Here in the San Francisco Bay Area injection drug use, primarily heroin, and the associated health problems have been major public health issues for decades. In response public health advocates in the Bay Area and beyond have implemented needle exchange programs in which injection drug users can obtain, oftentimes for free, syringes and related paraphernalia generally in exchange for an equal number of dirty needles. The main aims are to reduce needle sharing which leads to the spread of diseases such as HIV and Hep C as well as curbing the danger of discarded needles in public. Other services such as HIV testing and free condoms are also often available. Despite ideological and political opposition the effectiveness of these programs has since been validation by US and international research. Going a step farther than needle exchange are Supervised Injection Sites (SIS) where drug users can obtain clean needles as well as inject onsite with medical staff present in case of overdose. Clients can also gain access through such programs to counseling, drug treatment, and other services. This model, however, has yet to catch on in North America, with the only exception being Insite in Vancouver.
Science-based medicine and health policy are part of my primary interests in skepticism and so I’ve been disappointed by a lack of discussion of the claims for and against such harm reduction programs which offer a more compassionate and more science-based approach to the social and individual problems of substance dependence than criminalization of users. Interested in getting another point of view I left a voice message with the crew over at my favorite Canadian podcast, The Reality Check. In their latest episode the crew brings on Dina Tsirlin, who has done public health research in this area, to answer my questions. So give it a listen!
My Congressman by Fifteen (One of the greatest punk songs)