The Issue: Dreading the Needle?
Clean needles can help stop the spread of deadly diseases among IV drug users and others. But should the state pay?
Layers of swollen flesh surround Deborah LeCates' knuckles. At night her bloated fingers burn with pins and needles. Both are souvenirs from her heroin habit.
Pain and swelling aren't all addiction has given her. LeCates has Hepatitis C. There's no way of knowing when she got it, but she's sure of how—a dirty needle.
She didn't share often, not by a drug user's standards—30, maybe 40, times. When you have a twice-a-day habit for a quarter century, 40 times isn't much at all.
But eventually, when she didn't have the cash for another hit or a clean needle, heroin withdrawal would set in. It started with a tickle in her throat, then turned into chills that iced her to the bone. Soon exhaustion took over, leaving her body and mind limp.
"I would have to lie down," she says. "I couldn't do anything. But I had to get the next fix. You don't have the energy, but you have to make yourself do it."
She did anything she could to get the drugs she craved—theft, prostitution, even using second-hand syringes. It wasn't long until one of those needles gave her Hepatitis C and changed her life forever.
Though the disease is still in its early stages, her liver is starting to swell. Over the years the whites of her eyes will yellow like an old photograph. Stomach pains, nausea and fatigue will haunt her. Long-term liver infection or disease is likely, and if she doesn't watch for cirrhosis, she could die.
Yet she's one of the lucky ones.
"I thank God that I didn't contract HIV," she says.
Other drug users aren't so fortunate.
"Delaware has the remarkable characteristic that 53 percent of HIV-AIDS cases are caused directly or indirectly from [intravenous] drug use," says Jennifer Wooleyhand, community relations officer for the Division of Public Health. "Most other states are closer to 20 percent."
That fact has played a part in Delaware's unusually high rate of HIV infection. According to the Division of Public Health, Delaware has the seventh highest per capita rate of new HIV infections for all of the United States. That is bad news for not only those who shoot up, but for any resident who is sexually active.
The situation has led legislators to look at new means of controlling the disease. Most recently that includes a controversial program that 48 other states already have: a state-funded needle exchange program.
Starting last month and continuing for the next five years, a van parks in designated places around Wilmington offering a temporary site where drug addicts can exchange dirty needles for clean ones.
The van's staff also offers AIDS testing, drug counseling and information about sexually transmitted diseases. The idea is that giving addicts a supply of clean needles will prevent them from sharing with someone who is infected, which will in turn slow the spread of blood-borne diseases.
A similar program in Baltimore, Maryland, has had some success. When the program began in 1994, intravenous drug use was the leading cause of new HIV cases—accounting for 60 percent of new infections. Ten years later, that number dropped to 40 percent.
"We've definitely seen an impact," says Monique Rucker, bureau chief of Harm Reduction in Baltimore. "We can't credit the program for the entire decrease, but it has played a huge roll." Other measures may have led to the change in statistics, such as a drug counseling or a sexually transmitted disease outreach program.
Yet Baltimore's success has been limited. The city's rate of infection from needles is still twice as high as many other states. That leaves the unanswered question of whether Wilmington's program will be enough to make a difference.
Opponents not only doubt the program's potential, but also believe that providing free needles turns a blind eye to drug abuse. Not so, says Basha Closic, program director at Brandywine Counseling, the group that runs Delaware's program.
"If it was just a bucket over there and [program participants] never got to talk to me, then, yes, it just gives them easier access to their unhealthy and dangerous lifestyle," Closic says. "But because they have to talk to me, they have to do something difficult, and I have the opportunity to say, 'Are you ready to be clean?' I am not putting out a vending machine."
State Representative John Atkins of Millsboro drove the opposition while the bill was pending in the House. "I oppose it on moral reasons," he says. "We are telling our kids that drugs are bad and to just say no. And then, in the next breath, we say that if you choose to use heroin, we are going to supply a free needle. I just think it sends the wrong message."
Cost is an issue, too. This year the program will cost the state $300,000, which will be spent exclusively in Wilmington. That does not sit well with Atkins, who represents voters from Millsboro. "I don't understand why their Sussex County taxpayer dollars are being sent to Wilmington for such a controversial thing," he says.
The $300,000 price tag will hire a staff of counselors and outfit a van to distribute the needles. Costs for the next four years have not been estimated. Atkins points out that if the program continues spending as much as it will this year, it could cost the state $1.5 million by the time it reaches its end in 2011.
Yet much of this year's bill covers one-time expenses, meaning that future years could cost less. Supporters see the money as an investment that could save or prevent future medical costs, which often comes out of taxpayers' pockets. "The treatment of an AIDS patient generally falls on the public, at least for many of the patients," says Gus Rivera, director of the Division of Public Health. In 2006 that meant the Delaware Department of Health and Social Services spent $8.3 million on AIDS services, while Medicaid covered bills that totaled $12.1 million.
"We're going to save a lot of money," says State Senator Margaret Rose Henry of Wilmington, who wrote the legislation that created the program. "You can save some lives, and you will save a tremendous amount of dollars."
Henry crusaded for a needle exchange program for a decade, since about the time AIDS claimed the life of her cousin Joseph Lipton. Henry watched as Lipton died a painful death, one that was made excruciating not just from the shutting down of his body, but also his rejection from society.
"[His death] made it very real for me," she says. "People discriminated against you if you had AIDS. These were basic human rights issues, as far as I was concerned." Even now, she looks around her district and sees people suffering the same burden her cousin carried. "If we can do something to help them and stop the spread of AIDS, we should do it," she says.
It's taken Henry a decade of shouting to get the program launched. Some allies have popped up along the way, like State Representative Helene Keeley of North Wilmington, who cosponsored the bill. The pair worked for years spreading the idea and fighting for approval.
Their hard work was rewarded when Governor Ruth Ann Minner signed the bill into law on July 17, a day that couldn't have come soon enough for Henry.
"It's just unfortunate that it's taken us so long to recognize the benefit," she says. "We've had more people who have contracted AIDS and more deaths while we were waiting and trying to get this passed."
Now that the law is in place, residents are watching what happens next. One concern is how the Wilmington police will handle enforcement. The legislation mandates that a state needle found on a program participant with a registration ID cannot be used in a drug paraphernalia charge.
"It's going to lead to officer apathy," Atkins says. "It's just common sense." He poses a question: If an officer finds two people on a corner shooting heroin, will he arrest both of them, even if one has a state-sponsored needle? Wilmington Police Chief Michael Szczerba says officers are being trained to handle such situations and will follow the letter of the law.
Though Szczerba says he will do what it takes to enforce the new law, he still has concerns about its value. "I don't agree with the principles," he says. "But it's about the law. It doesn't mean that I agree with the program, but it's law and I'm sworn to uphold the law."
He questions how providing clean needles will help addicts quit such a powerful drug. Over the years he has seen drug users overdose, then return to heroin again and again. "I've seen them come back from the brink once and continue in that dangerous lifestyle to where they need help again," Szczerba says.
LeCates knows that lifestyle firsthand. She's lived for years in the tight space between a desire to be clean and a need to get high. She's quit before. But each time until now she's gone back to the drug that's become the most reliable part of her life. "It's always there," she says. "It's like your best friend."
LeCates is hoping to end the relationship for good this time with the help of the needle exchange program. These days she keeps herself busy—and away from temptation—by volunteering at Brandywine Counseling. After all, every minute she's busy is a minute she isn't using. LeCates fills her hours by helping maintain Brandywine Counseling's Rolodex and keeping the place orderly. But she aspires to bigger things.
"I want to interview to help with the van," she says. "You never know who might need me." D