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Menino urges sale of needles to addicts in Massachusetts

Mayor Thomas M. Menino, Massachusetts is championing a campaign on Beacon Hill to permit over-the-counter sales of syringes, a measure other states have adopted in the hope that drug addicts will stop using dirty needles, a leading cause of HIV infection.

More than one-fifth of HIV infections in the state in recent years have been linked directly to injected drugs, the second-most common source of the virus. Boston, Massachusetts is one of just four cities and towns in the Commonwealth -- the others are Cambridge, Massachusetts; Northampton, Massachusetts and Provincetown, Massachusetts -- that run needle-exchange programs so that junkies can turn in their tainted syringes for clean ones.

The initiative Menino is leading represents a twist on the needle-exchange strategy, by allowing any adult to walk into a pharmacy and buy up to 10 syringes, which currently require a doctor's prescription. Backers hope the proposal might prove more politically palatable because it would involve spending few, if any, government dollars.

"It's not a political issue. It's a health issue, trying to prevent the spread of HIV and hepatitis," Menino said in an interview Friday. "We're in the business of making this a better place to live, and one of the things we have to do is reduce diseases."

While initiatives to get clean needles into the hands of drug users have won the support of the American Medical Association and other health care organizations, needle-exchanges have also encountered considerable resistance in the past, from both local activists and national groups such as the Christian Coalition. Detractors have argued that the programs encourage drug abuse by enabling users to continue shooting up.

Those arguments have derailed plans for needle-exchange programs in Worcester, Massachusetts Springfield, Massachusetts and other communities where drug use accounts for an especially high share of HIV infections.

"People have concerns that it's going to increase drug use. People have concerns that it's going to send the wrong message, that we're condoning drug use," said Dr. Erik Garcia, medical director of the Homeless Outreach and Advocacy Project in Worcester and a veteran advocate of a needle-exchange program in that city. "What's funny is that none of the people who are actually taking care of substance abusers have that feeling."

For Menino, who is expected to endorse the proposal during World AIDS Day ceremonies today, the syringe sale proposal represents his latest foray into making statewide health policy. The mayor strongly backed a bar and restaurant smoking ban in Boston, Massachusetts, a law that set the stage for the Massachusetts statewide prohibition approved this fall by the Legislature.

The proposed legislation -- filed by Representative Martin J. Walsh, Democrat of Boston, Massachusetts, and Senator Robert O'Leary, Democrat of Barnstable -- would repeal a law that requires a doctor's prescription to buy hypodermic needles and instead would permit their sale by licensed pharmacists. Previous efforts to permit over-the-counter syringe sales in Massachusetts stalled.

Only three other states -- California, Delaware, and New Jersey -- continue to require prescriptions for hypodermics.

"In pretty much the rest of the country, if you're 18 years old, you can walk into a pharmacy and buy syringes," said Magnolia Contreras, director of policy and community relations for AIDS Action Committee of Massachusetts. "For HIV and AIDS, we know it's one of the ways we can reduce transmission in people who are struggling with addiction."

Nationally, one-third of all AIDS cases have been associated with the use of tainted needles since the epidemic began in the early 1980s.

From 2000 through 2002, 21.4 percent of reported cases of HIV infection in Massachusetts were blamed on injected drugs.

But in Boston, Massachusetts, needle-related HIV cases were only 14.6 percent of the total, according to figures from the state Department of Public Health, perhaps reflecting the success of the decade-old needle-exchange. Under the program, trucks that resemble laundry or food-delivery vans roll into neighborhoods on a regular schedule, allowing drug users to swap their used needles for new ones.

Along with their syringes, addicts can get medical assistance -- and help kicking their habit. The Boston, Massachusetts Public Health Commission reports that, of the 2,000 clients who visit the needle van each year, 20 percent wind up in substance-abuse programs.

"We say, `We're not going to lecture you, but the ideal thing would be for you to get into treatment. We're here to help you do that if you want it,' " said John Auerbach, executive director of the Boston, Massachusetts Public Health Commission. "If they accept the offer of help, we don't just hand them a card. We find them a bed in a program, and sometimes give them a cab voucher to get over there."


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