Needle exchange in New Jersey

Yes, needle exchange prevents HIV transmission. More surprisingly, it actually reduces drug abuse.

A reader informs me that, on his way out the door, Gov. McGreevey used emergency powers to legalize needle exchange in New Jersey. My reader wants to know whether this will reduce the spread of HIV.

This isn’t a topic I’ve studied myself, but those who have all come to the same conclusion: needle exchange not only reduces HIV infection rates but also reduces heroin use. Participation in needle exchange seems to be, for some users, a halfway house to entering drug treatment.

If needle exchange (or alternatively just permitting the legal distribution of needles and syringes) had been pursued aggressively in the early 1980s, it could have saved tens of thousands, or even hundreds of thousands, of lives. But of course St. Ronald and George I cared more about conservative votes than they did about the lives of homosexuals and injection drug users (in the 1988 campaign Bush Sr. was still pretending that testing was a policy for preventing HIV transmission), so the opportunity was lost. (And yes, if you’re curious, for once I got the right answer at the right time, but since I wasn’t following either the Administration line or the Gay Men’s Health Crisis line, I couldn’t get anyone’s attenion.)

The benefits of needle exchange are much smaller now: the epidemic has led to improvements in needle hygiene among injection drug users, and many dealers now sell “works” (some of them, unfortunately, previously owned) along with drugs. Still, there’s some benefit to needle exchange, and no loss.

The question is still open whether other forms of outreach to injection drug users besides needle exchange — forms that don’t involve handing out the paraphernalia of illicit drug use, which understandably annoys those who think of themselves as the potential victims of heroin addicts’ property crimes — would work as well. (Certainly expanding access to opiate maintenance would, but that confronts its own fiscal and regulatory challenges.)

But given that needle exchange demonstrably works, without any bad side effects that anyone has been able to detect, Gov. McGreevey’s decision was indubitably the right one substanatively, and it’s a little sad that the topic remains so controversial politically that he felt able to do so only after his career was over. Here’s hoping the still-active politician in New Jersey will be able to hold on to this little bit of progress, or trade it out for something better.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact: