Heroin

Why Are Local Officials Shutting Down Needle Exchange Programs During a Crisis?

Moral judgment of drug users overrules solutions that fight overdoses and halt the spread of disease.

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Needle exchange
Diego Vito Cervo / Dreamstime

Back when he was governor of Indiana, Mike Pence, after much praying and pressure, relented and signed legislation that permitted counties to establish needle exchange programs if they could show they were having an HIV or hepatitis C epidemic.

Rural Indiana was indeed having such an epidemic at the time, and even the sheriff of Scott County, where the number of new HIV cases had seen a dramatic increase, determined that a needle exchange program was needed. He told Pence as much.

After the needle exchange program began, Scott County saw a notable drop in new HIV cases. It has been a small but important success as America figures out how to deal with an increase in heroin use.

But those efforts are potentially at risk now. Two counties in Indiana have shut down their relatively new needle exchange programs, expert advice and actual outcomes be damned.

Lawrence County, Indiana, saw its Hepatitis C infection rate more than double in the early part of the decade, thanks to intravenous drug use; it's tough to determine trends on the basis of just two years of data, but numbers from the state indicate that there will be fewer infections in 2017 than in 2016. But the county council voted last week not to continue the program. One council member, Rodney Fish, told NBC that he voted against it for "moral reasons":

I did not approach this decision lightly. I gave it a great deal of thought and prayer. My conclusion was that I could not support this program and be true to my principles and my beliefs.

He claims that he spoke to several health professionals before his vote, and he said he would possibly support a hospital-based program.

In August, the council for Madison County, in northern Indiana, also voted to end its needle exchange program over the objections of local health officials.

In both counties, opponents of the program argued that operationally it was less about needle "exchange" than needle "distribution." Critics were concerned that they were facilitating drug abuse rather than decreasing the health risks of drug abuse.

Indiana's not the only place where local leaders are turning their backs on a needle-exchange-based solution to reduce the spread of HIV and Hepatitis C. In Camden, New Jersey, bureaucratic maneuvers appear to have shut down a needle exchange van that was serving hundreds of drug-users a week.

Journalist April Saul reports that property development in Camden forced the van off a vacant lot last year. The program organizers worked with the city to come up with a new location, and in April they identified one. But the mayor of Camden has not signed off on the new agreement, so the program has had to return tens of thousands of dollars in state funding and lay off an employee.

So to summarize the state of affairs: Government officials at various levels (including the Department of Justice) want to make it harder for doctors to prescribe opioids as a long-term pain-fighting solution. The result is that people are turning to heroin on the black market. This heroin is often adulterated with other drugs like fentanyl and opioids, causing an increased risk of overdoses and an increased risk of transmitting HIV and Hepatitis C. And government officials are standing in the way of medical solutions to those problems because of moral judgment about people with addictions and a public distaste for funding a solution that makes it seem like we're subsidizing self-harm.

If government officials don't like handing out needles to heroin users, they could let nonprofits take the whole thing over, including the funding. Or maybe they could think a little more carefully about how they approach opioid addiction in the first place.

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  1. “Why Are Local Officials Shutting Down Needle Exchange Programs During a Crisis?”

    Because Fuck You Cut Spending?

    Hitler?

  2. Rodney Fish, told NBC that he voted against it for “moral reasons”

    Hazel approves.

    1. It’s amazing how many Americans’ “principles and beliefs” include wishing junkies would just drop dead of AIDS already. Such compassion.

      1. Damn straight – nothing says compassion for your neighbor like robbing your other neighbor to pay for the care of the first party.

        1. I’m not making any argument for or against “robbing my other neighbor”. I suspect that Rodney Fish’s principles would lead him to look for a way to outlaw private needle programs too.

      2. Yep, for your true, hardcore drug warrior, dead junkies are a feature, not a bug.

  3. Critics were concerned that they were facilitating drug abuse rather than decreasing the health risks of drug abuse.

    The results of whatever study was done seem to agree with this concern. I think people don’t want fewer diseased junkies, they want fewer junkies.

