Opinions on Harm Reduction Initiatives

[Trish77]

There is an article in my newspaper today regarding the battle brewing over harm reduction intiatives - programs that provide clean needle kits, crack pipes, etc. to addicts to prevent the spread of disease.  There is one site in B.C. that provides public health nurses to assist with injecting safely and is admittedly very controversial.  The funding for these come largely from the province (this is Canada, so the equivalent of a state government in the U.S.)  

This approach is very controversial of course.  It's seen by some as perpetuating the problem rather than addressing it.  By others, it's seen as limiting the damage that would be done otherwise.

Tough thing to ask here perhaps.  Wondering if anyone has opinions on whether this is a regrettable necessity or if it is a misguided effort to do the right thing but in the wrong way.  

Since I'm asking .. I'll state that for myself, I'm perplexed by the whole thing and it seems as if in preventing one problem, the spread of communicable disease, we're prolonging the other problem, substance addiction.  However, there's still much I don't grasp on this and wondering if others have thoughts they want to share on this.

Hoping we can keep this respectful to each other.

Trish

[merryBe]

I think the way they relabeled the boards has people confused.

they should have had a HEP C-medical questions or issues side
and a Hep C social side....

instead they labeled the medical side as "Community", further clouding things.

I've been meaning to write to Cindy about this.
maryB

[merryBe]

Hot topic Harry...maybe we should rename you??

Amsterdam alone is the poster child for failed drug policies, more addiction, more prostitution and more STD's and smuggling/slave trade....the productivity of the Dutch has taken a nose dive comparitive to the rest of Europe, only the investments of prior generations now invested abroad (big wonder as to why) are what is keeping the government from insolvency.

It's always going to be a dilemna...do we teach more condoning than compassion in our efforts to reform. Do the young not mistake our needle philanthropy for license?
For that matter, B and D could put GET HELP on each syringe with a toll free number for 30 days of free treatment....like that will happen.

the whole process irritates me. they hand out Ru86 pills at my daughters school....And NEVER tell them what the possible permanent side effects could be.
sure that will save back street abortions...but will also make many infertility, cancer and worse...

On the other hand, if we don't pass out condoms...those opposing it are accused of wanting disease to spread or of trying to ethnically cleanse certain subgroups, by spreading HIV. Last I looked though, people do risky behaviors based on many factors in their lives and pasts. The idea that junkies will go out for clean needles is fairly ludicrous as someone pointed out.   OH sure....one OCD clean geek might....but for every one of him there's a thousand who aren't going anywhere as long as there's dope and one syringe around.  (now obviously addicted nurses and doctors might be an exception here, but that hardly proves a need or good end result.)
In fact, I don't think needle exchanges have lowered the rate of spread of blood borne disease in cities using it. If they have, we'd have heard about it.

here;s the dilemna.....
you want to do drugs....so we provided the tools...stopping short only of supplying the drug
you want to have sex, ...so we provide the tool .....if not the willing participant.
you want to kill your offspring so we provide the tools.....be they pills, clinics or clothes hangers..........

at what point do we become suppliers in a system we claim to oppose...
at what point does compassion taking leave of common sense become itself a form of abuse..not to mention hypocritical.

Reminds me of the mother I know who buys her 15 year old cases of whiskey...because he's going to drink anyway. Of course, she likes to drink with him, and his little friends...maybe it's she who needs to grow up. Maybe some do-gooders need to as well.

I don't think those who oppose needle programs are against halting the spread of disease.....I think it's more akin to "avoiding even the appearance of evil" in that which we minister to others.  It's the same reason some of us pass out socks and turkey sandwiches to those living on the street, but not money. Money goes predominantly for drugs and alcohol....the way to help folks out of that is not to provide the means, but a way out. We have a facility here where they can shower, learn computers, get clothes and job interviews....everything short of paraphenalia for their addiction.

Just remember, given a way out, doesn't mean everyone will take it.
Talked to a women just yesterday....we have a 30 day bed for her in rehab....she's on the street, has lost her shoes....it's freezing at night.....but her response..."I don't want to quit drinking." She would rather be wet shoeless and drunk than to come in out of the rain.
I think it's the same with junkies, at least those I've known, until they are ready to quit, not much will help....and they will share needles EVEN when they don't need to (they'll save handfuls of needles for later use,,,,and share one....even sharpening it with sandpaper to make it stay sharp for everyone.).......I guess that's why we call behaviors bad choices, or stupid ones....because that's what they are...and all our good efforts aside won't change that basic truth.

[HARRYBEADS]

  How about instead of harm reduction programs they spend the money on designing a one use syringe. Register the patent and arrange a Company to make them for the Hairy Foundation of Eastern Ontario, I'll give some funds back for rehab programs and some to lobby the government to increase the penalties for importation and trafficking.
  Why hasn't B+D done this already, answer they make tons off the needle exchange programs, don't agree... they make one use syringes for blood collecting already to protect nurses from being stuck, but f_ _ _ the addict (and or in my case the diabetic) to use the multy use ones that the needle exchange buys and hands out by the thousand daily.!!!! It's all big business, take from the unaware and screw the others.

Harry
THFEO

[fretboard]

Now regarding this issue that keeps popping up I'm not surprised that nobody has been a proponent for giving away crack pipes.  Especially since most crack users I've known don't even know how to log on to a computer, let alone type.  I have a massive disdain for crack and the users therein, so again with that said, here's what I have learned and have to say about the subject.  I have used plain powder cocaine both snorting and slammin', but I have never ever used that nasty a$$ rock cocaine.  Any society that promotes the use of crack cocaine by giving away free crack pipes doesn't realize the full impact and potential of that nasty, ugly drug.  Oh and believe it or not I had a friend who used crack cocaine IV, yes rock cocaine.  He died a very sad and lonely death around 3 years ago, but it wasn't from his IV use.  Crack is a killer, it kills your looks, it kills your pride, it kills your personality and then it kills you.  Almost everyone I know who has used crack, has continued using it steadily for years.  I have a brother who unfortunately, has basically disabled himself because of that highly addictive substance.  Same thing with an ex-girlfriend and another lady friend who I have known for over 30 years, she is strung out like a clothes line on that skank.  I can't go around these people, even my brother, if I run into him on the street I will talk to him and help him get some food or something, but he won't get any money or a free crack pipe from me.  I am very serious how I feel about this drug, not only have I lived in recovery houses but I've also done counseling.  I have seen the bottoms of almost any kind of drug addict you can think of, from a freon (sic) addict, glue sniffers, paint, meth addicts, cocaine, crack, heroin it doesn't matter they all destroy.  IMHO crack cocaine does it faster, and worse than anything I can think of.  So in closing, tough chips to the burnt lips, I played with a spike and found myself a seat on this forum.  Maybe God will be as generous to them crack users, I can only pray after I calm down.  God Bless  
  

[HARRYBEADS]

just to clarify

The dutch policy on drugs

The drug policy of the Netherlands is based on 3 principles:

1.Drug use is a public health issue, not a criminal matter
2.A distinction between hard drugs and soft drugs exists ***
3.High anti-drug related public expenditure, the highest drug related public expenditure per capita of all countries in EU (139 EUR per capita, 2004).  

It is a pragmatic policy. Most policymakers in the Netherlands believe that if a problem has proved to be unsolvable, it is better to try controlling it instead of continuing to enforce laws with mixed results. By comparison, most other countries take the point of view that drugs are detrimental to society and must therefore be outlawed, even when such policies fail to eliminate drug use. This has caused friction between the Netherlands and other countries, most notably with France and Germany. As of 2004, Belgium seems to be moving toward the Dutch model and a few local German legislators are calling for experiments based on the Dutch model. Switzerland has had long and heated parliamentary debates about whether to follow the Dutch model, but finally decided against it in 2004; currently a ballot initiative is in the works on the question. In the last few years certain strains of marijuana with higher concentrations of THC and drug tourism have challenged the current policy and led to a re-examination of the current approach.

The Swedish police has in a recent report blamed Belgium and Netherlands for being a European center for production of amphetamine and ecstasy and a transit center for hashish between Morocco and Sweden.


The reported number of deaths linked to the use of drugs in the Netherlands, as a proportion of the entire population, is lower than the EU average but the relevance of this is unclear since the methods for registration differ from country to country. The Dutch government is able to support approximately 90% of help seeking addicts with detoxification programs. TREATMENT DEMAND IS RISING.

Another effect is a problem with an extensive drug tourism from other countries. Drug tourists are in many cases excluded from the drug related statistics from Netherlands.

Criminal investigations into more serious forms of organized crime mainly involve drugs (72%). Most of these are investigations of HARD drug crime (specifically cocaine and synthetic drugs) although the number of soft drug cases is RISING and currently accounts for 41% of criminal investigations.

Despite the high priority given by the Dutch government to fighting narcotics trafficking, the Netherlands continue to be an important transit point for drugs entering Europe, a major producer and leading distributor of amphetamine and other synthetic drugs, and a medium consumer of illicit drugs. The Netherlands' special synthetic drug unit, set up in 1997 to coordinate the fight against designer drugs, appears to be successful..... THE  GOVERNMENT has intensified cooperation with neighbouring countries and STEPPED UP border controls. In recent years, it also introduced so-called 100% CHECKS and bodyscans at Schiphol Airport on incoming flights from Dutch overseas territories Aruba and Netherlands Antilles to prevent importing cocaine by means of swallowing balloons by mules.

