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Wednesday, November 26, 2008

On Needles

I had a talk with one of my patients who is a former heroin user. I asked what he thought of syringe exchange programs. He said he has utilized them in the past to protect himself and others. I was really happy to hear that.

I am completely in favor of safe needle disposal and syringe exchange programs. I have never in my life met a drug user who stopped because she couldn't find clean needles, nor have I met someone who started abusing IV drugs because a needle exchange program made it easier.

I have however met many very sick people who have contracted illness and even died as a result of sharing contaminated needles. I have also known people who have gotten stuck with a needle improperly disposed of. Although the highest risk occupation for this is clearly medical workers it could happen to a garbage collector, or a janitor in any public area like a T stop or a McDonald's. Or even you or me if we didn't look or think and pushed down the paper towels in a public restroom down, or if we didn't watch our step in a park or on the beach.

Most programs involve participants filling out a registration form. This helps clinicians who work within the program to track their clients. This helps the Department of Public Health to get information about the incidences of drug use, disease and co-morbidities in a population that would otherwise never step into a doctor's office. These programs, where they are instated, also give clients access to things like treatment programs, counseling, and confidential HIV and Hepatitis testing. All of which they do not have otherwise. Why? Because none of these people became drug users because they are well adjusted people who easily form good working relationships. They are paranoid and mentally ill in many cases, and engaged in illegal activity in EVERY case which makes them hard pressed to even go to the ER when they are hit by cars never mind call up and make yearly appointments with the doctors you or I go see.

This is all a part of a philosophy we call "Harm Reduction." Because yes, yes that lady is using heroin, but now she is using heroin and has a doctor she trusts and he got her onto birth control pills so she doesn't have a heroin baby. And yes, that guy is on heroin, but now he is also seeking a treatment program. We save people from contracting the AIDS virus and from passing it on. We offer other options.

Until we can stop treating people with mental illness and addiction as if they are sub human we will never solve the problems which plague our entire planet, our entire humanity. It is not going to condone any drug use any more than the existence of narcan condones it.

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