by Alan Markwood
June, 1996

Needle Exchange Programs are among the most heavily promoted applications of "Harm Reduction."  The theory of "Harm Reduction" is that drug use can be made more safe, as an alternative to drug abstinence.  Needle Exchange Programs (NEPs) seek to prevent HIV infection by providing clean needles to intravenous users of illegal drugs.

Evaluation studies have been equivocal.  NEP opponents claim that any apparent  positive results are flawed.

Three common flaws are:

  1. Failure to separate effects of NEPs from effects of concurrent interventions such as drug treatment and HIV/AIDS education.
  2. Failure to monitor sickness, injuries, and deaths resulting from continuation of drug use among NEP participants.
  3. Failure to compare NEP effects to alternatives known to be effective, particularly aggressive outreach and drug treatment.

The true effects of NEPs may take many years to sort out.  Based on the current state of knowledge, even the best designed and best administered NEPs will probably be found to increase drug deaths more than they decrease HIV infection, particularly in comparison to outreach and drug treatment.

Given this dismal scenario, why are proponents and opponents of NEPs so concerned and vociferous?  The reason is ideology.  "Harm reduction" in general, and NEPs in particular, is a major battleground between those of us who believe illicit drug use to be an anti-social act (due to drug-induced health problems, violence, negligent injury, negligent parenting, and destruction of pro-social values) versus those who believe that drug use is merely a lifestyle issue.

A stunning example of how fully drug culture permeates "harm reduction" and NEPs appeared in a recent day-long workshop given by Mr. Dan Bigg, who operates a major NEP in Chicago.  Printed material composed and distributed by Mr. Bigg clearly presents drug use as acceptable, unlike drug abuse, which he defines as drug use that produces "unwanted harm."  In other words, until the user perceives harm to self or others, use is acceptable.  Similarly, he defines recovery as "Any positive change as a person describes it for her/himself."

Mr. Bigg's handout sheet titled "Essential Ingredients of a Harm reduction Program" starts with, "Orientation toward the person seeking help as the expert in the direction and intensity of their own positive change(s)."  Again, harm is only that which is perceived by the drug user.  Accordingly, another "essential ingredient" is "Definitions of program completion and success that include the continued use of alcohol and other drugs."  The point is clear.  Drug use is not a problem unless the user decides it's a problem.

Another handout from Mr. Bigg is titled "Some Comparisons Between Typical Drug Treatment and Substance Use Management."  What are these comparisons?  For "process," typical drug treatment uses "coercion" while substance use management uses "clarification."  For "employers," typical drug treatment employs "drug‑free workers," while substance use management employs "drug-abuse free workers."  For "outcome," typical drug treatment aims for a "drug-free state," while substance abuse management aims for a "happy, productive, stable existence regardless of drug use."

Another handout created and distributed by Mr. Bigg is titled "Typical Goals of Substance Use Management (as selected by the person seeking help)."  Of the three goals listed, two are covered briefly: * "Abstinence:  As people freely define it for themselves (may include one or more drugs and be permanent or of a limited period.)" * "Improved:  Health, Relationships, Job Performance . . ."

The third goal, "Developing and Enacting a Safer Use Plan," is ore extensively discussed.  Sub‑headings include "Practicing Safer Drug Use,"  "Preparing Yourself for Use," and "Creating a Safer Drug Use Environment.

Other material distributed by Mr. Bigg continues along the same lines, as did comments he made in the course of the presentation.  A slide show included demonstrations of how to find good veins to inject, how to cook heroin, etc.

This is all very disturbing, but perhaps most disturbing is the acceptance of "harm reduction" and NEPs by legitimate authorities.  Mr. Bigg presented this material in Peoria, Illinois on May 22, 1996, at a presentation sponsored by the local Health Department, and widely promoted by that department.  The presentation was accredited by the Illinois Chapter of the National Association of Social Workers, and by the Illinois Alcohol and Other Drug Abuse Professional Certification Association!  When I wrote to these three organizations, I received no response except from the credentialing association.  The Executive Director pointed out that the organization, "doesn't endorse, support or approve the content of any training."  The Director has received "numerous calls from Association members complaining about his (Mr. Bigg's) presentations and disagreeing with the content."  Still, they feel the absurdity of the ideas speak for themselves, without need for censorship by the Association.

"Harm reduction" and NEPs are publicly promoted as having pragmatic value, but Mr. Bigg's presentation demonstrated that the defining characteristic here is not a concern for effective results, but a firm belief that drug use is fine.  I would encourage all responsible persons and groups to disavow any support for this.  I particularly believe that support for this so-called "harm reduction" movement is absolutely incompatible with legitimate drug abuse prevention and treatment entities.  Because of the support "harm reduction" has already received, active opposition is needed from those of us who believe that illegal drug use IS an anti-social act.

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Alan Markwood has been an InTouch Prevention Area Coordinator since 1987, serving nine Illinois counties as part of the statewide prevention coordinating system.  He was trained as a School Psychologist .  He earned his M.A. from Alfred University in 1977 and worked in School Psychology in Illinois and Massachusetts until coming to InTouch.  He earned a Certificate of Advanced Graduate Study at Boston University's School of Education and is a Nationally Certified School Psychologist.

Alan is also a Drug Watch Illinois Delegate.