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Eric DeMoura
Professor Bedell
CAS 137 H
October 20, 2012
Paradigm Shift: Perception of Heroin Users and the Introduction of the Needle
Exchange Program.
Diacetylmorphine, or more commonly known on the streets as heroin, is an
opiate generated from poppy seeds found mainly in Southeast Asia. Heroin can be
used in a number of ways, including snorting, sniffing, or smoking, but the main
route of administration of the drug is injecting it into one’s veins with a syringe. The
outcome of the injection of this narcotic is a “surge of euphoria, the ‘rush,’
accompanied by a warm feeling of the skin, heaviness of the extremities, and
clouded mental functioning” i(Drugabuse.org). Continuous use of heroin leads to
increased tolerance of this poison, and users of heroin are at extremely high risks of
becoming dependent on it. Addicts of course are at a higher risk to the numerous
health conditions related to heroin use, including “fatal overdose, spontaneous
abortion, collapsed veins and… infectious diseases, including HIV/AIDS and
hepatitis.” When Injection Drug Users, or IDU’s, share needles for their habit, they
multiply the risks of contracting something as serious as the likes of HIV or hepatitis
significantly. Due to an explosion in the 1970-80’s in the number of heroin addicts in
the United States, coupled with an outbreak of the Hepatitis C virus and the
emergence of the HIV, the government shifted its approach from one solely focused
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on heroin use as a criminal act to one that also considered its vast health
implications, resulting in the Needle Exchange Program.
Opiates have been in use in American culture since the nineteenth century.
As morphine, the earliest derivative of poppy flowers, was prescribed as a painkiller
by doctors during medical operations, as well as traumatic injuries. Its effectiveness
was optimized in 1843 when Alexander Wood, a doctor from England discovered
the new technique of administration of the narcotic through a syringe, injected
straight into the bloodstream. The first mass-exposure to morphine occurred after
the Civil War, when veterans were treated with heavy doses of morphine, and the
number of addicts in the country sky rocketed, to the point where “tens of
thousands of Northern and Confederate soldiers became morphine addicts”
ii(Narconon.org).
In 1874, C.R. Wright became the first to synthesize heroin by
boiling morphine over a stove, in an attempt to create a “safe, non-addictive
substitute” (Narconon.org) for heroin. Heroin was sold as a cure for alcoholism,
tuberculosis, and common colds, among other things, until the 1920’s, when
Congress finally recognized the dangers of the drug and banned it under the
Dangerous Drug Act. By this time, however, it was too late, as there was an
estimated 200,000 heroin addicts in the United States by 1925 (Narconon.org). This
number would level off, and some experts even go as far as to say the number would
drop, until the 1970’s, and the Vietnam conflict.
In an attempt to stop the spread of Communism in Southeast Asia, the United
States and France not only supplied drug lords in the region with arms and
ammunition, but also provided transportation for their prized export, opium. East
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coast cities such as New York and Boston were (and continue to be) the main
inheritors of this plague, and the number of heroin addicts in the United States
would reach an all time high, with an estimated 750,000 people becoming
dependent on it (Narconon.org). There was little sympathy for these addicts at the
time, as popular formulations in the early 1970’s “emphasized peer group
pressure… and self-destructive themes” (Khantzian, 1259)iii to explain the nature of
drug addiction. Basically, it was a worldly view that if one was dependent on a hard
narcotic, such as heroin, it was because one was a weak, or even evil person, who
had no one to blame but themselves. However, psychoanalytic studies done in the
1970’s identified “psychological vulnerabilities, disturbances, and pain are
predispositions for individuals and drug dependence” (Khantzian, 1259). This
change in perception of drug users was a critical step in the development of
rehabilitation centers and the Needle Exchange Program, but it was not the most
significant trigger.
The 60’s and 70’s were a unique time in American history, to say the least,
with the “free love” and experimental drugs that accompanied it. It was a time when
the sharing of needles was commonplace among America’s youth, because quite
honestly the repercussions of distributing injection-based narcotics to several
people with a single syringe were unknown. The sharing of needles in this time
frame would coincide with an incredible number of cases of Hepatitis C, but that is
not to say that this was a coincidence by any means. It takes ten to thirty years for
chronic liver diseases, the main sign of HepC, to develop iv(CDC.gov), which is an
incredibly obvious indication that the sharing of needles caused the outbreak.
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During the 1960-80’s, the peak of the needle-sharing years, the average number of
cases of HepC was an astounding 240,000 cases a year – compared to an estimated
30,000 cases in 2000 (CDC.gov, 3).
This happened to just the tip of the disease iceberg, so to speak, as an HIV
epidemic hit the country in the early eighties. HIV was first discovered in
homosexual men, and this lead to a stigmatism in the gay community, one that only
homosexuals could contract the HIV or AIDS virus. The idea that only the
homosexual community could fall victim to the newly found virus was such a wideheld commonplace that it was originally coined GRID, or “gay-related immune
deficiency” in 1982 (Avert.org)v. It wasn’t until a newborn baby, who had had
multiple blood transfusions, died of AIDS, that it was determined that “AIDS was
caused by an infectious agent” (Avert.org) and was not just applicable to the gay
community. By the next year, those seen as major-at-risk individuals included -along
with homosexuals - Haitians, hemophiliacs, and heroin users. In 1983, the number of
cases in the United States had risen to over 3,000, an incredible spike considering as
of July 1982, there were only 450-recorded diagnoses (Avert.org). Scientists and
activists took to attacking the problem immediately in Europe, and one of the first
institutions put in to stop the spread of this epidemic was a needle exchange
program, started in Amsterdam in 1984. The project spread to the United States in
1985, and has grown ever since.
This project illustrates the train of thought that accompanies heroin users.
