Annals of Health Law
ACHIEVING AN AIDS-FREE GENERATION
Despite the evidence supporting SEPs as a prevention measure, SEPs face
strong opposition.65 Opponents express concern that supporting SEPs
excuses injecting drug use66 and will increase the number of IDUs by creating
a network of known users.67 In some states, “zero tolerance” policies for
drugs and drug paraphernalia allow no exceptions for even the most
compelling reasons—such as preventing transmission of life-threatening
diseases like HIV.68 Zero tolerance policies perpetuate tension between
health care professionals who consider IDUs to be patients, and law
enforcement officials who consider them to be criminals.69 Moreover, as
described further in Part II, any programs that do operate may do so at their
of HIV Among Injection Drug Users: A Simulation Study, 80 J. URBAN HEALTH 302 (2003)
(finding that while needle exchange programs, NEPs, are effective at reducing general risk,
the greatest impact of NEPs is on populations of “high-risk” IDUs); Abby E. Rudolph et al.,
Comparison of Injection Drug Users Accessing Syringes from Pharmacies, Syringe Exchange
Programs, and Other Syringe Sources to Inform Targeted HIV Prevention and Intervention
Strategies, 50 J. AM. PHARM. ASS’N 140 (2010) (finding IDUs more likely to use a new sterile
syringe for each injection when obtained from an SEP).
65. Semaan et al., supra note 41, at 103; David J. Merrill, Comment, Compassion for Drug
Addicts or Government-Sanctioned Drug Use?: An Overview of the Needle Exchange
Controversy, 23 PEPP. L. REV. 939, 941–42 (1996).
66. WILLIAM MARTIN, NEEDLE EXCHANGE PROGRAMS: SENDING THE RIGHT MESSAGE 10
(2009), available at http://bakerinstitute.org/publications/DRUG-pub-MartinNeedle
ExchangeUpdate-011609.pdf; Gostin, supra note 32, at 132; Ban Lifted on Federal Funding
for Needle Exchange, supra note 19 (reporting that those criticizing the modification to the
ban fear that doing so provides incentives to continue drug use).
67. Martin T. Schechter et al., Do Needle Exchange Programmes Increase the Spread of
HIV Among Injection Drug Users?: An Investigation of the Vancouver Outbreak, 13 AIDS
F45, F49 (1999). However, this study found no evidence that participation in NEPs increased
needle sharing or risky behavior. See id.; see also Am. Found. for AIDS Research, Syringe
Exchange, BACKGROUNDER (June 2011), http://www.amfar.org/uploadedFiles/On_The_Hill/
SEPbackgrounder.pdf?n=3777; Joseph Guydish et al., Evaluating Needle Exchange: Are
There Negative Effects?, 7 AIDS 871 (1993).
68. See, e.g., State v. McCague, 714 A.2d 937, 944 (N.J. Super. Ct. App. Div. 1998); State
v. Sorge, 591 A.2d 1382, 1384–85 (N.J. Super. Ct. App. Div. 1991) (The state of New Jersey
“refuse[d] to treat as trivial the possession of even the most miniscule amounts of a controlled
dangerous substance,” under the state’s “zero tolerance drug policy.”); Tempalski et al., supra
note 18, at 437–38 (“[T]he United States has been the historical leader in law enforcement and
abstinence-based approaches to illicit drug use . . . .”). However, there is little evidence that
an aggressive criminal law approach has “succeeded in reducing drug use, infectious diseases
in [IDUs], or overdose mortality of [IDUs].” Semaan et al., supra note 41, at 103.
69. Tempalski et al., supra note 18, at 437.
70. See infra notes 90–93 and accompanying text (discussing State v. McCague, 714 A.2d
937); Leo Beletsky et al., The Roles of Law, Client Race and Program Visibility in Shaping
Police Interference with the Operation of US Syringe Exchange Programs, 106 ADDICTION
357, 362 (2010) (concluding that “SEP authorization and laws governing syringe possession
do not influence substantially the frequency of police interference”).