First in the Nation : Portland Addicts to Get Needles in AIDS Fight

The nation’s first experiment in giving clean hypodermic needles to drug addicts is to begin next month in Portland, Ore., testing a controversial AIDS-control strategy that has proven too politically unpalatable to be tried anywhere else in the country.

The needle exchange program, announced Thursday, is modeled on similar experiments abroad. The Oregon plan has won the cautious acquiescence of state health and law enforcement officials, who say it represents a rational, if regrettable, acknowledgement of the disturbing realities of acquired immune deficiency syndrome.

“The way of looking at it is we’re at war,” said Dr. Mervyn Silverman, president of the American Foundation for AIDS Research, which is financing the research project. “In wartime you do things you don’t do in peacetime, hopefully for the good.”

The experiment, which is not without critics, is seen by some as exemplifying the state’s and city’s often innovative approach to a number of social and public health problems ranging from homelessness to AIDS.

The project is aimed at controlling the spread of the AIDS virus among intravenous drug users--the fastest growing category of people affected by the fatal disease and the principal route by which it is reaching heterosexuals and infants.

The Portland social service agency running the project intends to exchange sterile needles and syringes for used, possibly contaminated, equipment. By eliminating the need to buy new needles, the agency hopes to reduce the needle-sharing that has been implicated in the spread of the blood-borne virus.

But the agency will also use the opportunity to educate needle-users, a group that has been difficult to reach through traditional AIDS prevention programs. All participants in the program will be counseled about AIDS and encouraged to enter drug treatment.

“It is easy to think about this as simply a mechanical process of exchanging needles,” said Hugo Maynard, a Portland State University psychologist. “But really the most difficult part . . . is having some kind of effect on the social psychology of intravenous drug users.”

The project will also be a scientific research effort aimed at answering questions that researchers hope may prove useful to other cities: Does a needle exchange program slow the spread of the AIDS virus? Does it increase or decrease intravenous drug use?

The researchers, led by Maynard, will track the participants, testing their blood and examining their drug habits every three months. They will compare the results from a study group of 125 people who complete the program to those of users in two other cities where no such program exists.

Maynard said he does not expect there to be a limit on the overall number of people allowed to get needles.

“We are not willing to support this kind of program without some evidence that this is an appropriate and positive thing to do,” said Norma Jaeger, manager of the Multnomah County Alcohol and Drug Program. “But we are willing to support finding out.”

Began With 2 Women

The project was developed quietly by a private nonprofit agency in Portland called Outside-In. More than a year ago, two pregnant women visiting the agency’s prenatal clinic tested positive for exposure to the human immuno-deficiency virus, which causes AIDS.

Because both cases involved intravenous drug use, the agency began examining the AIDS risk among drug users in the Portland area, where officials estimate that there are 7,000 to 10,000 intravenous drug users injecting such drugs as heroin, methamphetamine and cocaine.

But when the agency’s director asked about needle exchange programs elsewhere in the United States, she found that none had ever gotten off the ground. Political opposition has blocked attempts in San Francisco and New Jersey and is now stymieing efforts in Boston.

Only in New York City, where 60% of the estimated 225,000 needle users are believed already to be infected, has a small needle exchange effort received tentative approval. But the city has yet to receive its final go-ahead from the state.

In other parts of the world, by contrast, needle exchange programs began as early as 1984. They now include programs in the Netherlands, Scotland, England, Australia, Italy and Sweden. Initial results show no rise and perhaps a decline in drug use, at least as measured by drug overdoses and entries to treatment.

Finds Itself Alone

“It was surprising to us when we were unable to find any other program in the country distributing needles,” said Kathy Oliver, the executive director of Outside-In. “Because, to us, it did seem like a very rational thing to do.”

The agency’s board voted unanimously to try the project. Donors--from the United Way to the First Unitarian Church--did not object. Over time, tentative assent came from state and local bureaucrats, drug treatment programs, even law enforcement officials.

Jaeger, the county alcohol and drug program manager, contends that it is “hypocritical” to argue simply that drug users should enter treatment--at a time when there is not enough treatment to go around and the success rate remains relatively low.

Mike Schrunk, the county’s district attorney, makes a similar argument: “I don’t know of any law enforcement community that’s been able to stop all drug use. So if we can reach any of these people, I think we’re ahead.

“I don’t like this,” Schrunk said in a telephone interview. “I’m saddened that there’s such a problem that we have to do this. . . . But I’ve been assured that (Outside-In is) still going to take a strong, anti-drug usage stand. I’m willing to believe that.”

Why Portland would pioneer such a program is a topic of some speculation.

Relatively Small Group

Compared to larger cities, Portland has a relatively small population of needle users. Less then 5% of them are believed to be infected. But some officials suggest that Portland, for that reason, still has hope of containing the spread of AIDS.

Unlike California or New York, Oregon has no law requiring a prescription for the purchase of hypodermic equipment. So there is no need for any waiver of state laws in order to set up a needle-exchange program.

The state, city and social service agency all have traditions of innovative public health programs. The agency has worked for 20 years with groups like the homeless and street youths. The county already distributes to drug users condoms and bleach for cleaning needles.

“I think what we’ve mainly been successful in doing is putting together a public health program that meets reasonable standards and has avoided eliciting broad community condemnation,” Jaeger said.

“That doesn’t mean that any of us probably like the fact that this is necessary,” she said. “We would certainly rather that AIDS had never come along. We would rather be involved in the kind of wellness-oriented programs that everyone can . . . embrace. Like fun runs.”

The program is not, however, entirely unopposed.

Two Opponents

On Thursday, a former Portland police chief running for mayor suggested that the needle exchange program will sully the city’s reputation, and the director of an 18-month-old conservative citizens group said his organization opposes the scheme.

Lon Mabon of the conservative Oregon Citizens Alliance said the program fails to address the basic causes of drug abuse. Efforts should be focused instead on better education about drug risks and stricter enforcement of laws against drug abuse, he said.

“On the one hand, we’re saying drug abuse is wrong,” said Mabon, who said he will explore the possibility of legal action to block the program. “And yet we’re handing to the people doing it the paraphernalia that’s necessary to break the law.”