“I don’t understand. Why would you, with all your experience and training, vote for a needle exchange program that supports the habits of drug users?” Her question was not rhetorical. Her face flushed with emotion, angry tears in her eyes, she radiated the frustration behind her outburst. Though the need for answers was obviously deep, she was too overwhelmed to wait through any discussion and stormed out of the room.
I fully understood her point of view, as well as her expectation that I should know better than to entertain what she saw as a completely irresponsible position, counter to all that I should know. But it was precisely my experience, as well as all my education and training, that over the years had brought me slowly but convincingly toward my present convictions on the subject. Like many of us, she may have had close and painful experiences with the devastating results of drug abuse, and with addiction. She may even have taken courses where professors taught the evils of drug use with passion, hoping to spare their young charges the life changing downward spiral of drug use. Or, she could easily be a social worker, or health care provider, daily living with the emotional draining and burnout of working with abusers and addicts. Who would blame her for her perspective on the subject? As I often tell my students, where we stand on a given issue depends on where we stand in life. Experience is valid; it is real. With social problems, however, it just can’t be generalized to explain the whole issue.
Without comprehending the whole issue, we fail to take other valid points into our understanding. And without those other valid points, we make decisions that are almost guaranteed to produce negative unintended consequences.
What are some of those other valid points?
- Drug abusers use and share dirty needles. This leads quickly and devastatingly to increased numbers of diseases, primarily HIV and Hepatitis C. Even if only drug users were to be affected, the incidence of disease could reach epidemic proportions.
- When users respond to and comply with the regulations of a needle exchange program, they can be tested for HIV and HepC, and immediate treatment begun. The cost of a needle exchange program is high, and the additional cost of treating one HIV patient could be as high as $100,000. There will be more than one patient. This is a commitment of both financial and emotional proportions that is, and should be, taken seriously by any community.
- The cost of not doing it is exponentially higher. First, an untreated HIV victim is likely to progress into full-blown AIDS. THE COST OF TREATING ONE AIDS PATIENT FROM THE TIME OF DIAGNOSIS TO DEATH IS, ON AVERAGE, ONE MILLION DOLLARS. Second, that untreated carrier of HIV and/or HepC is eventually going to infect any number of others in a variety of ways: Family, sex partners, healthcare workers, First Responders, law enforcement officers, good Samaritans…all are at risk. They are not the limit, however. And each one infected is going to generate costs of $100,000 to $1,000,000. The financial costs do not even begin to quantify the emotional and productivity costs to everyone from family to the entire community.
In other words, no matter the cost of the program, the cost of NOT having the program in the presence of a proven epidemic is incredibly higher!
Given #s 1-3, we have only looked at the actual costs of having, or not having, a needle exchange program. But what about the perspective of those who resent what they see as a moral, or an ethical, objection to “helping” drug abusers and addicts?
To this, I would answer first of all that the issue is NOT only about drug addicts. IT IS A PUBLIC HEALTH ISSUE. It is simply not rational to fail to protect our families, neighbors, public servants and health care workers because of our antipathy toward ANY one group of people, no matter how deeply that antipathy is grounded in our being.
Second, I would remind those of us who claim to be Christians, that–all appearances to the contrary–these abusers and addicts are still human beings. Once, many were teenagers or young adults who in the blissful ignorance of their mortality succumbed to the desire for the drug-induced high, the shared forbidden experience with like-minded peers.
Others were veterans, returning with dependencies or addictions already in place as one of the costs of defending our rights to live in freedom. Still others began as patients, some who were denied proper medication and sufficient care by our laws; others who for any number of reasons (rational or irrational) took to the streets when their increased tolerance for drugs failed to meet their need for them.
And finally, the fact is that addiction is not something anyone deliberately chooses for their life. No one looks forward to that relaxing drink after a hard day at work, or even a drug-induced escape from the stresses of life, believing that one day in the future they will be a slave to a substance that no longer provides these things, but instead has become a painful, frightening and life-threatening craving, constantly demanding to be satisfied. Instead, we either say “I can’t handle [the substance]” and leave it alone; or we believe that “I can handle it,” and take our chances.
Many, in fact, may be able to handle it better than others. However, no one is fully immune from potentially developing the disease of addiction. We are learning more about risk factors on almost a daily basis, but we still cannot predict with certainty who will develop addiction.
The disease is one in which the reward center of the brain runs amok, refusing to turn off when the need for the reward is satisfied. Aside from he repeated use of the “addicting” drug, there are risk factors:
1. Genetic factors actually account for about half of the likelihood that an individual will develop addiction.
2. Environmental factors (i.e. where and with whom do you live and work) are influential. Unstable social supports and problems in interpersonal relationships affect the risk.
3. Individual resiliencies (through parenting or later life experiences) are important.
4. Culture also plays a role, as does exposure to trauma or stressors.
Also at risk are those who suffer from chronic disease, depression, or who feel themselves alone in the world–that no one cares if they live or die.
We may never eradicate drug abuse. That is no excuse for refusing to accept the personal and financial responsibilities for changing our perspectives about those who become victims of it.
What have we got to lose by changing the ways we think about this issue and working to alleviate it? By helping users and addicts to stay alive long enough to be helped and encouraged onto a pathway out of active addiction? In our thousands of years of civilization, we certainly haven’t accomplished much with our old ways of attempted control of drug abuse. I believe it is worth trying, worth the effort to erase the stigma of addiction and restoring the will to change that must happen before an addict can fight their addiction.
After all, when a person repeats the same ineffective activity over and over, expecting a different and positive result, has this not become one definition of insanity? Haven’t we criminalized the disease of drug addiction long enough? Don’t we need to stop the insanity? Dealing in a positive manner with addicts early enough has the potential to lower the rate of addiction that eventually leads to serious criminal activity in order to feed the addiction. Must we simply stand by and watch this happen? Programs like needle exchange and early testing in clinics don’t increase the problem. They are the only thing proven useful so far in decreasing the infectious diseases, the illegal drug use, and the consequent costs to the community.
I choose, however, to see this not as a dilemma of abandoning a moral issue for a practical one, but rather the blessing of making the right choices, for all the right reasons.
Reference for the risk factors and definition of addiction: