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In conversation, Plummer is no foaming fanatic. Asked for his views on needle exhanges, he says, "What's wrong wiht it is it's against the law" and that he's "not convinced by the studies I've read that it prevents the spread of AIDS. It sends the wrong message."
Plummer is more a legal dogmatist than he is a drug dogmatist: Ask him about pot, and he volunteers, "It's absolutely asinine to prohibit people who are in chemotherapy from having marijuana. They ought to be able to get a prescription and get what they need."
"Laws really are like the old boxcar on the freight train," Plummer adds. "They take awhile to catch up with the rest of the train," adding that is the state legalized needle exchange, he would then enforce that law.
The origin of the term "harm reduction" can be traced back to 1992 in Northern Europe, where regarding drug addiction as a disease rather than a crime is more widely accepted. In Switzerland, addict populations are aggressively surveyed, treated, and counseled; at a last resort in the Netherlands, addicts are given government heroin.
Stateside, harm reduction is the latest semantic tool in the war on the War on Drugs. As everyone in the abortion battle knows, it's image-enhancing to be for something, instead of against something: Pro-abortionists present themselves as "pro-choice" and anti-abortionists bill themselves as "pro-life." Who can possibly oppose harm reduction? If you're against harm reduction, you must be for harming people, right?
Harm reduction marks the convergence of AIDS activism and the drug legalization movements. The closest the movement has to a leader is Arnold Trebach, president of the anti-drug-war Drug Policy Foundation in Washington, D.C., who says harm reduction starts with the assumption that a drug-free society is "impossible ... [and] of you accept the presence of drugs [in] normal people, using drugs in a decent way, you blow apart the assumption of current policy."
Trebach espouses the idea that if drug users are treated humanely. with counseling, contact with the medical system, and education, addiction-driven theft can be reduced, as well as emergency room admissions, jail populations, blood-borne disease, and overdose deaths. Harm reductionists advocate, for instance, that the medical establishment train drug users to do their dope after a welfare appointment, not before, so as not to be kicked off welfare. Once that habit is established, maybe you can talk about easing users into a methadone program.
Trebach wants addiction handled in a British fashion, with heroin addiction considered a medical matter between doctor and patient. He thinks injectable methadone for junkies would be a great idea, saying the dispensing of that heroin substitute "would be such a major step forward, the logical next step," which sounds reasonable. But in the next breath, he says, things like, "Heroin is a perfectly good drug," which to a drug warrior is the screech of nails on a chalkboard.
IDUs by the Numbers
Public health director Hernandez believes "unequivocally" that needle exchange and condom availability have lowered the infection rates for HIV, hepatitis B, and hepatitis C, and, anecdotally at least, the incidence of endocarditis (heart-valve infection).
Because IDUs live furtively in a criminal underground, measuring anything about their lives is a tricky business. But as best as anyone can determine, the rate of HIV infection in IDUs in San Francisco has hovered around 13 percent to 14 percent since the exchanges snuck into operation in 1988. This figure is substantially better than surrouding communitites that lack needle exchanges, especially heavily African-American cities like Richmond (26.4 percent) and East Palo Alto (31.9 percent).
A UCSF research team that studied the San Francisco needle exchanges put hard numbers to the question of the efficacy of needle exchanges and found that increases availability of clean needles reduced needle sharing "and the high rate of infectious disease transmission that accompanies this practice." The findings, "Syringe and Needle Exchange as HIV/AIDS Prevention for Injection Drug Users," was published in the January 1994 Journal of the American Medical Association.
The paper's primary author, John Watters, is a pyschologist whose interest in harm reduction came after years of working in the Massachusetts penal system, where he got to know a lot of cons and ex-cons. Listening to their stories, he says he gradually learned that two-thirds of the people behind bars were there for drug crimes - usually simple possession - and practically none had committed a crime against a person. These users were guilty of what Watters calls "utilitarian crimes" against property - i.e., stealing a car to finance their habit. Otherwise, they appeared to be normal people warped by a lack of access to heroin, needles, and health care.
Watters became convinced that imprisoning addicts was "cruel to these people, destructive to their lives" and those of their spouses and children.
"It struck me that this [imprisonment] was not only unnecessary and tremendously expensive to the Commonwealth [of Massachusetts], but ultimately self-defeating," since it created a permanently or serially incarcerated population. This led Watters to harm reduction, and to an associate professorship at UCSF, where he teaches epidemiology and surveys addict populations to determine risk behaviors for hepatitis and AIDS.