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 wars.
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 counseling.
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.
Needle exchanges 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.
Second, Kerlikowske 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 become official.