  4. Serious question. I thought that heroin was an opioid? Is Shackford insinuating that the heroin is adulterated with even more opioids?

    1. Heroin is technically an opioid, the same way a BB gun is an assault rifle if you assault somebody with it or there’s a rape crisis on college campuses if you count a smile and a nod as a rape. IOW – “opioid” no longer has any meaning beyond “a bad thing that we hope causes people to shit their pants in fear and not object to us raping them some more”.

        1. So’s illegal immigrants and Chinese imports and Obamacare. Except for the parts that are terrorism and sex trafficking.

  5. “Why Are Local Officials Shutting Down Needle Exchange Programs During a Crisis?”

    Seems like a loaded question.

    My guess is that the officials involved are concerned about the voters and the taxpayers. I certainly don’t want to pay for other people’s heroin needles.

    My risk of contracting HIV from a lack of clean needles is zero since, you know, I’m not an intravenous drug user.

    Why can’t doctors simply make needles available by prescription? There are all sorts of prescription medications where patients are sold needles to inject themselves by prescription. Is there a law somewhere that prohibits doctors from prescribing needles to heroin addicts? If so, maybe that problem needs to be addressed.

    I’m not here to help you buy your needles. Go buy them yourself.

    1. This quasi-psychopathic attitude is why we can’t have nice things. You do realize that the point of such programs is that without them people reuse needles, causing the social problems meant to be addressed?

      I’d say that your interest in having less disease in society is painfully obvious, but of course you don’t think society should pool resources for healthcare costs either, as if there is some magical alternative that is not horrific.

      1. You interpret me not wanting to buy your needles for you as meaning that I don’t want addicts to have access to needles, but that’s false.

        I clearly articulated that people should be free to buy their own needles.

        I also don’t want to pay for your condoms.

        1. People are free to buy their own needles. That didn’t address the problem. Do you really think this glib ostrich nonsense is a convincing political argument?

          It’s not society’s fault, or liberals’ fault, that your ideology is half-baked horseshit. It just happens to be the case that social costs exist regardless of what you want the world to look like. You’ll pay one way or the other. Might as well do it in an organized and thoughtful manner rather than just ponying up the maximum possible cost every time someone visits the ER and can’t pay.

          1. Well, Tony, could my money not be better spent on humanity by donating to charity for some 3rd world country where income is less than 1.90 a day? Perhaps I’d spend my money on my own children’s health expenses. Maybe I put it towards retirement so that I can retire at a decent age and spend my golden years doing good works.

            See, here is where you’re an idiot: You’re so fucking vapid, so shallow, that you can’t see beyond anything that is right in front of you.

            1. No, that is precisely your problem. If you examine my argument you’ll find that its entire point is to save you money.

      2. Maybe it would be safer overall if people could buy cheap heroin at their local CVS and then have money to afford the needles they stock on the next shelf over, rather than deal with a black market, organized crime, gangs, product laced with who-knows-what, a hyperviolent police force, etc. Then the money the government saves on the War on Drugs could be, I dunno, shifted to clinics that could assist the people who decide they don’t want to be hooked on heroin anymore.

        1. Ken would be against paying for such clinics.

    2. But Ken, as someone else put it so well upthread, if you don’t want to provide junkies with free needles to support their habit, then you just want them to drop dead! Where is your compassion?

      1. It’s also authoritarian on its face–if anyone is decrying country commissioners and such for being concerned about the wishes of voters and taxpayers.

        Some things shouldn’t be democratic. Freedom of religion, freedom of speech, etc. genuinely shouldn’t depend on the outcome of a popularity contest. The First Amendment starts with “Congress shall make no law . . .” because those questions really shouldn’t be subject to a popularity contest.

