San Francisco Chronicle - Tuesday, October 27, 1998
Reynolds Holding, Chronicle Legal Affairs Writer

It would take Dr. Milton Helpern, assistant medical examiner, until March 1934, but with help from two narcotics detectives he made the connection: The dead addicts had shared home-made syringes contaminated with malaria.

"This method of taking the drug is comparatively new in New York," explained Helpern in a 1934 article on the outbreak, "but has been practiced for many years in other localities."

Over the next 64 years, the emergence of AIDS, hepatitis and other deadly diseases would heighten the danger of sharing syringes to inject illegal drugs. Today, directly or indirectly, contaminated needles cause 40 percent of new AIDS infections in the United States, according to Surgeon General David Satcher. The figure among women and children is 75 percent.

The statistics have intensified a search for ways to stop the sharing of syringes and needles. One response has been the development of syringes that are impossible to use more than once. But these single-use -- or autodestruct -- syringes have not caught on in the United States, in part because few are available here.

Seeing little demand in the U.S. health care industry, manufacturers market them almost exclusively for medical use in developing countries. Even if more were available, though, drug addicts might not want them.

Autodestruct syringes are more expensive, and a new one would be required for each high.

"It's like using a fork which self-destructs after you put a bit of food into your mouth," explained former drug user Bruce Stepherson at a conference on autodestruct syringes in 1991. "This is not practical unless one is receiving forks free of charge."

If autodestruct syringes were the only ones available, addicts would either defeat the single-use mechanism or make reusable syringes from eyedroppers, old needles and modified baby pacifiers, said Stepherson.

"In the same way you and I are concerned with the costs associated with the necessities of life," he said, "so too is the drug injector with the necessities of getting high."

A far more controversial response to needle sharing has been needle exchange programs, where drug addicts can get sterile syringes for free. There are about 100 such programs in more than 20 states.

A growing number of studies shows that needle exchanges often help prevent the spread of disease without encouraging illegal drug use. Seven major surveys -- including one conducted in 1993 by researchers with the University of California at San Francisco -- have found that programs reduce syringe sharing and the spread of HIV dramatically while sending thousands of participants to drug treatment.

But opponents such as Barry McCaffrey, the Clinton administration's national drug policy director, contend needle exchanges convey the wrong message: that illegal drug use is an accepted way of life.

And in July, President Clinton acknowledged the benefits of the programs while refusing to lift a 9-year-old ban on federal financing of needle exchanges -- a decision that provoked outrage from all sides, even within the White House.

"Basically, they made a political decision," said Dr. Peter Lurie, a public health advocate and professor affiliated with UCSF. "For those of us who have been laboring in the field for years, it was an enormous slap in the face."
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