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The First Step Back 

Yes, needle exchanges can save lives. But they can do even more

Wednesday, Sep 6 2000
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The lore has been out there practically since first I learned to read: It’s the legend of the totally out-of-control, self-and-everyone-else-destructive junkie. First, I think, came Frankie Machine, counterhero of Nelson Algren‘s classic, 1949 The Man With the Golden Arm. Then there was William S. Burroughs’ then-pseudonymous paperback, Junky, in 1953, and Jack Gelber‘s beatnik-era, off-Broadway smash, The Connection, in 1959. And their many contemporaries.

All of them were fictions about heroin addiction, and all of them, to a greater or lesser extent, presented drug addiction as both a sophisticated response to postwar straight, consumer culture and a dire, parodistic affliction of that same commodity-driven society. The addict, the lore agreed, was typically a totally destructive individual, first toward himself (during this period, most junkies were imagined as male) and then toward everyone he trusted, everyone he touched -- wife, children, friends, parents. Most accounts held out only the barest hope of redemption, let alone of cure.

What was interesting to me at the time about the ’50s and ‘60s’ fictive image of the drug addict was, while it sought to show us a brutally accurate portrait of society‘s ultimate outsiders, how closely it hewed to the federal Bureau of Narcotics’ line on the nature of addiction. Even the artistry of an Algren served, in his most famous book, pretty much to color in the official dark outlines of addiction as presented in U.S. government propaganda, initiated by legendary 1930s supernarc Henry J. Anslinger. The stage was set for a perpetual media drama that one sly hipster called ”Fuzz Against Junk.“

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Over the past 10 or 20 years, though, we‘ve come to see addiction -- hard-drug needle addiction, that is -- through an even darker lens. Besides sexual contact, such drug abuse has become the key cause of the spread of AIDS. This spread is almost entirely caused by the exchange among addicts of used narcotics needles and syringes, passed around among addicts in the manner so often and melismatically alluded to by Burroughs and his compeers and successors, right up to and including Trainspotting.

So we all know the territory. Which is why, around 10 years ago, someone had this great idea: Why not give clean needles to addicts, so they would not spread the HIV virus, various hepatitis strains and other infectious diseases among themselves and others with whom they had sex? Six years ago, the idea finally made sense to a majority of the Los Angeles City Council, which overruled a mayoral veto to bring it into effect. And just last week, the Los Angeles County Board of Supervisors took the first step in doing the same thing. In so doing, I think, they behaved sensibly. But in a more subtle way, they also took a crucial step away from the 50-year Algren-Anslinger consensus that all drug addicts are hopeless, thieving, doomed degenerates: that they are completely unable to help themselves. And that change may be as important an effect of needle-exchange programs as the fact that they save lives.

In the light of the lore of other days, these points are still very hard to get across. The basic social revulsion against needle exchange -- and it is revulsion -- lies in the perception that it’s another term for handing addicts the tools of their own destruction. For making their addiction easier. And why should something as vile as drug addiction be abetted by local authorities?

These were among the reasons for which Dick Riordan vetoed the city‘s ordinance nearly six years ago. Better reasons prevailed, and the council overrode the veto. As Councilwoman Jackie Goldberg, who introduced the motion and fought the issue to successful conclusion, put it, ”If you’re squeamish about the idea, you should get over it. This saves lives.“

How many lives? According to Ferd Eggan, Los Angeles city‘s AIDS coordinator, ”only a rough estimate“ gives 4,000 fewer new HIV cases per year due to the exchange programs. Supervisor Zev Yaroslavsky said that his staff had determined that treating each AIDS patient costs the county $195,000, while the entire budget for one needle-exchange program is $169,000. If you assume that half of the 4,000 new HIV infectees end up in county public-health programs, there’s a savings of some $390 million in there someplace.

But to many who support the program, there is a far more important savings. This is the saving of lives. According to Yaroslavsky‘s figures, 75 percent of new HIV infections in women are ”linked to IV drug use.“ Even more tragically, ”75 percent of new HIV infections in children are due to drug use by a parent.“ The social profile of the typical needle drug user has changed since the days of Frankie Machine. And the wives and children don’t just suffer financially, like they used to, as the family junkie shot everything he could steal up his arm. Now they also get to suffer the onslaught of the incurable disease of AIDS.

In Seattle, New York, San Francisco and now, for six years, right here in Los Angeles, the needle-exchange concept has battled its way toward respectability. Last year, a state law -- AB 518 -- was finally passed that enabled cities and counties to set up the programs legally, without declaring a public-health emergency -- even though Los Angeles and San Francisco already had such programs in operation. According to county Public Health Director Jonathan Fielding, the county now has 90 days in which to bring forward such a plan for the board‘s final approval.

Not everyone on the board approves. Although I saw no one else come to testify against the program, 5th District board member Mike Antonovich pretty much toed the old line on dope fiends. There are two kinds of people, Antonovich appeared to be saying -- drug fiends and normal people. And the only proper expenditure of funds on narcotics prevention should be to keep people in the second category out of the first. ”We have to realize there is no such individual as a healthy junkie . . . Tax dollars are better spent to keep young people and adults off drugs and provide treatment for those who are on drugs.“

He continued, ”We don’t have good medical care if our doctors are addicts; we don‘t have good education if the teachers are addicted.“ The last seemed a bit of a non sequitur. Did Antonovich really think that the proposed program, rather than simply exchanging new needles to drug users for old ones, was planning to hand out syringes to medical and educational professionals to encourage experimentation? Who knows? At this point, members of the supervisor’s own staff seemed to be wincing. (Antonovich‘s conservative colleague, Don Knabe, also voted against the measure.)

In fact, as Dr. Fielding explained, the county’s needle program ”would include HIV prevention, testing, early intervention and treatment“ as well as provision of condoms and bleach to reduce the risk of infections. Fielding stressed that the exchange program is a crucial first step to get addicts back in touch with the health-care system that can both wean them from addiction and prevent disease. ”The benefits probably extend beyond AIDS prevention; there is evidence that you can solve other problems, and that HIV can be prevented for one-third the cost of treating someone with [AIDS].“

But to some people closely involved with such programs, the potential goes even beyond that. Needle exchange gives addicts themselves a chance to make a crucial, first-step decision to alter destructive behavior by giving them a chance to save their own lives. To begin, perhaps, an escape from the Golden Arm cycle.

Yaroslavsky credited health activist Mimi West with pushing the measure into law. West, a longtime local public-health advocate and member of the county‘s Narcotics and Dangerous Drugs Commission, said she first got interested in the needle-exchange program in 1992, when she met an exchange volunteer from New York who told her, ”Every time I hand out a clean needle, I feel like I’m saving a life.“

”There‘s no greater mitzvah than that,“ West exulted.

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