        Other things truly belong well within the bounds of democracy. If you’re telling me that elected officials shouldn’t take the opinions of voters into consideration on issues like budgets and what the government should spend money on, that’s elitist authoritarianism.

        If you’re telling me that voters need to change their minds on this issue because they’re wrong, then you’re at least moving in a less authoritarian direction.

      2. if you don’t want to provide junkies with free needles to support their habit, then you just want them to drop dead! Where is your compassion?

        Eh, that’s not how I’d put it. That’s assuming intent, wherein the reality is that dead junkies may or may not be your intent, but they are your consequence. So my phrasing would be

        if you don’t want to provide junkies with free needles to support their habit, then you need to accept that they’ll die in greater numbers as a consequence! Where is your compassion?

        The end result is the same (ending needle exchange programs results in more dead junkies), but it makes a better distinction between intent/goal and acceptable collateral damage.

    3. Well since girls won’t have sex with me I shouldn’t have to pay for the health centers free condoms either. And I definitely don’t want the EMS I fund responding to any alcohol overdoses or accidents not involving a sober person, because fuck alcoholics. It’s not my intoxicant of choice right?

      It’s called public health, you don’t get to pick and choose, you get programs that reduce death and serious health problems, and not according to your own moral vision of what is and is not worthy. Did you even stop to consider that unless you’re calling for these people to be turned away from ERs when they’re dying from their preventable diseases, you’re going to wind up paying *a lot* more?

      1. Yeah, I do get to pick and choose.

        In a budget, I’m a tax payer and a voter, and if the local county commissioners are spending my money on things I don’t care about, then I get to choose other country commissioners.

        In markets I get to pick and choose. I choose not to be an intravenous drug user. That’s my participation in that market.

        No, I don’t want to pay for your condoms either. Go buy your own condoms and leave me out of it.

        I do not exist for your benefit. I care more about myself than I do about you. I’m living life for me and the people I care about. I am not here for your benefit. Do you care more about me than you do about yourself and the people you love? How ’bout sending me your money?

        Learn to take care of yourself. Coyotes and raccoons do it in the wild. You’re at least as smart as they are, aren’t you? Maybe the reason they’ve evolved to take care of themselves better than some people is because they don’t suffer a society that saves them from the consequences of their own bad decisions. Does the term “moral hazard” mean anything to you?

        In drug addiction treatment, they have a for people who mean well but actually add to the problem. They’re called “enablers”.

        https://www.merriam-webster.com/dictionary/enabler

    4. Syringes and needles no longer require a prescription in 49-50 (I lost count) of the 50 states. So what’s needle exchange about?

      1. Exchanges provide them for free. Plenty of junkies will choose another bag over new needles. Exchanges collect old ones in order to get new ones, reducing the number thrown out in regular trash and in parks. They provide other clean supplies that could potentially lead to infection if shared– like individual tubes of sterile water instead of a community cup, cotton, and cookers. They provide other supplies for free, like bandages. Often they’ll have on-site HIV and HepC testing. They provide information and direct contact with treatment providers and can assist addicts with getting help. And not to be neglected, they provide community support for a problem people can’t get support for anywhere else.
        Pharmacies don’t do any of that, and while it’s important that they do provide syringes for sale when requested, because they’re far more prevalent than exchanges, they’re not enough and we need more exchanges.

  6. Living in a city, I would like to see the exchange part really emphasized. Addicts are not careful were they drop their needles, I am not sure how this would be done, but the needle distribution criticism is valid.

  7. “So to summarize the state of affairs: Government officials at various levels (including the Department of Justice) want to make it harder for doctors to prescribe opioids as a long-term pain-fighting solution. The result is that people are turning to heroin on the black market.”

    We’re missing an important piece of the puzzle here. I’ve linked the following facts before under Riggs’ pieces on this issue, but I don’t have time to dig up the links. In short, here’s the way they break down:

    ObamaCare’s Medicaid expansion added some 11 million people to the Medicaid rolls.

