The United States spends an estimated $50 billion every single year in drug-related enforcement efforts, with little to show for it. While incarcerated populations swell and private prisons turn staggering profits, millions of people go without basic medical treatment. Hundreds of thousands are exposed to preventable diseases and infections. Tens of thousands overdose and die. The ripple effect on families and entire communities is basically incalculable.
The consequences of our current drug policies, disproportionately shouldered by people of color, are poverty, illness, misery and death. Lawmakers, historically, have been pretty OK with the human toll of beefed up criminalization efforts and gutted prevention and treatment budgets. But the political tide may be turning, however slowly and unevenly.
One sign of the shift: a small number of states, some with Republican-controlled legislatures, have started to reconsider needle exchanges in response to rising numbers of HIV and Hepatitis C infections related to intravenous drug use.
A needle exchange is very much what the name suggests. They replace used syringes with sterile ones to prevent the spread of disease. The service is either low-cost or no-cost. There are currently around 200 in the United States, and 97 percent of these facilities provide other public health services, including treatment referrals, HIV counseling and testing, and basic health care.
There is ample data showing that needle exchanges help prevent the spread of disease, which is why public health experts and harm reduction specialists support them. And because lifesaving care isn’t always cost neutral (and really shouldn’t need to be), consider it a bonus that these programs make great financial sense. According to data gathered by the ACLU, it costs a city an average of $160,000 each year to run a needle exchange program, whereas a single year of public health expenditures related to care for a person living with AIDS costs around $120,000.
It’s good policy that saves lives. But as it tends to go with other personal and public health issues (family planning, abortion, health care in general), there is a major gap between what medical experts recommend and what lawmakers actually do.
But conservatives in Indiana may be waking up in response to a recent HIV outbreak in a rural part of the state. Despite a stated opposition to needle exchanges, Republican Gov. Mike Pence earlier this month approved a measure that would allow counties to set up needle exchanges. But there is a catch: counties have to prove that they are in the midst of a full blown HIV or Hepatitis C crisis in order to qualify. It may be a low bar for progress, but a shift on needle exchanges, however partial, will save lives in Indiana.
Lawmakers in Indiana may be swallowing the bitter pill of needle exchanges to address a health epidemic, but there’s no indication that Congress is ready to catch up and lift a federal ban on funding these programs. As the New York Times reported earlier this week, “Congress appears unlikely to overturn the moratorium even with drug problems hitting hard in states represented by those responsible for the spending bills that impose the ban.”
More from the Times:
Representative Harold Rogers, the Republican who is chairman of the House Appropriations Committee, has seen drug addiction spread in his rural district in southeastern Kentucky, leading him to direct money home for both treatment and law enforcement. But a spokeswoman says he remains opposed to needle exchanges, which he considers a matter of local discretion.
“While he will continue to monitor the implementation of these programs and their impact, he continues to support the ban on the use of federal funds for needle exchange programs,” said the spokeswoman, Jennifer Hing. She added that Mr. Rogers intended “to focus federal resources on education and treatment programs that support communities in their drive to end the cycle of dependency.”
But as Tara Culp-Ressler pointed out on Tuesday at ThinkProgress, some Republicans in states like Oklahoma , Kentucky and West Virginia recognize that there is a cost to inaction. “I’m certainly willing to look at [needle exchanges] as an option,” said Sen. Shelley Moore Capito, a Republican from West Virginia. “Our state is really suffering from this. It’s very worrisome.”
It’s a welcome bit of candor and perspective, but it’s hardly the guiding ethos when it comes to drug policy. Particularly stark when it comes to drug use during pregnancy.
Pregnant drug users are often treated like a distinct category of person, with distinct and lesser rights. Tennessee flouted recommendations from the American Medical Association, American Academy of Pediatrics and American College of Obstetricians and Gynecologists and enacted a law criminalizing women for using drugs during pregnancy. Counter to the expanded treatment programs counseled by leading medical organizations and local public health experts and physicians, the state in 2014 became the first to jail women based on their pregnancy outcomes.
The law allows prosecutors to charge a woman with criminal assault if she uses illegal drugs during her pregnancy and her fetus or newborn is considered harmed as a result. The law has done little to improve pregnancy outcomes in the state, but there is evidence to suggest that it has driven women out of the state to seek medical care and treatment where they don’t fear arrest.
Listen to the lawmakers who support Tennessee’s criminalization law and the responses are remarkably similar to holdouts on needle exchanges: they don’t want to appear lax on drug use.
But the a hard line on effective treatment is a difficult one to walk, even for some staunchly conservative Republicans. Republican state Sen. Mike Bell, one of the few lawmakers -- Republican or Democrat -- to vote against Tennessee’s criminalization law told me in 2013 that he opposed the policy because he knew it would hurt the women in his district.
“I represent a rural district,” he said at the time. “There’s no treatment facility for these women there, and it would be a substantial drive for a woman caught in one of these situations to go to an approved treatment facility. Looking at the map of the state, there are several areas where this is going to be a problem.”
Some congressional Republicans may be taking a similar approach -- both pragmatic and compassionate -- to needle exchanges. “As Republicans, we don’t want to look like we are facilitating drug use,” Rep. Tom Cole, Oklahoma Republican and chairman of the appropriations subcommittee that controls health funding, told the Times. “We want to get you help, but we want to do other things.” But, he conceded, “If the evidence is such that [needle exchanges] really makes a difference, it is something to look at.”