publications

<<previous  | index  |  next>>

VIII. ARGUMENTS AGAINST STERILE SYRINGE PROGRAMS

Arguments by U.S. government officials

In spite of overwhelming scientific evidence to the contrary, many police officers and public officials in the United States, including some interviewed by Human Rights Watch, maintain that syringe access programs are not an effective or appropriate method of HIV prevention. These officials frequently cite concerns either about the impact of syringe access programs on public order, or about the symbolic message sent by allowing injection drug users unimpeded access to syringes. All of these arguments rely on erroneous factual premises or moral prejudices against injection drug users. None justifies putting injection drug users at risk of premature and preventable death as a result of the reuse and sharing of syringes.

Concerns related to public order

Some opponents of syringe deregulation cite concerns regarding drug-related crime and public order. The first of these concerns, cited most notably by Governor Gray Davis in his veto of SB 1785, is that deregulation of sterile syringes will increase the number of improperly discarded syringes in public places. In fact, the available evidence suggests the opposite. Studies in Portland, Oregon in 1993 and Baltimore, Maryland in 1997 found similar or decreased numbers of improperly discarded syringes with increased access to sterile syringes.210 A two-year follow-up study in Baltimore found that the mean number of needles per 100 “trash items” per block had decreased from 2.42 before the syringe exchange program opened to 1.30 two years later.211 Accounts from Human Rights Watch’s witnesses suggest that criminal penalties for syringe possession increase the likelihood of improper syringe disposal because they discourage drug users from carrying syringes to a safe disposal location.212 Syringe exchange and pharmacy sale programs, when combined with the decriminalization of syringe possession, provide drug users with a safe and nonpunitive method of syringe disposal.213

A second issue related to public order is that syringe access initiatives will increase crime by encouraging drug users to congregate in neighborhoods where syringes are distributed and exchanged. This argument has been studied at least three times (once in a review of sixteen syringe exchange programs and the other times in Baltimore and New York), and no relationship between syringe access and increased crime, drug-related or otherwise, has been found.214 In the Baltimore study, arrest data from before and after the opening of a syringe exchange program were compared and analyzed according to proximity to the program. The data found no change in crime levels within a half-mile radius of the syringe exchange program compared to other areas of the city. In fact, break-ins and burglaries, which are considered to be economically motivated crimes related to drug use, fell by 11 percent in syringe exchange areas but increased by 8 percent in non-syringe exchange areas.215

Police officials in California nevertheless told Human Rights Watch that drug paraphernalia laws provided an important tool of narcotics enforcement and street policing. Finding individuals with sterile syringes, they said, might allow officers to establish probable cause to search for possession of narcotics, or to “get them off the street” by citing them with a misdemeanor.216 If a neighborhood started experiencing a rash of burglaries, the police might attempt to restore a sense of order through lower tolerance for minor infractions; as Lt. Ben Fairow put it, police sergeants might “do a low tolerance of what they call quality-of-life crimes. They’ll start citing people for needles and stuff like that.”217 Testimony from Human Rights Watch’s witnesses also suggested that police were using syringe possession to clear the streets of homeless people, a policy that would be unconstitutional were it not for the existence of drug paraphernalia laws.218 Lt. Fairow admitted that these were at best temporary solutions. “It is essentially a stopgap measure,” he said. “Arresting somebody for having a crack pipe does not solve their problem or our problem, because they get back out . . . . But you know there is no long-term solution so far, no coordinated long-term solution.”

The problem with using syringe regulations as a tool of quality of life policing is that, in many cities, such a policy conflicts with an established public health policy favoring the implementation of syringe exchange. Even where syringe exchange has not been legalized, the fact that drug paraphernalia laws are being used to achieve otherwise unconstitutional ends—that is, the arrest of persons based on their status of being homeless—erodes any justification in their support. In all cases, the marginal value of this additional tool of street policing must be weighed against the potentially life-threatening consequences of penalizing people for carrying sterile syringes. “We have a vehicle code that’s literally that [about two inches] thick,” Lt. Fairow told Human Rights Watch, referring to the countless infractions police may enforce to improve a neighborhood’s quality of life. “We use all kinds of other things—jaywalking, speeding, unlicensed vehicle, every tool at our disposal—to try and have a positive impact out there.” Making the possession of sterile syringes a misdemeanor, in addition to the hundreds of other misdemeanors police officers have at their disposal, therefore adds little to public safety and interferes with life-saving public health practice.