    People who make less than $20,000 per year (like Medicaid patients) are 4.3 times more likely than average of becoming opioid addicts.

    80% of new heroin addicts start with prescription opioids.

    75% of the people who use opioids for non-medical reasons get them either from a doctor, who gives them a prescription, or for free from a friend or family member, who gets the opioids by way of a legal prescription.

    Put these stats all together, and it isn’t about the Department of Justice or anybody else restricting the prescription of opioids for long term pain. The problem is that ObamaCare made opioids available for free and legally by way of expanding Medicaid to 11 million more adults–and it did this to the population that is most susceptible to opioid addiction.

    1. Here’s a link to my comments with all the stats above:

      https://reason.com/blog/2017/10…..nt_6991153

    2. I believe that was a part of the equation, the other part is that we’re increasingly paying our nation’s poor people to not work. This makes the opioid use attractive in the first place. But that’s another long, complex discussion.

      1. As I said in the comment just below this one, I think there are two interrelated problems that get conflated under the heading of opioid addiction.

        Rolling back Medicaid eligibility to what it was before ObamaCare will not make those who are already addicted suddenly non-addicts. That damage is done.

        However, if we’re interested in stemming the increase in new addicts, then cutting Medicaid eligibility back is a necessary part of the solution to that problem.

        The explosion in addiction rates after the implementation of ObamaCare is not unrelated to the expansion of Medicaid. Anybody less biased than Tony should be able to see that making opioids suddenly accessible to new Medicaid patients and taking the price of opioids all the way to zero (by way of Medicaid) will tend to increase the consumption of opioids among the population that is most susceptible to opioid addiction (the poor).

        But we’re not likely to see rate of new addiction rise like that again in the future–unless we expand Medicaid eligibility even further. The people who are claiming that opioid addiction somehow mean we need to expand Medicaid even further are out of their minds. And if we had single payer in this country (with Medicaid for all), we’d see opioid and, subsequently, heroin addiction rates skyrocket like they’ve never skyrocketed before.

        1. Yes and it’s pretty sad that reason hasn’t picked up on this aspect. The divergence between medicaid expansion states and non-expansion states is striking.

          But, like, mass effect andromeda, dude.

        2. … if you can’t come up with a better solution then “cut off people’s access to health care”?, then I’m not sure you have a very good solution.
          ________
          ?Yes yes yes, health insurance != health care. But the end result of the nuance is still that health insurance is the gatekeeper, and without it, it’s very difficult to get non-emergency care.

          1. Point 1

            The question wasn’t about cutting off people’s healthcare. The ObamaCare replacement bill moved people from Medicaid to private insurance with vouchers–much like school vouchers would move students from public schools to private schools.

            Point 2

            Again (and again, and again, and again), the problem I’m talking about is the creation of new addicts.

            Pulling the Medicaid rug out from under existing addicts won’t do anything to make them suddenly become non-addicts. However, making the people most susceptible to addiction eligible for free and perfectly legal opioids made more opioid and heroin addicts than there would have been otherwise.

            Conclusion

            We will continue to create more new addicts at an elevated rate because of the ObamaCare Medicaid eligibility expansion, and if we further increase the eligibility for Medicaid, we should expect a similar increase in the rate of new addicts.

            However, people on the left are talking about expanding Medicaid in order to stop the opioid addiction problem, which is profoundly stupid. Expanding Medicaid to stop the opioid addiction problem is like putting out a fire by dousing it with gasoline.

  8. The question of what to do with all the present opioid and heroin addicts remains, but new heroin addicts are overwhelmingly coming to heroin addiction by way of Medicaid. The problem is that prescription opioids are insufficient to feed a full blown addition. The supply of opioids people get through Medicaid enrollment are simply in insufficient supply to feed a full blown addiction as it progresses–that’s why people people graduate to heroin.

    if we want to stop the flow of new opioid addicts, giving addicts more opioids through prescription isn’t the solution. If you want to stop the flow of new addicts, the solution is roll Medicaid eligibility back to what it was before ObamaCare.

