Needle Exchange - NY Times OpEd Submission

Monday, September 23, 1991

The New York Times
229 West 43 Street
New York, NY 10036

To The Editor:

I was both saddened and angered by the Op-Editorial "Giving Away Needles Won't Stop AIDS" (New York Times, Saturday, August 17th, 1991, page 21). It was, in a word, scary. That such attitudes are prevalent in this society is bad enough. That these views are held by the man at the helm of Phoenix House, a "treatment center" for drug abusers, is very disturbing indeed.

I am a heroin addict. I am also a functioning, contributing member of society - a wife, a daughter, and a professional in my field. I actually possess a certain renown, and my work has earned your respect. You wouldn't suspect my addiction if you were to meet me on the street. Those of you who have employed me, worked closely with me, and relied upon me have never discovered that I'm a junkie. If you did know of my addiction, you would shun me - like the plague. Nowadays, a dope addict is a pariah. But we are everywhere. Some of us are brazen, flaunting our well-tracked arms. Others, like myself, live and work discretely in your midst. To successfully pursue my professional and personal goals, I must remain "in the closet." An obvious consequence is the alias at the end of my letter. I yearn for the day when I can do otherwise. In the meantime, this small sacrifice of routine New York Times policy permits me to be honest, open and authentic. Therein lies the utility and singular quality of my testimony. Mr. Rosenthal, President of Phoenix House, may be suffering from extreme ignorance. If so, let him read and learn. I fear, however, that he is more or less aware of the following facts. Nonetheless, he maintains the dangerous stance he took in his Op-Editorial. Scary, as I said above. Just plain scary.

For those of you possessing an open mind, common sense and a conscience, the following information will be of considerable constructive value. I write from fifteen years of raw personal experience.

(1) The choice is not between needles being given away in "free exchange" and not being given away in "free exchange." It is, rather, between "free exchange" and illegal acquisition. As things stand now, an addict faces his greatest fear when attempting to "cop" a new, clean needle - cold turkey detox in jail. Needles are fairly easy to find for sale (approx. $3-4) on the street. However, both the sellers and buyers are in constant danger of arrest. Unlike bags of heroin, which one can hide, ditch, or even swallow when threatened by the police, a needle is a bulky, obvious item which is easily discovered. This summary of my own recent (and not unique) experience will illuminate the present attitude of the justice system towards an addict's efforts to remain AIDS-free. I, myself, was recently jailed for mere possession of a syringe. That's it - no drugs - just a syringe. What was the implication? That I ought not to have had my own, but rather should have shared one? After arrest, I awaited arraignment in jail. The process takes an average of about thirty-six hours, though it commonly drags on for three days or more. While in the Tombs, I suffered critical symptoms of heroin withdrawal. Terrible spasms spread from my legs to every conceivable part of my body. Not merely were my limbs consumed by these ghastly, truly indescribable attacks, but breathing and swallowing became a frightening challenge. Of course, I was also victim to frequent fits of vomiting, sneezing, and coughing. The horrible diarrhea was awfully hard to manage on the available toilet - one upon which no one in their right mind would allow themselves to sit down. Apart from unconscionable pain, my body suffered a blood pressure and pulse rate that I knew, from previous experience, had entered a danger zone. As any experienced physician will confirm, cold turkey detox can kill. (I was the worst case in the cell at that particular time, but I was not the only one going through this Hell. Also, the presence of "kicking" junkies in the already overcrowded "cages" does not make it any easier for the other prisoners. Our vomiting and diarrhea, our uncontrollable thrashing about on the floor - all this adds to the tension in the "cage." One of my legs, in a spasm, kicked a particularly large, sleeping woman in the face. This did not erupt into a fight only because I discovered that she, too, was a junkie. Her healthy appearance was due to the fact that she had only just been busted, and had a few hours left before the advent of "junk-sickness.") As my condition had reached a crisis stage, I asked to be taken to the hospital. The Corrections Officers refused, and treated me very abusively. Instead of granting me medical care, they further delayed my arraignment. You can imagine my appearance, demeanor and general physical condition when I finally did appear before the judge. (I have known junkies who, quite literally, could not help but puke all over the courtroom. Needless to say, this does not help the judge to see us as anything but hideous, filthy scum. Police and Corrections Officers have made "Junkie-Piece-of-Sh**" the term of choice these days.) In a few weeks, I face trial. This is the punishment I received (in addition to the legal ramifications from this, not my first arrest), for the crime of attempting not to contract AIDS. Cold turkey detox is not "what a junkie deserves," or "just like the flu." These dangerous misconceptions, fraught with bad faith, have cost many their lives and thousands more untold suffering. When needing a syringe, a junkie faces a grave choice, indeed: risk cold turkey detox in jail and all else that arrest entails, or make do with "rotten" or used "works," and "maybe" get sick some years from now. Many opt for the short-term solution. Particularly when one is "dope-sick", one tends to look for, shall we say, the "quick fix."

