Why is New Jersey the Last State to Implement Needle Exchange?

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Despite the strenuous efforts of numerous organizations and individuals over the last decade, New Jersey has managed to become the only state in the country that does not provide for legal access to clean syringes for intravenous drug users. Empty rhetoric and senseless stonewalling have prevented the institution of a measure that is proven to stem the spread of HIV. This is an issue of particular significance in New Jersey, where the rate of adult HIV/AIDS cases is the fifth highest in the nation, and the percentage of infections caused by injection is nearly double the national average.

On Sept. 18, the State Senate health committee passed an amended version of a bill that would allow New Jersey municipalities to establish needle exchange programs. This bill, in one form or another, has languished in the hands of the health committee since 2004, when it was passed by the Assembly and initially sent to the Senate.

The Senate health committee includes, among others, Sens. Tom Kean Jr. (R-Westfield) and Ronald Rice (D-Newark), both staunchly opposed to needle exchange. Kean Jr., who is currently running for US Senate, and state Sen. Diane Allen (R-Burlington), voted against the bill, which passed 5-2 after nearly 10 hours of hearings. Rice abstained from the vote, but lamented that needle exchange programs “compound a problem by making things available.” Kean Jr. urged the committee to “just do a treatment bill” instead. Rice and Kean Jr. are co-sponsors of a bill that would allocate $100 million to establish regional drug treatment facilities.

Municipal needle exchange programs could work hand-in-hand with such facilities, as they do in many other states, as a measure to reduce the use of illegal drugs. But Kean Jr. and Rice do not appear to appreciate this possibility.

Among those on the committee who voted in favor of the legislation are Committee Chair Joseph Vitale (D-Woodbridge) and Co-Chair Ellen Karcher (D-Freehold), both co-sponsors of the bill, and Sen. Robert Singer (R-Jackson), who stated he voted yes not because he supports the measure, but because he thinks it should be weighed by the full Senate, where he believes it will not easily pass. Sen. Barbara Buono (D-Edison) also gave the measure a qualified yes, saying that while she is not convinced of the effectiveness of needle exchange programs, she is “willing to at least discuss the possibility of a pilot.”

The future of the bill is far from certain. The bill could not garner enough support to pass the committee in its original form, so it was amended to limit needle exchange programs to six municipalities in the state. As a further compromise measure, a provision was added to allocate $10 million in drug treatment funds, meaning that it will now have to pass the budget committee before moving on to the full Senate for a vote.

At first glance, the budget committee would not seem to be an environment hostile to needle exchange. Of the 15 committee members, six represent districts that contain one or more of the 10 cities with the highest rates of HIV infection in New Jersey. In addition, the budget committee notably includes Sen. William Gormley (R-Mays Landing), who is one of the primary sponsors of the bill. Sen. Buono also sits on this committee.

On the other hand, so do a number of Republicans who may be more conservative. While needle exchange has never been a strict party-line issue in New Jersey, those who take a dim view of the practice are often those with socially conservative leanings. Committee vice-chair Sharpe James (D-Newark) will likely prove a further obstacle to the bill; despite the fact that Newark is high on the top-10 list of HIV rates in the state, he has joined his close colleague Rice in the past as a vocal opponent of needle exchange.

If the bill does manage to pass the Senate, it must return to the Assembly for a second vote. Assembly Speaker Joseph Roberts (D-Camden), who has voiced support for needle exchange programs, deems it likely that the legislation will pass the Assembly without much trouble. Gov. Jon Corzine has indicated in the past that he would sign a bill like this, saying in February of this year that establishing needle exchange programs is a priority for his administration.

Of ‘mixed messages’ and ‘tacit endorsements’

Even as the future of this bill remains in question, a larger question looms: why is needle exchange such a contentious issue? Objectively, the facts are quite clear. Numerous studies by health agencies such as the Centers for Disease Control and Prevention (CDC), the National Institutes of Health, and the American Public Health Association clearly establish that by providing intravenous drug users with access to sterile syringes, needle exchange programs slow the spread of HIV.

Existing programs across the country demonstrate that they can be used as a gateway to link hard-to-reach individuals with medical care, drug treatment, and social services. In this way, needle exchange programs can benefit those at high risk for contracting HIV, those who are already infected, and everyone in the communities where they live.

(comic copyright Gregory Benton)

Despite the strong arguments in favor of needle exchange, and despite the existence of these programs in 49 other states, the opposition in New Jersey remains vigorous. However, the rhetoric of needle exchange antagonists is often groundless and rarely compelling.

The origin of strong opposition to needle exchange in New Jersey can be traced back to 1994, when Gov. Christine Todd Whitman appointed a special advisory panel to investigate ways to combat AIDS. With an eye toward prevention, the panel began examining needle exchange, which at that time was showing itself to be effective in places like Connecticut and New York, states that were early adopters of these programs.

Early in 1996, well before the panel released any official recommendations regarding the practice, Whitman publicly denounced needle exchange, saying it “sends a mixed message about illegal drug use.” Later that year, after considering a wide array of evidence and visiting programs in other states, the special panel urged Whitman to change her position and recommended the establishment of needle exchange programs and non-prescription sales of syringes at pharmacies.

Rather than heeding the panel’s advice, she dug in her heels, reiterating her claim that legal needle exchange is a “tacit endorsement for drug use,” and saying that while these programs “may prevent the spread of AIDS,” there is a “broader responsibility to not only prevent AIDS, but to prevent crime and promote public safety.”

In 1996, there was no credible evidence showing that needle exchange programs encourage first-time drug use or even continued use among participants, and no such evidence has come to light since. Nor has it been shown that the existence of legal needle exchange in a state sends a message that the use of illegal drugs is condoned. The numbers of arrests, prosecutions, and convictions on drug charges remain high nationwide, despite the existence of needle exchange programs in 49 out of 50 states. A CDC study shows that the rate of injection drug use in New Jersey actually increased during Whitman’s administration.

Whitman’s claim that the responsibility to prevent crime and promote public safety is separate from and outweighs the need to stem the spread of HIV, even if assumed valid, does no damage to the worthiness of needle exchange programs. There is clear evidence that they provide otherwise hard-to-reach individuals with access to drug treatment, medical care, and social services, all of which contribute to the prevention of crime and the promotion of public safety. There is certainly no evidence that the absence of needle exchange programs in any way contributes to those worthy goals.

Morality and mortality

Some leaders have framed the issue in moral terms. New Jersey’s Catholic bishops have been outspoken detractors, saying that needle exchange “fails to treat people who are addicted to drugs in a compassionate, dignified, and comprehensive manner.”

This is an important concern, but it is also certain that whether any needle exchange programs succeed or fail in this respect is a function of how the individual programs are structured. There is no indication that needle exchange programs by their very nature exclude this possibility. There are plenty of examples of needle exchange programs that act compassionately and comprehensively on behalf of users of illegal drugs, affirming and securing their dignity in the process.

Perhaps most alarming is the opposition of many prominent community figures in Newark, including Rice and several religious leaders, who might be expected to embrace needle exchange as a badly needed public health measure in their communities.

Objections like those of Rev. Elijah Williams are typical. After the special panel released its recommendation in 1996, Williams, from Newark’s Welcome Baptist Church, called needle exchange programs “immoral,” condemning addicts to “die just a little bit slower than they’re dying now.”

In 2004, Rice told the New York Times that clean needles will “kill” drug addicts instead of getting them the help they need.

This sort of moral appeal makes a certain perverse sense, coming as it does from leaders in an impoverished community where illegal drug use can be very visible and the spread of HIV is a source of daily concern for many people. However, it ignores the very real benefits that needle exchange can have, favoring instead a message that urges the complete elimination of illegal drug use. The best chances for such a project would be quite slim indeed.

How does opposition to needle exchange find footing both in hardscrabble Newark and in the communities of privilege, where illegal drug use is by turns hidden and condoned, and where wealth makes some crimes associated with drug use, such as theft and prostitution, far less common? Like community leaders in Newark, social conservatives in more affluent communities often see drug use as a moral issue — they are uncomfortable with needle exchange because it represents the blurring of clear moral boundaries.

Kean Jr. responded to September’s health committee vote by echoing the concerns articulated so many years ago by Whitman that needle exchange “aids … illegal activity.” He also commented that the practice “circumvents law enforcement activities.” These reasons simply do not outweigh the clear benefits of needle exchange.

Kean’s opponent in the US Senate race, the incumbent Sen. Robert Menendez, has indicated that he is in favor of the practice. In 1997, while serving as a US Representative, he voted against prohibiting the use of federal funds for needle exchange programs.

Within the obfuscating rhetoric of moralizing politicians and religious leaders, one thing is quite clear: in their estimation, the only way to counter the negative public health and safety effects of illegal drug use is to “stop the abuse of drugs.”

This alarm bell rings hollow, because none of these leaders has yet proposed a comprehensive plan for eliminating drug use or allaying its ill effects that approaches the effectiveness and cost efficiency of needle exchange.

Whether drug use can or should be completely eliminated is a subject for another discussion, but it’s clear that those on both sides of the needle exchange issue agree that reducing the harm associated with illegal drug use, to both the user and the community, is a valid policy goal. Therefore, we must be willing to cut through the moral murk, look squarely at the facts, and recognize that needle exchange is an objectively valuable tool for achieving this goal.

SIDEBAR

Newark, Jersey City, Paterson, East Orange, Elizabeth, Trenton, Irvington, Atlantic City, Camden, and Plainfield are the ten NJ cities with the highest numbers of HIV infections.

The US remains the only country in the world to explicitly ban the use of national government funds for syringe exchange services. Many industrialized nations (Great Britain, France, the Netherlands, Canada, Australia) have widely-used needle exchange programs.

The first state to implement and fund a needle exchange program was Hawaii, in 1990.

Sources: National Academy of Sciences, The Institute of Medicine

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