    1. “The question of what to do with all the present opioid and heroin addicts remains, but new heroin addicts are overwhelmingly coming to heroin addiction by way of Medicaid.”

      Isn’t medicine from the government wonderful?
      If only we could have more of it.

  9. Have any States/localities tried to re-write the laws so that Red Cross, etc., can distribute privately-provided needles if it strikes their fancy?

    1. I keep wondering this. That final line, If government officials don’t like handing out needles to heroin users, they could let nonprofits take the whole thing over, including the funding. seems important. If this is illegal now, then this is an obvious cause of a lot of misery and dissent. Because they people who take issue with subsidizing it have a point, but if charities are not allowed to do it legally then it’s ridiculous.

      I imagine charities would do it just fine.

  10. If government officials don’t like handing out needles to heroin users, they could let nonprofits take the whole thing over, including the funding.

    Hypodermics are sold otc in Indiana, no?

    1. Hypodermics are sold otc in Indiana, no?

      Good point and, AFAIK, yes. Store/chain policies my vary (you might have to have a prescription in order to buy), but that can be solved local mom-and-pop stores as well as the internet.

    2. I think you need a prescription.

      If you need to inject yourself with something like insulin, etc., I believe you need a prescription from your doctor.

      Methadone is almost always taken orally.

        1. Well there you go then!

        2. Wait!

          Help me understand . . .

          “Paraphernalia law exempts sellers of items “historically and customarily used in connection with the … injecting … of … lawful substance[s].”

          The sellers may be exempted from selling–but does it say they can sell it without a prescription? I’m assuming it does, but you know what they say about “assume”.

          1. This one is more interactive (and maybe more informative) than SIV’s.

      1. I think you need a prescription.

        I’ve never directly ordered syringes, but have a number of first-hand accounts (second-hand knowledge) that make me fairly certain this is incorrect. There are a handful, maybe two, of states that require prescription or some manner of record on file for syringe sales (Indiana is not one of them). Some vendors do lots of business in those states and just have a general policy to match. Pretty much anybody else will sell you syringes. Even if you local Rx gets uppity about it, veterinary supply will usually sell you anything but controlled substances with few/no questions.

        1. Look at SIV’s link. There are a lot of states, there, with both prescription and paraphernalia laws against syringes.

          “Syringe prescription laws (denoted Pres. law in table) require a prescription for the sale or possession of injection equipment. These laws were enacted to remedy the abuse of prescribing opiates like morphine during the late nineteenth and early twentieth centuries. Physician prescription practices, however, no longer contribute to illicit drug use since the medical profession is now subject to strict regulation.”

          “Paraphernalia laws (denoted Para. law in table) were primarily enacted in the 1960s and 1970s to regulate the growth of the drug paraphernalia industry. These laws restricted the manufacture, sale, distribution, and possession of items like rolling papers, bongs, pipes, freebasing kits, and in some states, needles. In 1979, the Justice Department’s Drug Enforcement Administration (DEA) promulgated the Model Drug Paraphernalia Act.”

          Any good libertarian should contend with some of those interpretations.

          “Physician prescription practices, however, no longer contribute to illicit drug use since the medical profession is now subject to strict regulation”, that’s horseshit.

          Like I said, I have a link (to a link) that shows upwards of 75% of heroin addicts started on prescription medication. The suggestion that regulation means any problem was solved should ring a *bad answer* buzz tone for any libertarian.

          1. There are a lot of states, there, with both prescription and paraphernalia laws against syringes.

            If you sift through the laws, all except a handful are like “

            1. Argh! HTML tag fail.

              …less than 10 per sale” or “For sale to minors by prescription only.” Only a handful like CA and IL are “By prescription only [full stop].”

