"The best and fairest that can be said is that the case that needle exchanges work has not been made."
David Murray, director of research, Statistical Assessment Service
At an intersection, I moved away as a man in tan pants and a blue shirt approached Davis. They stepped around the corner. The man handed a dollar bill to Davis, who pulled out a brand-new needle from a small black pouch. This is how Davis, who said he is a former construction worker on disability, spends his days. Enrolled in the needle-exchange program for five years, he told me he picks up 25 fresh syringes from the van, sells some for drugs, then scrounges others to exchange.
Sitting on a stoop, he motioned up and down the street and said, "In these three blocks, there are probably 15 people selling needles. Everybody's got 'em."
And not just in this neighborhood. On another day, at the intersection of Baltimore and Monroe streets across town, drugs, needles and cash are exchanged around the clock.
A woman wanting to buy a syringe approached a needle-exchange participant I was speaking to. He did not have one. "Anybody got some new ones?" he shouted.
Immediately, a man in jeans and dark sunglasses stepped out of a rowhouse doorway and slipped the woman a needle for a folded dollar bill.
"An addict will always find a way to hustle the system," Jerome Rogers (not his real name) would tell me. Rogers, a 47-year-old former heroin and cocaine addict who participated in the needle-exchange program, is in treatment. Selling needles, I learned, is not the only hustle.
Jackie Webster (not her real name) said she started injecting heroin eight years ago. Now the 26-year-old prostitute shoots up 15 times a day. When I met her, she had recently been arrested for carrying syringes containing heroin residue. Released on $1,500 bail, she figured a needle-exchange ID card would be her ticket to freedom.
When addicts are registered in the program, they are given a laminated yellow identification card with a participant number. Holders of these cards, which do not have a name or photograph, are immune from the city's drug-paraphernalia laws and cannot be arrested for carrying needles.
"I'm going to show this card to the judge, and he'll throw my charges out," Webster explained to the two health department workers in the needle-exchange van. Her words were slurred, and she was nearly falling off the bench. The workers grinned at each other while enrolling her in the program, then gave her an ID card and two "starter" needles. After she left, they commented that she wasn't as high as "some of the people we get in here."
Drug treatment or help of any kind was never mentioned. A month later Webster appeared in court, where a judge dismissed the charges against her.
City Health Commissioner Peter L. Beilenson acknowledges that Baltimore's needle exchange has flaws. "Is this a perfect system? No. There's no question it's not."
But, he says, the benefits far outweigh the abuse, which he describes as occurring among a "very, very small" percentage of participants. Officials at the needle-exchange program directed me to Durond Coats (his real name), whom they cited as a success story. Coats had been a heroin addict for 17 years when he registered with the needle-exchange program at age 34.
"Heroin had destroyed my life," he told me. His wife and daughter had left him, and he had lost his house.
Coats remained disease-free, and counselors got him into a treatment program. The former restaurant worker, who said he receives disability for a bad back, has been clean for more than three years: "The needle-exchange program changed my life. Now I get up and go to the library and spend time with my daughter." He is, indeed, a success story. And there are undoubtedly others. But Coats acknowledged that for the first six months in the program, he, too, sold his needles to buy drugs.
Personal anecdotes aside, various studies during the past several years have reported that needle exchanges led to a decline in HIV infection rates. In Baltimore, for instance, Johns Hopkins University researchers reported that the rate of new HIV infections dropped from 4.2 percent to 2.7 percent annually in the four years after the program started.
Critics have pointed to shortcomings in many of these studies, such as relying on self-reporting about disease instead of actual blood testing, small sample sizes, and high dropout rates, which make follow-up impossible.
The Baltimore study did use blood testing, though its sample size, 484, was small in relation to the total number of addicts in the city. David Vlahov, the lead researcher, believes that the program contributed to the drop of infection rates, but cautions that there were probably additional factors, and that the needle exchange was not directly responsible for the drop.