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But potency is only one of the variables in a heroin-related death, as researchers reported in Science in 1984 and later in the Journal of Forensic Sciences (1989). Studying heroin-related fatalities in Washington, D.C., they were unable to establish a relationship between heroin purity and death-by-overdose or nonfatal overdose. The primary risk factors discovered were intermittent or post-addiction use of heroin, and the deadly combination of alcohol and heroin, a fact that harm reductionists across the country preach to their IDU populations.
The Dry Doc
From political middle to far-right, stopping just before Barry Goldwater-style libertarianism, the cries of "Wrong!" still ring out against drugs. One quotable naysayer is former Reagan administration drug czar William Bennett, who co-wrote a recent series of inspirational drug-war editorials in the Washington Times.
"The cornerstone of national anti-drug efforts," Bennett and his co-author write, "is to give force to the principle that drug use is wrong, harmful and will not be tolerated. This principle should be embodied in the institutions of society, which, in turn, should be organized to give force to that principle."
Bennett would have the government secure our borders and the inner cities, decapitate domestic trafficking organizations, and administer piss tests.
Clintonian wishy-washiness isn't much friendlier to the needle-exchange concept. Drug czar Lee Brown ducks needle exchange in a written statement, saying his job is solely to "reduce the use of illicit drugs in America," adding, "We must ensure that approaches used to confront one epidemic do not compromise our efforts to confront the other."
One needn't agree with Bennett or Brown to have mixed reactions to harm reduction. Darryl Inaba, doctor of pharmacology and perennial force at the legendary Haight-Ashbury Free Clinic, says that sometimes harm reduction doesn't mesh well with 12-step programs, which focus on cold-turkey approaches. The two should be kept separate, he says, because they can be "too conflicting with people who are trying to get off drugs. ... We deal with then walking wounded," who don't need the additional stress of being around mixed messages. Besides, he remarks, the studies he's seen indicate that "95 precent-plus" of the people who try to merely manage their addictions are "not able to keep it al the controlled level."
It's not that Inaba totally opposes harm reduction; the Free Clinic was one of the first organizations to dispense bleach and condoms to IDUs incapable of getting off the hard stuff.
But he prefers "continuous abstinence. All the research on the addictive process ... has shown that the part [of the brain] addicted is the old brain, not the new brain. It's not the conscious part of the brain that's being impacted, it's the instinctive or subconscious part." In other words, addiction is not so much a monkey on your back as an ancient reptile on your cortex.
Prevention Point leans in the other direction, only referring clients to methadone, counseling, and 12-step programs if the client first asks.
"We don't ever suggest it to people without their first showing interest. It's a completely nonjudgemental program," says Fernando Aguayo-Garcia, Prevention Point project coordinator.
An Ounce of Prevention
It is 6:36 at the Taylor Street needle-exchange site one recent Wednesday night, and Prevention Point's royal-blue Grumman delivery truck is six minutes late. The clients and volunteers are antsy, lighting cigarettes and forming a ragged line where the steel cart-tables usually atand between two trees in the middle of the block. Every five seconds or so, the clients scan the horizon toward Turk and Market, where the truck must come from.
Taylor Street is where the run-down Tenderloin borders what travel agents optimistically call the "Union Square area." The Tenderloin's teeming masses abut the enormous Hilton hotel at the corner of Taylor and Ellis and the holy edifice of Glide Memorial Baptist Church. Armies of European tourists head south to Market from the Hilton, white American prostitutes head east toward Union Square's fringes, choral singers of every stripe walk to Guilde for evening practice. It is the Asia Minor of needle exchanges: Everyone has to go by to get somewhere else.
Except that damned truck. Volunteers Rosie, Elissa, Bob, Mike, Marian, and Kelly talk amongst themselves about why the truck could be - check watches - 10 minutes late now, while the waiting line turns into a crowd and the crowd into a 50-person throng. It's going to be standing room only.
Finally, at 8:42, the truck appears way down Market Street. It spends another agonizing minute at the stoplight at Eddy, and then it's here. There's now a neat queue, which in turn has blossomed into a zigzag three people wide as those farther back attempt to see around the people in front of them. The volunteers start exchanging needles at 8:44, and for the next half-hour they may as well be working at a high-speed assembly line for all the time they have between exchangers.
"This is the bulk line, folks," says Bob. Taylor Street is so busy it has an "express" line and a "bulk" line for volume exchnagers (30 or more points). Meanwhile, the German tourists go by, surprisingly nonplused and possibly wondering why a needle exchange would be on a dirty street instead of a clean lighted building, with nurses and shooting rooms, like at home in Germany.