              I should amend what I said. I’ve ordered syringes online from IL (just not in IN and never for personal use) privately (for professional reasons) with the most serious inquisition being “And how are you going to pay for this?”

              I do agree it’s neither here nor there with regard to the opioid (or any other drug) “crisis” though.

      2. 3ml Luer Lock Tip Syringe with 23g 1 1/2″ Needles 100 per box https://www.amazon.com/exec/obidos/ASIN/B06XDWXB8G/reasonfoundation-20/

        1. Yeah, Thermo Fisher, Sigma-Aldrich, Grainger, Lab Supply… I’ve never had anybody ask me if syringes could be legally dispensed/sold where I was.

        2. I feel there must be something we are missing, or else I would be surprised if some church or something doesn’t take this up on their own. Or, at the very least, someone would make a non-profit or something doing just this.

  11. Hepatitis C infection rate more than double in the early part of the decade

    Lawrence County is among the top 15 counties in the state for the highest rate of Hepatitis C per 100,000 people. A third of the Lawrence County Jail population in a six month period of 2015 tested positive for Hepatitis C.

    The county is ~40-45K people total. The Lawrence County Jail is a single-story building that has less than a dozen parking spaces. As Mitsima points out, it would be one thing if they were talking about forbidding (or continuing to forbid) the Red Cross from distributing needles. As it is, they’re handing out needles on the taxpayer’s dime to several handfuls of users in the hopes that it will likely prevent a few additional BBP cases. Go ask Bailey, as libertarians, we are not required to subsidize others’ risky behavior.

  12. RE: Why Are Local Officials Shutting Down Needle Exchange Programs During a Crisis?

    Because they can.
    (Local government official flexes muscle.)

  13. I am confused. A 3ml syring with 23g needle is 23 cents on Amazon with free shipping.

    Why the fck would you share that? And why isn’t it easier to buy a needle than to attend some stupid needle exchange program where the gubment is going to see who you are?

    1. I agree. This is setting off some alarm in my head. I just feel like there is some law here that is preventing this from happening by private charity. Or, hell, even a wholesaler buying 1,000,000 at a time and selling at a discount.

      1. I always considered it the usual lefty good intentions blockade crap. The places (CA, IL, NY, NJ) where syringes are the most heavily regulated (effectively preventing large organizations from distributing) are the places where the Catholic Church could set up the exchange program next to the soup kitchen. Rural dispensaries and Churches don’t want heroin addicts camped out on their lawns and everywhere in between is NIMBY.

    2. Maybe ’cause you need to have an address to get it shipped from Amazon?

      I dunno, but this story seems more complicated than what I’m reading.

  14. IANAL and all that but it appears that:

    No prescription is required to purchase hypodermic syringes in Indiana. It is illegal to possess a syringe for the purpose of injecting controlled drugs for non-medical purposes. Only pharmacists and practitioners are supposed to dispense syringes. The needle exchange law provided an exception to the second two laws for those dispensing the rigs under that program.

    !. You can buy spikes at the pharmacy (obviously don’t present yourself as wanting them to shoot dope)

    2. You can hypodermics legally via what us old-timers call “mail order”, such as Amazon.

    3. You can’t legally sell them at the gas station

    1. 4. Possession of syringes you use, or intend to use to shoot dope is illegal wherever you acquired them, including a public health needle exchange program.

      5. It would be illegal for an unauthorized charity, drug dealer or social service to distribute syringes even if everyone knew they would only be used by diabetics to inject insulin.

      It should be relatively easy and, depending on your intentions,perfectly legal for anyone to obtain new, clean and sharp hypodermic syringes in Indiana.

      Drugs should be legal.

  15. “Why are officials shutting down needle exchanges during a crisis?” Um, let’s see . . . because they want drug users to die? Because every dead drug user posthumously becomes an “addict,” and every dead addict is job security for drug warriors? Because if they wanted to save lives, they’d legalize the damn drugs? Oh, wait, was that a rhetorical question?

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