Chicago Tribune - July 31, 2003
Steve Chapman

This elementary insight is one resisted by many supporters of the drug war. They fear that if we reduce the risk of gruesome death from injecting heroin or other drugs, everyone this side of Hilary Duff will soon be lying in a gutter with a needle in her arm.

They don't want drug users to practice their habit in a less dangerous way; they want them to give it up, period. Any assistance that doesn't tell addicts they must stop using drugs, immediately and forever, is seen as actively promoting irresponsible conduct.

That's why uncompromising prohibitionists, many of whom are in positions of power, have long opposed one simple step to prevent the transmission of the AIDS virus by drug users: giving them access to sterile hypodermic needles. It's also why they are not lining up to support an innovation that would save addicts when they overdose on heroin.

At least 28 percent of new AIDS cases in 2000 stemmed from injection drug use. Some hard-liners think it's rough justice for those who insist on using illegal drugs to get AIDS and die. Unfortunately, it's hard to detect any sort of justice when the wives, husbands, lovers or children of these people get AIDS and die through no fault of their own. Nor is it fair for law-abiding taxpayers to pay the medical bills of those infected with HIV.

You could build a skyscraper out of all the studies documenting the public-health value of clean needles. Let drug users have uncontaminated equipment and, it turns out, they will forgo the chance to inject themselves with HIV microbes. After Connecticut scrapped its prescription requirement for buying syringes, needle sharing fell by 40 percent.

Not only that, people who don't use heroin, upon learning they could get clean utensils, generally don't decide they want to be slaves to opium. In fact, needle-exchange programs often serve as a gateway to get existing addicts into treatment.

Armed with all that knowledge, Gov. Rod Blagojevich last week signed a bill, pushed for years by State Rep. Sara Feigenholtz (D-Chicago), legalizing the over-the-counter sale of up to 20 syringes. Only five states still require a prescription for hypodermic needles.

The general change of heart offers hope about another method for keeping drug users out of the graveyard. The federal government reports that emergency room admissions of people using heroin rose by nearly 50 percent between 1994 and 2001. Thousands of people die each year from heroin overdoses. Fortunately--well, some people think it's fortunate--there is a simple, well-established remedy for this malady.

A drug called naloxone, administered by syringe, safely and immediately reverses the respiratory failure that leads to death. There is no doubt about its efficacy. Dan Bigg of the Chicago Recovery Alliance, which has trained people in using the medication, says the effort has produced 165 "reversals"--lives saved--in the Chicago area.

Bigg wants Illinois to follow up the new syringe law with a measure to exempt physicians from liability if they give naloxone to patients for heroin overdoses. Just as people with severe allergies or diabetes carry drugs that can prevent sudden death, he thinks heroin users and their family members and friends should keep naloxone at hand to avert drug-induced suffocation. New Mexico recently eliminated criminal and civil liability for anyone administering it.

Another option is to allow the sale of naloxone, now a prescription medicine, over the counter, making it far easier to get. Since the medicine has no enjoyable properties, there's no chance it would be abused. And there isn't much risk that more people would use heroin if they had a lifesaving antidote, since receiving the antidote is not a pleasant experience.

This remedy will doubtless evoke opposition from anti-drug zealots, who are suspicious of anything that diminishes the danger of drug use. They're right that it would be nice if every heroin user would just swear off the stuff, or at least seek treatment to conquer their addiction. Given time, some will. But there's no rehab in the morgue.

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E-mail: schapman@tribune.com

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