This article was reprinted with permission from Reader's Digest, where it first appeared. The author changed the names of some of the addicts to protect their privacy.
PARKED NEXT to an abandoned lot on Baltimore's south side, the big cream-colored recreational vehicle seems out of place. So, too, do the dozen-odd men and women who gather by the RV's side door, most of them carrying brown-paper lunch sacks filled with used syringes.
One or two at a time, they step inside and dump the needles onto a table. Casually dressed public-health workers verify identification, then hand each of the men and women another bag with an equal number of brand-new needles. They will use them to inject heroin and cocaine.
Since 1994, the Baltimore City Needle Exchange Program has distributed more than 2 million syringes to some 10,000 addicts. It is the largest program of its kind operated by a local health department, though there are 167 others across the country.
Many are run by AIDS activists and nonprofit groups in violation of drug-paraphernalia laws. The Baltimore program, however, was granted an exemption from state drug laws by the legislature. Baltimore's needle exchange, like the others, is defended principally as a public-health measure. Advocates say that there is a population of addicts who will inject drugs regardless of the law.
At least with a free supply of clean needles, they won't borrow those of fellow addicts and risk infection. Peter Lurie of Public Citizen's Health Research Group, for example, argues that programs like Baltimore's "reduce new HIV and hepatitis infections for drug users, their sex partners and children without increasing drug use."
Many hotly oppose these programs. "The risk that needle exchanges might encourage a higher rate of drug use clearly outweighs any potential benefit," asserts retired Gen. Barry R. McCaffrey, director of the Office of National Drug Control Policy and the nation's No. 1 drug warrior. "The only proven answer lies in comprehensive drug treatment" getting addicts to quit.
Over the course of three months in some of Baltimore's most drug-infested neighborhoods, I talked to drug users inside and outside the needle exchange.
I also interviewed treatment specialists, researchers, public-health officials and police. Evidence that the program encourages a higher rate of drug use was hard to come by. But there was plenty of evidence that it doesn't work as it's supposed to.
The plain fact is, many addicts share their clean needles with others, and sell them to buy drugs.
I met Debra Clark (not her real name) last summer outside the needle-exchange van on Ramsay Street. The 43-year-old had frizzy, shoulder-length brown hair and smoked a cigarette, which she occasionally wedged in a gap between two teeth. Clark told me she had been an addict for several years and stole to get money to buy drugs.
Her apartment, in a run-down neighborhood, was in disarray. Little sunlight filtered through the pulled curtains of an upstairs bedroom; trash, newspapers and clothes were strewn on the floor and piled on a dresser, several of whose drawers were missing. Near the door, a baby slept in a crib. Clark said she was watching the infant for a friend. There was a machete underneath a small TV.
Clark's brother, a heavily tattooed 31-year-old, was sitting, bent over, on the edge of a soiled mattress. Sweating profusely and gagging, the man badly needed a fix. He told me that he had been in and out of jail for assault. He was not in the needle-exchange program.
Clark melted a caplet of heroin in a bottle cap, drew it into her new syringe and injected a vein on the back of her hand. Droplets of blood oozed out as she withdrew the needle, which she handed to her brother. He drew more heroin from the cap, jabbed the needle into his forearm, then put the needle on a nightstand next to an overflowing ashtray. Clark told me that she and every other addict she knew shared needles.
That very day, before we met, she'd shared a program needle with a friend. "If you find somebody who doesn't share, I'll give you $100," she bet. "Common sense tells you not to, but when you feel like you're dying, you don't care." It's a remark I heard again and again.
"The underlying assumption of needle-exchange advocates is that addicts behave rationally," notes Herbert D. Kleber, executive vice president of the National Center on Addiction and Substance Abuse at Columbia University and among those who question these programs. "But often they don't, especially when they are experiencing severe muscle cramps and vomiting, in the throes of heroin withdrawal."
Wearing an orange T-shirt, a white baseball cap and black wraparound sunglasses, Darryl Davis (not his real name) walked slowly up Greenmount Avenue in East Baltimore. "New ones, new ones," he called out. The insides of his tightly muscled forearms were scarred horribly from years of injecting heroin and cocaine.