Monday, March 1, 2010
Readers may recall that on February 13, I posted my thoughts on the Albany diocese’s plan to proceed with a needle exchange program. On February 19, I invited one of the interlocutors who commented on my post to provide me with “the peer review scientific literature that attests to his” views which were critical of my position. Although I did not hear back from this commenter, I independently did a search of “peer review scientific literature” on the topic of needle exchange programs. In particular, I consulted documentation available through the National Institute of Health. My study of these reports demonstrated that the authors largely concluded that, “methadone treatment is the modality most directly targeting the injection drug user”; therefore “it has the greatest capacity for reducing HIV risk behaviors.” Interestingly the same documentation of the NIH states that, “the efforts of community-based organizations offering AIDS prevention outreach and needle exchange have resulted in increased demand for treatment services, suggesting the need for drug abuse treatment programs to work collaboratively with these organizations on behalf of a common concern about the health and well-being of their clients.” The emphasis here is not on needle exchange programs per se but on treatment programs that may work in tandem with exchanges.
I hope that readers of my original post understood me to say that the health of drug users and others who may be associated with those addicted are the major concern. While there appears to be some correlation between treatment programs and needle exchange programs if the organizers of both collaborate with one another, nothing is said about the availability of data indicating what happens to the needles given in the exchange since supervision and treatment appear not to cover monitoring of the use of the needle once the new one is given to the addict who may also be under treatment. Giving clean needles does little to assist the health of drug users and their friends, sexual partners, and casual acquaintances.
If treatment is not the principal focus of a program, will programs that only provide clean needles really address the underlying and related problems of drug addiction? The NIH materials that I consulted suggest no. As some research indicated: “making available the implements of drug taking, needle exchange programs” was not considered as a way of “removing, societal sanctions against drug use. The response of those championing the harm reduction strategy was that rehabilitation, although a laudable goal, was impossible in the absence of a client’s survival.” While there is other data from these studies suggesting that those involved in needle exchanges may be more inclined to enter treatment programs, there is virtually no data about “sexual partners” or other persons who may be “recruited” into drug use by those addicts who do exchange needles. There is little if anything known about the effects of needle exchanges on third parties who know and come in contact with the addict who is receiving clean needles.
The peer review material repeatedly emphasizes the important correlation between exchange programs and treatment. But if that correlation does not exist or succeed, what happens then? The answer is obvious: the abuse of drugs continues perhaps with some decrease in risks to the needle exchanger but not for anyone else.
The point of my original post was this: must the Church, through her charitable works, be forced to engage in needle exchange program to combat drug abuse and related health issues? My position was and remains that the Church in her good and well-formed conscience must do what she can to treat those afflicted with drug dependency. There is no reason why a treatment program must also provide needle exchange opportunities. These points that I have made appear to be reflected in the NIH studies which indicated that “the primary barrier to linking needle exchange clients to treatment is the lack of available or effective treatment in many communities.” What prevents any organization, including Catholic Charities, from concentrating its resources on treatment? Apparently none; moreover, peer review scientific data indicate that treatment is the real objective, not providing means for continuing addiction which may reduce blood-borne disease infection of the addict.
Some of the peer review scientific data concede that with the often expected 30% drop out rates from treatment programs, it might be “better” to instruct addicts on “safer drug injection.” In other words, there is a concession that drug addiction rather than treatment and cure may be all that is possible. And if this peer review literature is correct, then what is Catholic Charities to do? In spite of the fact that my interlocutor suggests that needle exchanges do not encourage drug use, it seems from the peer review data suggest otherwise.
I have presented my position that Catholic Charities ought not be involved with needle exchanges or, for that matter, instruction on “safer drug injection.” My argument about what happens to the “new” needles once given but whose use is not supervised is not “irrelevant” as my interlocutor suggested: “Most importantly, the arguments about what people are doing with the needles and whether there is an assurance that they’re not being shared is utterly irrelevent. [sic] These programs are very well demonstrated to reduce the transmission of blood borne diseases. Whether some of the syringes from the program are shared does not matter because those injections would have been with a dirty needle anyways. The bottom line is the one that matters, and the bottom line shows that these programs save lives and are incredibly cost effective at doing so.”
It matters a great deal what becomes of the syringes once they leave the exchange site. The assertion that it does not matter if syringes from the program are shared “because those injections would have been with a dirty needle anyways” is problematic. My interlocutor concedes that there is a problem with dirty needles; well, my point is that the fact that a needle may be new and clean one day does not mean that it will remain so until returned to the exchange site. Indeed, he concedes my point and yet he dismisses it. A needle intended for one injection becomes a used needle that may be used again, and my interlocutor concludes that it is “a dirty needle anyways.” He further maintains that sexual partners and other third parties are protected by the exchange programs. But are they really? There is no data in the peer review materials to indicate that such a conclusion can be tendered and supported because there is no information about what happens to the “new” needle once it leaves the exchange site.
Let us hope and pray that any Catholic organization contemplating needle exchange projects reconsider this; moreover, let us encourage them to help those suffering drug addiction find treatment rather than sustenance of this destructive menace.