(2) Mr. Rosenthal questions the effectiveness of the New Haven Needle-exchange program by assailing the soundness of their statistical reports. He entirely misses the point. Statistics, whether accurate or inaccurate, cannot possibly "address the issue of how needle-sharing behavior has changed." Mathematical methods stand impotent before the essential moral issues. Nor can they even begin to explain the practical anomalies which irk Mr. Rosenthal. Why do some needles never return, while other strange needles mysteriously appear? Compassionate common sense will give you the answers. Junkies will go to great lengths to keep a spare "set" around. If need be, they'll "return" a needle they found in the gutter (and never used). This is not because they intend to sell the other needle or use it to some nefarious effect. Their behavior stems from the fact that it is a hard fate to have only one needle. If it breaks, you're screwed. You're back on the street corner again, looking to buy one and risking arrest. Or you're forced to ask a friend to lend you that "like new" needle that he "only used once." Anyone can see that as long as an addict is able to obtain a free, clean needle whenever needed, no responsible user will opt for sharing needles in today's perilous health environment. It is clear, morally, that that is a good thing. Stop criticizing useless statistics and listen to your conscience.

(3) Mr. Rosenthal feels that the New Haven program's 60% dropout rate casts further doubt upon the virtues of needle-exchange. In fact, it has nothing to do with the positive potential of needle-exchange, per se. However, it does point out a problem among New Haven-style programs. Addicts abandon or shun this sort of program because of its major flaw: lack of security. We junkies are not deaf and blind. We know what you think of us, and know it's getting worse. We are not fond of giving you our names and numbers, of letting you test us for AIDS or anything else, or of letting you monitor our habits. Someone has to make a leap of faith and understand that, facing the AIDS crisis, we do want and need help - but not at any price. If you want our trust, you're going to have to give us some first. A needle-exchange program will only be used consistently if it is a "no-strings-attached" situation. Try to gather too much data on us, and we'd rather take our chances buying works in the streets.

(4) The junkie community desperately needs de-criminalization of syringes - or in the meantime, a needle-exchange program that values our lives more than our "cleanliness." "Help" cannot be considered synonymous with "making us clean." First of all, help us to live, and live disease-free. Contrary to a romantic stereotype that may ease the conscience of society at large, we do not, I repeat, do not want to die. The desire to live is something we have in common with you. Being alive is more important than being "clean." I hope you agree with this. If you don't, please do some heavy soul-searching.

(5) Think soberly - what can we possibly do with these needles that is so bad? If there are more clean needles in the community, there will be more clean fixes, and fewer dirty ones. That's all. What are you worried about? That someone will figure out a way to come to the "program" six times without returning his old needles, and so collect a bunch of new needles that he can sell at $3 apiece? At this desperate point, if the needles are clean, more power to him! Besides, if the needle-exchange program is effective, no addict will purchase a needle when he can get it for free. If there's one thing everyone agrees upon, it's the general reputation junkies have for a certain well-channelled "thrift."