Concerns related to the symbolism of syringe access

Dave Cox, Republican Party leader in the California State Assembly (the lower house of the state legislature), expressed a widely held view when he wrote to Governor Davis in September 2002 that “[p]ermitting a pharmacist to sell a needle or syringe to any person eighteen years of age or older without a prescription would send the wrong message about illegal drug use. We should not give up on the need for treatment for drug addicts.”219 Cox’s sentiments echoed those of the former U.S. Office of National Drug Control Policy director, Barry McCaffrey, whose views on syringe access influenced President Clinton’s decision not to allow federal money to be used for syringe exchange services. “We have a responsibility to protect our children from ever falling victim to the false allure of drugs,” McCaffrey said in 1998. “We do this, first and foremost, by making sure that we send them one clear, straightforward message about drugs: they are wrong and they can kill you.”220 Other opponents of syringe access programs have characterized the programs as “part of the intolerable message to our nation’s children . . . that illegal drug use is an acceptable way of life,” and as “an endorsement by the government of the insidious and false notion that injectable drug use can be done ‘safely’.”221

The argument that syringe access programs “send the wrong message about illegal drug use” is difficult to comprehend given that numerous studies have shown that syringe access programs do not result in increased drug use and in fact provide users with referrals into treatment for drug addiction. The limited evidence on the symbolic impact of syringe exchange programs suggests that these programs deter, rather than promote drug use. A 1999survey of high school students in Baltimore, Maryland found that the majority of students did not perceive that seeing drug users utilize syringe exchange promoted illegal drug use. Almost half of the survey respondents perceived seeing drug users utilize syringe exchange as deterring illegal drug use, leading the authors of the study to conclude that “the effect of [syringe exchange programs] on adolescent’s attitudes appears to be more similar to factors related to drug prevention rather than drug promotion.”222

Moreover, there are ample ways to discourage illegal drug use without consigning drug users to a preventable death from the reuse and sharing of syringes. Evidence-based educational programs, as well as some mass media campaigns, can be effective (and nonfatal) methods of deterring illegal drug use. Supplementing these programs with restrictions on sterile syringes is tantamount to discouraging prostitution by regulating condom use, or sending an antismoking message by banning low-nicotine cigarettes. Each of these devices, like sterile syringes, helps people to mitigate the health risks of actions that governments have a policy of deterring. Restricting their use does not effectively deter the underlying act, but simply renders the act more dangerous and potentially lethal.

In some cases, objections to syringe programs stem more from stereotypical attitudes toward injection drug users than from legitimate fears about increasing drug use. Art Croney, executive director of the Committee on Moral Concerns, expressed this attitude in a letter urging Governor Davis to veto SB 1785.

The idea [of SB 1785] is to slow the spread of AIDS. It doesn’t work. Drug addicts are not clear-thinking, responsible citizens. They don’t brush their teeth and gargle twice a day. They don’t wash their hands before every meal. And they don’t mind sharing needles with their friends, even if clean needles are available.223

A different story emerges from the testimony of drug users who told Human Rights Watch of the daily risks they take to protect their health and well-being. Individuals who risk a jail sentence to use a sterile syringe, as dozens of injectors testified to doing, are clearly trying to act responsibly. To the extent that restrictions on syringe access are predicated on stereotypes about the respectability and moral responsibility of drug users, they are discriminatory and unsustainable.

United Nations anti-drug conventions

Multilateral agreements on the control of illicit drug use also fail to recognize the importance of syringe access programs in preventing the spread of infectious disease. These agreements generally contain weak language on the treatment and prevention of drug use while obliging states to adopt strict law enforcement measures. The three U.N. conventions related to drug policy arethe Single Convention on Narcotic Drugs of 1961 and its additional protocol of 1972; the Convention on Psychotropic Substances of 1971; and the Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances of 1988.224 Between them, the three conventions define both “dangerous” narcotic drugs and “drugs of abuse” and urge states parties to “adopt such measures as may be necessary to establish as criminal offences under its domestic law, when committed intentionally,”225 the possession of illicit drugs. The conventions also oblige states parties to establish rehabilitation and social integration services for drug users, and to take appropriate measures to reduce demand for illicit drugs.

The three international drug conventions contain no language on harm reduction or disease prevention. As the International Harm Reduction Development (IHRD) program of the Open Society Institute has noted, these agreements “were developed decades before HIV/AIDS was identified, and do not appropriately address the realities of today’s growing pandemic.” As a result, IHRD notes, the conventions “directly undermine HIV prevention efforts by discouraging countries from implementing effective, realistic and compassionate public health measures.”226



210 See P. Lurie and A.L. Reingold, eds. The public health impact of needle exchange programs..., p. 388, and M.C. Doherty, R.S. Garfein, D. Vlahov, et al., “Discarded needles do not increase soon after the opening of a needle exchange program,” American Journal of Epidemiology, vol. 145, no. 8(1997), pp. 730-737, cited in J. Ruiz-Sierra, “Research Brief: Syringe Access.”

