State and city public health officials have brushed aside a controversial recommendation by the National Commission on AIDS that drug addicts be given legal access to needles.
The officials say such a drastic step might be worth studying, but should not be taken until there's greater evidence of its effectiveness in reducing AIDS virus infections.
The commission said yesterday there's already evidence of the effectiveness of needle-exchange programs operating in Tacoma, Wash., and a few other cities. Addicts turn in used needles for new ones to discourage needle sharing, a major transmission route for the human immunodeficiency virus that causes AIDS.
A Maryland law prohibiting possession of drug paraphernalia would have to be changed to permit addicts to carry injection equipment or participate in a needle-exchange program.
"Maybe sometime in the future we'll take a look at needle exchange," said Elias A. Dorsey, acting city health commissioner. "But that's not going to happen now. I think there's still a legal question to be answered about it. I don't think anyone in law enforcement or the business of making laws is espousing changing the laws so we can do that."
Baltimore Mayor Kurt L. Schmoke previously indicated an interest in studying the effectiveness of needle exchange but did not pursue the necessary change of law.
"What he's prepared to do" now, mayoral press secretary Clint Coleman said, "is participate with state officials in a discussion about effective strategies for reducing the incidence of AIDS without deciding beforehand what those strategies ought to be."
Schmoke indicated support for other commission findings. In its report, the commission recommended expanded drug treatment programs and strongly criticized the Bush administration for failing to coordinate the campaigns against drugs and AIDS.
The commission said the government is failing to address the rising incidence of AIDS cases caused by drug use. A third of recent AIDS cases are attributable to drug use, the advisory group said.
The director of the federal Office of Drug Control Policy, Bob Martinez, challenged the "most recent studies on needle exchange" and the commission's report, saying they "fail to provide clear scientific evidence that such programs reduce risk-taking behavior."
He also said the report "distorts the administration's position on expanding and improving drug treatment." He said the major obstacle to expanding programs has been cuts by Congress in the Bush administration's funding proposals for treatment.
State and local officials cited longstanding concerns that access to needles encourages, or at least appears to encourage, drug use.
"It's a real dilemma because we don't want to do anything to promote drug use in any way," said Dr. Eric Fine, assistant director of the state AIDS administration. On the other hand, officials recognize the increasing rate of HIV infection related to drug use, he said.
"This might be a good topic for the governor's advisory council to look at," Fine said.
But the new chairman of the governor's advisory panel on HIV prevention and treatment, Dr. Richard T. Johnson, isn't enthusiastic about giving addicts needles.
"It's very offensive to the general population, I think, to hand out needles," he said. "It looks like you're supporting people's habits. And I think we have to be very sensitive to that."
"It's kind of a last option in my view," said Johnson, director of neurology at Johns Hopkins Hospital. "But I don't eliminate any possibilities, in my mind."