureaucratic hurdles that can seem insurmountable to people with chaotic lives. Anything that makes treatment access easier, even in small ways, tends to help. For example, a recent study showed that starting addiction treatment with medication in the E.R. nearly doubled treatment uptake, compared to referring people elsewhere to get help later.
Of course, opponents fear that handing out needles might make IV drug use attractive to children. But anyone who has visited a needle exchange knows how ludicrous the claim is. These are indeed places of hope for those who need them, but they are not glamorous and nothing about them advertises addiction as a fun way of life. While people do recover, relapse is also common and often not a pleasant sight.
As odd as this sounds, however, needle exchanges are nonetheless some of the most spiritual places I’ve ever visited, because they provide radical, non-transactional acceptance, people feel safe. The message needle exchange really sends isn’t the wrong one — it’s a message of unconditional love.
Photograph by: Robert F. Bukaty/AP Photo