211 See M.C. Doherty, B. Junge, P. Rathouz, R.S. Garfein, E. Riley, and D. Vlahov, “The Effect of a Needle Exchange Program on Numbers of Discarded Needles: A 2-Year Follow-Up,” American Journal of Public Health, vol. 90 (2000), p. 936, cited in Burris et al., “Syringe Access Law...”, p. 60.

212 See “Interference with safe syringe disposal,” above. See also, Scott Burris, Joseph Welsh, Mitzi Ng, Mei Li, and Alyssa Ditzler, “State Syringe and Drug Possession Laws Potentially Influencing Safe Syringe Disposal by Injection Drug Users,” Journal of the American Pharmaceutical Association, vol. 42, no. 6, Suppl. 2 (2002), pp. S94-S98.

213 See S. Burris et al., “Syringe Access Law...”, pp. 60-61.

214 Ibid., pp. 59-60.

215 Steffanie A. Strathdee, “No evidence that needle exchange increases crime or encourages drug use among youth,” press briefing, March 29, 1999.

216 Human Rights Watch interview with Capt. Ron Roth, San Francisco, California, January 28, 2003; Human Rights Watch interview with Lt. Ben Fairow, Oakland, California, January 28, 2003.

217 Human Rights Watch interview with Lt. Ben Fairow, Oakland, California, January 28, 2003.

218 In Papachristou v. City of Jacksonville, 92 S. Ct. 839, the U.S. Supreme Court declared a statute criminalizing “vagrancy” as void for vagueness. A California anti-camping ordinance that had the effect of punishing homeless people based on their status was struck down in Tobe v. City of Santa Ana, 27 Cal. Rptr. 2d 386 (Cal. Ct. App. 1994).

219 Letter from Dave Cox, Assembly Republican Leader, to Gov. Gray Davis, September 11, 2002.

220 “Drug Czar Statement on Administration Decision to Continue Ban on Use of Federal Funds for Needle Exchange Programs,” Office of National Drug Control Policy press release, Washington, D.C., April 20, 1998. McCaffrey’s statements, in turn, echoed those of Robert Martinez, director of the ONDCP under President George H.W. Bush. “Distributing needles undercuts the credibility of society’s message that drug use is illegal and morally wrong,” Martinez said in 1994. He added that HIV/AIDS “should not undermine our determination to win the war on drugs.” In an early controversy over syringe exchange in Boston, Catholic Archbishop Bernard F. Law was quoted in The New York Times as saying: “The answer to drugs must be an unequivocal no. It is difficult to say that convincingly while passing out clean needles.” See “Can Clean Needles Slow the AIDS Epidemic?,” Consumer Reports, vol. 59 (1994), p. 466; Allan R. Gold, “Bostonians Split on Mayor’s Idea of Needle Swap,” The New York Times, March 24, 1988.

221 See Sean Scully, “House bans funds for free needles,” Washington Times, April 30, 1998, quoting Rep. Gerald Solomon (New York); Peter Verniero, “Preserving New Jersey’s Drug Possession and Paraphernalia laws: A Law Enforcement Response to the Legislative Proposals to Decriminalize the Possession of Hypodermic Syringes Intended for use to Inject Illicit Drugs” (Trenton, N.J.: Department of Law and Safety, 1998), p. 2, cited in Robert L. Maginnis, “1999 Update: Needle Giveaway Debate,” Family Research Council, [online] http://www.frc.org/insight/is99b2dr.html (retrieved June 8, 2000).

222 Steffanie A. Strathdee, “No evidence that needle exchange increases...”.

223 Letter from Art Croney, Executive Director/Lobbyist of the Committee on Moral Concerns, to Governor Gray Davis, September 4, 2002.

224 Single Convention on Narcotic Drugs, 1961, as amended by the 1972 protocol amending the Single Convention on Narcotic Drugs (entered into force December 13, 1964, protocol entered into force August 8, 1975); Convention on Psychotropic Substances of 1971 (entered into force August 16, 1976); United Nations Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances of 1988 (entered into force November 11, 1990).

225 Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances, E/CONF.82/15, (December 20, 1988), art. 3.

226 “UN Drug Control Efforts Contribute to HIV Explosion: Russia and Ukraine see 1800% increase in infections through injection drug use,” International Harm Reduction Development press release, April 14, 2003. See also, International Harm Reduction Development, “Unintended Consequences: Drug Policies Fuel the HIV Epidemic in Russia and Ukraine” (2003), pp. 5-6.


<<previous  |  index  |  next>>

September 2003