No longer do we, on a community scale or government scale, deny the responsibility
we must take in terms of public health. We can no longer take the stance that heroin
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addicts are only harming themselves by using their injection methods, because the
rates of terrible diseases, like Hepatitis C and the HIV, have skyrocketed as heroin
usage rates have raised. As of 2000, nearly one third of all HIV/AIDS cases in the
United States were directly or indirectly (indirect as when a pregnant mother
continues to do heroin, resulting in an infected and addicted child) related to
injection drug users (Vlahov & Junge)vi. This is a staggering number, but one which
makes sense in the context of the world at the time, as there were only 110 Needle
Exchange Programs, or NEP’s, in all of North America. This number doubled in the
past ten years, with there now being over 220 such programs in the United States
alone (Vlahov & Junge). Overall, data shows that NEP’s have greatly lowered the
number of positive tests of HIV/AIDS among injection drug users, with a report from
the New Haven NEP showing that participants in the program have a 33% less likely
chance to contract the deadly disease (Vlahov & Junge). A study from Tacoma,
Washington, displayed similar results, showing that those who did not participate in
NEP’s saw their chances of contracting Hepatitis C increase seven-fold (Vlahov &
Junge). Users of heroin are able to legally attain clean needles at these health
centers, which is a monumental change in the heroin addict landscape, because
before these outbreaks, prescriptions were needed to attain syringes and needles
from health centers or hospitals, and arrests for the possession of such
paraphernalia was common. The attitude has certainly changed since then however,
and as of 2006, 48 states in the United States had authorized needle exchange
without prescriptions, and as of 2012, 35 states had a legal syringe exchange
program run by the state government. One of the biggest healthcare issues of the
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late nineties/early twenty-first century was whether these programs should be
funded by the national government. Originally, in 1988, federal funding of these
programs was banned, but this band was lifted in 2009. However this was short
lived, as the ban was reinstated by Congress in 2011, leaving state governments to
both fund and run these programs at their own will. All these programs are not
intended to promote the use of heroin – in Massachusetts, for example, one of the
centers of opiate (OxyCotin, heroin, etc.) use on the East Coast, penalties for the
possession of heroin range from two to twenty years, depending on the amount on
one’s person. It should be made clear that heroin use is - as it was in 1970, with the
passing of the Controlled Substances Act, deeming it a Schedule I drug – still viewed
as a criminal act in our country, as it should be. However, it is no longer a case of
protecting the individual user’s health, but rather a pubic health and safety concern.
This paradigm recognizes that individuals who seek help and are, at the very least,
trying to reduce the amount of harm to others, and therefore should not be denied
of this privilege. Many centers offer some sort of rehabilitation to those who come
forward and participate in the NEP, and again, this rehabilitation is two-fold in its
purpose. It is not only seen as morally right to help our fellow human beings, but it
is extremely cost effective as well. It is estimated that health care costs associated
with hepatitis-related liver disease costs an upwards of $600 million dollars
annually (CDC.gov). It is also estimated that a person living with HIV/AIDS spends
approximately $200,000 dollars for treatment in their lifetime (aidsaction.org)vii. As
of 2012, the most recent data collected showed that in 2008, almost 1.2 million
Americans were living with an HIV infection (aids.gov). This number comes out to
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an astounding $240 billion dollars spent on HIV treatment, one third of which, as
previously mentioned, can be attributed to injection drug users. This is still a mindblowing number, with nearly $80 billion dollars annually being spent on injection
drug users/HIV patients a year. When compared to $37 million, the estimated
amount necessary to run every needle exchange program in the United States in a
year ($169,000 per program x 220 programs in the U.S.), the number looms even
larger.
The biggest issue today with needle exchange programs is the question of
whether or not we are actually solving the issue at the heart of the problem, or
simply finding lazy ways to curb it’s growth. Although there is significant evidence
which suggests that these programs, which make needle and syringes easily
attainable, do not promote heroin use in communities, it is fair to question whether
this is valid or not. However, what cannot be questioned is the curtailing of these
terrible diseases, as well as the spreading of awareness of public safety. This shift in
thought from one of a solely criminal outlook to one in which public safety was
seriously considered was a significant milestone in the history of injection drug use
in not only the United States of America, but the entire world
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Works Cited
AIDS Action. Needle Exchange Facts. June 2001. 24 October 2012
<www.aidsaction.org/legislation/pdf/policy_facts-needle_exchange2.pdf>.
IDU/HIV Prevention. Viral Hepatitis and Injection Drug Users. September 2002. 24
October 2012 <www.cdc.gov/idu/hepatitis/viral_hep_drug_use.pdf>.
International HIV/AIDS Charity. History of AIDS up to 1986. 2011. 24 October 2012
<www.avert.org/aids-history-86.html>.
Junge, David Vlahov & Benjamin. Public Health Reports. June 1998. 24 October 2012
<www.ncbi.nlm.nih.gov/pmc/articles/PMC1307729/pubhealthrep000300079.pdf>.
Khantzian, Edward J. Self Medication Hypothesis of Addictive Disorders: Focus on
Heroin and Cocaine Dependence. November 1985. 24 October 2012
<www.ap.psychiatryonline.org/data/journals/AJP/3404/1259.pdf>.
Narconon International. History of Heroin and Opium Use And Abuse. 2010. 24
October 2012 <www.narconon.org/drug-information/heroin-timeline.html>.
National Institue of Drug Abuse. Heroin. October 2012. 24 October 2012
<www.drugabuse.gov/drugfacts/heroin>.
(National Institue of Drug Abuse)
(Narconon International)
iii (Khantzian)
iv (IDU/HIV Prevention)
v (International HIV/AIDS Charity)
vi (Junge)
vii (AIDS Action)
i
ii