(6) Look beyond New Haven! Look beyond New York City! We New Yorkers consider ourselves quite the civilized lot. But when compared to the citizenry of other States of the Union, we come off as rather barbaric. Needles are legal in several states. In other states, they are legal when it comes down to daily practice. In Iowa, for example - not a state known for its flaming radicals - needles can be purchased over the counter in any pharmacy. And when we compare our pitiful policy to what exists across the Atlantic, New Yorkers should feel truly ashamed. In Holland, a "junkie union" actually collaborated with the law enforcement agencies in the design of a needle-exchange vending machine that ejects a fresh needle whenever an old one is inserted. In this manner, a junkie can obtain a new syringe at any hour of the day or night. And he retains his anonymity. The AIDS rate in Holland has fallen drastically, and is now miniscule in comparison to ours. It is interesting to note that the "junkie union" helped police "tamper-proof" the vending machine, so no one would be able to take more than his rightful share. If AIDS is entering the heterosexual community primarily via junkies, such a vending machine would protect not only us, but you! Think about it.

(7) What hubris, Mr. Rosenthal! Do you really think that your attitude, your Op-Editorial, or the availability of a needle-exchange program has anything at all to do with whether or not an addict will get his next fix? The reason for the spread of AIDS is precisely that we will do the drug, one way or another. An effective needle-exchange program would simply make it easier to do it right. It's tragically simple. Believe me, when an addict is facing dreadful sickness unless he or she obtains a fix, nothing could be more irrelevant than the supposed "encouragement" you associate with a needle-exchange program. Needle-exchange doesn't "condone" our behavior. We've never been "encouraged," our lifestyle has never been "condoned;" we don't expect it; we don't look for it. We're quite self-reliant! Mr. Rosenthal actually believes that "by accommodating drug use, through needle-exchange, we foster ambivalence." No, you simply demonstrate that a human life, even that of a "user," is more important than trying to pressure users into treatment by making it more difficult to fix safely. The withholding of safe syringes amounts to threatening junkies with the death penalty, by lethal injection. And you people wonder why we don't trust you! Your attitude, Mr. Rosenthal, has no effect upon whether we do heroin. All you can affect is the body count. Your Op-Editorial only potentially added to it. It is interesting to note that, though Mr. Rosenthal is clearly into statistics, nowhere in his Op-Editorial does he cite the current New York AIDS numbers for the junkie population. The figures vary according to the source, but it's generally judged that 60 - 75% of New York City's junkies are HIV-positive or living with AIDS. Had that figure been included in Mr. Rosenthal's Op-Editorial, his views might have appeared starkly criminal, then and there. For those people possessed of an active conscience, that figure is really all one has to know. All other material in my letter is but a personal illumination of that single, horrifying statistic. Remember: Even if you want to "clean us up," we have to be alive first.

(8) Why do we do heroin? Once and for all, here is the answer to the "Great Mystery": We do the drug out of some personal combination of the following - we like the way heroin feels, we love the dreams it brings on, and besides, we get damn sick if we don't "get straight." Simple, right? Also, unlike other substances people ingest, heroin is quite benign. In regular maintenance doses, it is safer than all those other drugs. We junkies know this from personal experience; the bolder and more honest members of the medical profession have confirmed it for the record. So there you have it. A drug that feels wonderful, allows for fascinating dream exploration, and doesn't do you any particular harm. (Society at large, however, does try to harm us. We are constantly threatened with impurities in the drug, "beat bags" full of flour or strychnine, cold turkey detox, arrest, AIDS, other diseases, a mind-numbing drug called methadone which is many times more addictive and harmful than heroin, and so on. But the heroin itself is not at fault.) The government has spent millions commissioning scientists to figure out why people like heroin. How ridiculous! In the earliest known writings, thousands of years BC, symbols were found meaning "opium." Among the ancient Sumerians, the symbol for "opium" was the same as that used for "joy." We've been around forever! And I dare say we'll always be here. And whether or not Mr. Rosenthal says this or that, and whether or not needles are disease-free and free of cost, and whether or not you declare an absurd and doomed "War On Drugs" and murder us with your laws, we'll be here. Trying to avoid getting junk-sick, and trying to stay AIDS-free, and sometimes even having enough heroin to "get high."

Your choice is this: Do you want to help us to live, addicted or not? Or to help us die, addicted or not? Questions of "cleanness" come after "questions" of life and death. There are terrible problems in our community of addicts. We need help in solving them, but if need be, we'll continue as we always have. We do take care of our own. But our resources are limited, and we are under siege by the law.

Get back to us. We'll be here. But we won't be waiting.


D. D. Blackspoon