Federal ban on Needle funding needle exchange programs and its incidence of HIV infection. Baltimore incidence of new HIV cases dropped from 53 to 16 percent amongst IV drug users.
Original Publication Date: January 09, 2014
WASHINGTON — — Needle exchange advocates are urging lawmakers to use a coming must-pass budget bill to lift the decades-old prohibition on spending federal funds for clean syringes for drug users, supporters of the effort said Thursday.
The groups are pressing members of Congress, including Senate Appropriations Committee chairwoman Barbara A. Mikulski of Maryland, to ease a ban they say does little to curb drug abuse but stymies efforts to prevent HIV and hepatitis infections caused by needles.
Lawmakers approved the ban in 1988 as the crack epidemic was sweeping the country and the Reagan administration had expanded the nation's war on drugs. Congress has repeatedly extended the provision even as it has revisited other federal drug policies, such as mandatory minimum sentences for drug offenses.
"This is really a holdover policy from an earlier era," said Dr. Chris Beyrer, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health. "We see this as a window — perhaps a modest window — to lift the ban."
Beyrer is among more than 70 Maryland health care professionals who signed a letter to Mikulski recently asking her to push for the ban's repeal. Mikulski, a Democrat, supports doing away with the policy, but it appears unlikely that the GOP-led House will back that move.
"It prevents disease, saves lives and saves money," Mikulski said in a statement, noting that an earlier Senate version of the funding bill she oversaw removes the ban. "It's now up to the House to do the same."
Congress has historically addressed the issue in legislation used to fund government operations. Because of partisan gridlock in Washington, lawmakers have recently relied on stop-gap spending measures that have largely kept the status quo in place for years.
That changed last month when Republicans and Democrats negotiated a rare budget agreement that set spending for 2014 at a little over $1 trillion. Lawmakers have until Wednesday to fill in the details of how the money will be spent or risk another government shutdown.
Advocates stress they're not seeking additional money for exchanges. Instead, they want states to be able to choose to spend federal health funding they already receive on the syringe programs.
The Baltimore City Health Department exchanges roughly a half-million syringes each year, said Dr. Patrick Chaulk, an acting deputy commissioner at the city agency. About three-fourths of the program's roughly $800,000 budget comes from the city and the rest comes from the state.
An increase in funding would allow the city to upgrade the RVs it parks around the city to distribute the needles in neighborhoods and expand medical care that is often delivered to users simultaneously, Chaulk said.
Advocates say Baltimore's work on the issue is partly responsible for lowering the share of new HIV diagnoses attributable to injection drug use from about 53 percent a decade ago to 16 percent in 2010.
"For most of these people, it's literally the only point when they're going to have someone coaxing them into treatment," he said. "It's not 100 percent effective, but it's still the only opportunity."
Lifting the ban has received some support from Republicans — notably Rep. Ileana Ros-Lehtinen of Florida, who has co-sponsored legislation on the issue in the past — but the exchanges have generally met opposition from the GOP. The late Sen. Jesse Helms, a North Carolina Republican, was the champion of the original ban.
In 2009, when Democrats took control of Congress and the White House, the ban was briefly lifted. About two years later, when Republicans reclaimed the House, it was reinstated.
Calvina Fay, executive director of the Drug Free America Foundation, said that if needle exchanges operated with more oversight, they might be successful. But, she argued, there's little accountability in ensuring drug users seek addiction treatment along with the clean needles.
And she said there is not enough effort made to ensure people don't wind up sharing the clean syringes they receive once they're back home.
"We as taxpayers really shouldn't have to be subsidizing somebody's drug habit," Fay said. "I want the money spent on helping people get sober."
Michael Collins, a lobbyist for the New York-based Drug Policy Alliance, argues that without the federal funding the potential impact that a network of exchanges could have on a community has not been fully realized — particularly as state and local budgets have continued to be squeezed.
"We're seeing fewer and fewer syringe exchanges being funded," he said. "Lifting the federal ban would give the green light."
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