Fischer M; Center for Strategic and International Studies. A story of banning federal funding for needle exchange programs. 6 February 2012. www.smartglobalhealth.org/blog/entry/a-history-of-the-ban-on-federal-funding-for-syringe-exchange-programs/. Retrieved 19 January 2016. Why Obama doesn`t fund needle exchange programs. Hour. 16 May 2009. content.time.com/time/nation/article/0,8599,1898073,00.htmlAccessed January 26, 2016. Drug paraphernalia laws, if they are to be consistent with public health objectives, should emphasize the prohibition of the illegal sale, rental or distribution of injection drug devices. Such prohibitions would affect the drug dealer or the owner of a shooting range, but not the doctor, pharmacist or health official. The law would regulate the sale of syringes and subcutaneous needles in the same way as it currently does – ensuring that they are only sold in appropriate locations (e.g., pharmacies, not candy stores) by trained and experienced professionals, and that the equipment is in a safe and sterile condition.

It would not be true that the authorized seller did not know the buyer`s intention. Most importantly, the addicted purchaser is not deterred by the threat of criminal penalties for purchasing, possessing or using sterile injection equipment. Any unauthorized person who sold or distributed the equipment would continue to be prosecuted. The public health approach does not require the legalization of drugs, nor does this document support such a proposal. Whether society ultimately decides to relax or lift criminal prohibitions on drug use, the morbidity and mortality associated with the drug and AIDS epidemics will continue to require carefully crafted health policies with adequate financial resources. Only criminal prohibitions that impede public health efforts need to be reformed. When properly designed, drug control and public health can exist in harmony and even synergy. Opposition to the NEP in the United States was purely ideological [12] and stemmed from the political position that the NEP «undermines the credibility of society`s message that drug use is illegal and morally reprehensible» [20]. The federal ban on NEPs began in 1988 after North Carolina Senator Jesse Helms equated the NEPS with federal support for drug addiction [17] and led Congress to enact a ban on the use of federal funds for such programs [21]. This prohibition was imposed by the Public Health and Welfare Act, Section 300ee-5, which stated that «no funds provided under this Act or any amendment to this Act shall be used to provide needles or syringes to individuals to enable such persons to consume illicit drugs» [22]. However, this was not an absolute prohibition [21], as Congress had included a provision in the ban stating that the funding ban could be lifted if «the Surgeon General of the Public Health Service determines that a needle exchange demonstration program would be effective in effectively reducing drug abuse and the risk of public infection with [HIV]» [22]. Despite evidence from the medical and public health community that NEPs reduced the transmission of infectious diseases, subsequent legislation in the years following this legislation focused solely on treatment, renewed the ban, and included it in the highly regarded federal HIV/AIDS program, Ryan White Comprehensive AIDS Resources Emergency Act [23].

Researchers have identified strong social and cultural forces that create an environment conducive to sharing injection drug use devices. However, this sharing is not just a learned response or a function of the culture and routines of drug users. It is also a direct result of a limited supply of needles and syringes, which can deprive drug users of realistic opportunities for safer behaviour.10, 11 Most drug users report that the lack of injecting equipment is an important reason for sharing. Instead of obtaining sterile syringes and needles from pharmacists, health professionals or health services, they source injection equipment from street vendors and shooting ranges.12, 13, 14, 15, 16, 17 The continued use of informal programmes risks intensifying the unproductive struggle between public health objectives and drug control. Exchange volunteers and customers shouldn`t have to worry about informal arrangements where law enforcement officers don`t stop, district prosecutors don`t prosecute, and courts don`t convict. A judge in the New Jersey Municipal Court, like the judges in the New York and Boston cases, said that any remedy has its own facts, that the court would not allow its decision to be considered «a license for other well-intentioned groups or individuals to court this community and engage in a needle exchange program» [State of New Jersey v. Carl Sigmon, Rodney Sorge, Brad Taylor and Jon Parker, City Court, Hudson County, Jersey City, N.J., File No. V70-V81, November 6, 1991]. In the 1990s, an expert panel at the Institute of Medicine recommended that the U.S.

government lift the federal ban on needle exchange programs based on evidence that such programs reduced HIV rates without increasing drug use [24]. In addition, the Centers for Disease Control and Prevention conducted its own review of the NEPs and found equally positive results [25], giving even more legitimacy to the call to lift the ban. State-authorized exchanges have clear advantages over clandestine programs. Formal exchanges can be used to promote public health and can be established under well-defined circumstances. These circumstances could include: Twenty states that positively allowed PHC had provisions exempting PHC participants from the crimes of possession of needles or accessories. This figure includes 3 states (Connecticut, Illinois and Massachusetts) where court approval has been incorporated into law. Eight states do not prohibit simple possession of drug paraphernalia (i.e., possession without intent to sell or distribute). Laws that explicitly exclude syringes from the definition of illicit paraphernalia present in 3 states reduce legal questions about possession by consumers in the same way they do when distributing needles.

Six States did not refer to syringes, hypodermic devices or objects used to inject drugs in their accessory laws. Utah had an exception for unused syringes in sealed sterile packages. Four states have granted immunity to individuals who disclose possession of needles to police officers prior to the search. Eighteen states, including 7 states, that had laws approving or reducing legal barriers to PHC had no laws that eliminated or reduced the legal danger to PHC participants related to needle ownership. Ten states had explicitly restricted arrests or prosecutions for possession of illegal drug residues in used syringes. If legislators, public health officials or community organizations establish needle and syringe sharing, they may need to establish legal authority for such programs. There are several legal strategies to introduce needle and syringe exchange into law: Most states and virtually all of Western Europe do not have laws on needle prescribing. These jurisdictions and many others allow over-the-counter syringes and needles to be sold over-the-counter.31 Your experience has shown no obvious adverse effects. They generally have a lower prevalence of HIV infection among drug users and lower rates of drug use than states that have such laws.26, 28 While general data of this type do not provide scientific evidence of a causal effect, they complement reports from drug users and researchers who say that sharing is linked to the inaccessibility of sterile devices.32 In 1988, David Purchase, a former addiction counselor, started a needle-and-syringe exchange program in Tacoma, Washington, in violation of state law, but with the support of the police chief. In January 1989, the Tacoma County Board of Health voted to formally implement the program and pay a salary to Purchase.39 In July of that year, the Attorney General issued an opinion that the program violated the state`s Drug Accessories Act. The county health officer filed a lawsuit seeking a declaratory judgment that the exchange program was legal.

The court held that the program did not violate the law [Allen v. City of Tacoma, No. 89-2-09067-3 (Wash. Super. Ct., Pierce County, May 9, 1990)] because the Act provides an exemption from liability for government officials engaged in the lawful performance of their duties. The court also noted that the Washington AIDS Act (Wash. Rev. Code, § 70.24.400 (Supp. 1990)) permits locally developed public health programs to control the spread of HIV through needles. The defence in needle exchange lawsuits has generally relied on a wealth of public health evidence and testimony on all the necessities: the rapid spread of locally transmitted needle infections, the absence of government-sanctioned exchanges, the scarcity of treatment, and research evidence showing the impact that formal exchanges in other jurisdictions have on seroprevalence and drug use. has..