Harold Pollack is a public health policy
researcher at the University of Chicago's School of Social Service
Administration, where he is faculty chair of the Center for Health
Administration Studies. He is a regular contributor to The Treatment.
Last week, I chided the Obama Administration for its tepid
approach to HIV prevention policy. No doubt responding to my broadside,
incoming Drug Czar Gil Kerlikowske granted his first official interview
to the Wall Street Journal. The piece
was a disorienting read. For the first time in years, we have a Drug Czar making
sensible and informed points rather than invoking the tired tropes of past culture
Mark Kleiman has already put up a nice posting. In addition
to his web journalism, Mark is one of the nation's leading drug policy experts.
His book Against Excess remains an
essential reference. So he ought to know. The title of his latest column, "The
drug war is over," says it all.
Kerlikowske was specifically asked about needle exchanges.
Here is what he said:
I think needle exchange programs are part of a complete public-health model
for dealing with addiction. Some people get the impression folks just walk in
and exchange needles or get clean needles and you do want to reduce HIV and
Hepatitis C and other transmittable diseases but you also would like to see,
which those in Buffalo and Seattle do, access to treatment, access to
Not an elaborate
policy treatise, but he got the high points quite right. Two things I
especially liked about this statement:
First, Kerlikowske noted that Americans have an
oversimplified idea of what needle exchanges are, and what they try to do. Yes,
exchanges provide sterile syringes (and collect used ones) to injection drug
users (IDUs) to prevent HIV infection. Yet they do other things, too. Needle
exchanges provide a way to engage street users. Once these human relationships
are created, you can address other serious problems in users' lives, help link
people into methadone treatment and into other needed services.
are--or should be--part of a continuum of care. If the ban on federal funding
were lifted, these programs could operate much more effectively. We could also
do much better health services research to explore new strategies to improve
these services, not only to make them more effective in reducing HIV, but also
in achieving other goals such as reducing drug use and criminal offending among
the men and women who use these services.
noted the incredibly serious challenge of hepatitis C (HCV). This damn disease
is rampant in pretty much every population of street IDUs. Around the world--even
in places that achieve very low HIV prevalence and do everything right from
treatment-on-demand to widespread needle exchange services-users generally
become infected if they inject for more than a few years.
We seem unable to reliably protect street users against HCV.
We also struggle to address another serious challenge: Fatal overdose. HIV
provides one reason not to become an injection drug user. There are lots of
other good reasons, too.
In addressing such daunting problems, an appropriate seriousness
and humanity is beginning to intrude. This new mood didn't start with the Obama
administration. Many Democrats and Republicans have been backing away from the
drug war for awhile now. The comments of our new Drug Czar suggest that it's