New development

By 2009, 27 coffee shops selling cannabis in Rotterdam, all within 200 meters from schools, must close down. This is nearly half of the coffeeshops that currently operate within its municipality. This is due to a new policy of city mayor Ivo Opstelten and the town council. The higher levels of the active ingredient in marijuana in Netherlands create a growing opposition against the traditional Dutch view of cannabis as a relatively innocent soft drug. Closing of coffeeshops is not unique for Rotterdam. Many other towns have done the same in the last 10 years.


Hard and soft drugs

These are loose categories of psychoactive drugs. This distinction is used in both official and casual discourse. The term hard drug generally refers to drugs illegal for nonmedical use that lead to profound and severe addiction, as opposed to soft drugs that has weaker or no physical withdrawal symptoms. Some so-called soft drugs are however strongly habit-forming for other reasons than physical withdrawal symptoms; the dividing up between hard and soft drugs is therefore only accepted in the legislation in certain countries, such as Netherlands. The executive director of UNODC, for example, does not accept cannabis as a soft drug. Classification of alcohol and nicotine as hard drugs is also commonly rejected in most countries.

A large part of the distinction a subjective, SOCIALLY CONCEIVED notion of the consequences of usage for each. Depending on context, a particular drug can be categorized in many different ways for various reasons.
Examples of hard drugs include heroin, morphine, cocaine, amphetamines, alcohol, and nicotine (tobacco). Drugs in this group are generally described as being physically addictive, easier to overdose on, and/or posing serious health and social risks, including death. Most, if not all, of these drugs are stimulants or depressants. Some of these drugs (alcohol and tobacco) can be freely purchased by adults; some can be purchased only with a doctor's prescription, and two (heroin and cocaine) are generally illegal, although cocaine is sometimes used legally as a local anesthetic and heroin is legally used as an analgesic in some countries: for example, the United Kingdom. A few analgesics even stronger than heroin—notably, fentanyl—are widely used in the U.S., but are usually administered directly by doctors.

The reality of it

Harry

[Trish77]

"I do not get the reasoning for handing out crack pipes .. the only thing you can catch from sharing crack pipes i would think is burnt lips??!! "

Here is a study done at the University of Victoria here in British Columbia, Canada:

http://communications.uvic.ca/releases/release.php?display=release&id=874

It found that these burnt lips and mouth sores allowed for blood transmission via crack pipes, finding evidence of the virus on the pipes and furthered the spread of HCV as a result.  

That's the basis for the reasoning.  Crack pipes are now known to transmit viruses, the way snorting from the same vehicle someone else used (sorry, not up on my terms) can do the same thing.

Thank you for the article.  It adds yet another dimension.  Very interesting.

Trish

[pjhep80]

American drug policies DO NOT WORK... we need to take a lesson from the Dutch...


"It is apparent that many of our drug problems, such as drug-related crime and the transmission of HIV through needle sharing, are the result of the supply reduction efforts themselves rather than of the actual use of the drugs.  On the other hand, demand reduction relies on treatment programs which have notoriously low success rates and prevention programs which have an even poorer record of success.

Clearly, there is a need for a third alternative -- a tertium quid. Such a third alternative strategy exists in the harm reduction or harm minimization strategy which has developed in Western Europe and Australia.  Harm reduction is a policy of preventing the potential harms related to drug use rather than trying to prevent the drug use itself.  More than one policy critic has suggested that those who are dissatisfied with the current alternatives in the American drug policy debate might look toward these developments overseas.

The Netherlands, and especially the City of Amsterdam, has been in the forefront of the developing harm reduction movement in Europe. Interest in Dutch drug policy has been stimulated in recent years by the HIV epidemic of the past decade. The Dutch have held the prevalence of AIDS down to only about 800 cases in the entire country -- 65 of whom are intravenous drug users.

That policy has been described as a compromise between legalization and the war on drugs by one of its shapers, Eddy Engelsman, who also states that, It is just an example of the way in which the Dutch try to control or to solve their [social and medical] problems. ... The Dutch being sober and pragmatic people, they opt rather for a realistic and pragmatic approach to the drug problem than for a moralistic and over dramatized one.

To the consternation of many American critics, the liberal drug policies of the Netherlands have resulted in no increase or a negligibly small increase in drug use. Cannabis use has remained steady in the Netherlands since 1976 while it has increased in the rest of Europe despite vigorous prohibition efforts. Declining numbers of young people are experimenting with drugs. There is only a very small market for cocaine and virtually none for crack. With few new addicts, the population of heroin and cocaine addicts in the Netherlands is now a relatively stable population of about 1,500 aging addicts -- 30-40% of whom are foreign nationals drawn to the Netherlands by the greater safety of drug use there.

The Netherlands is a small country, bounded by the North Sea on the West and North, by Germany on the East and by Belgium on the South. It is about one-fourth the size of the State of New York. More than 14.5 million people, including about 600,000 foreign residents, live within this area of roughly 13,000 square miles, making the Netherlands one of the most densely populated countries in the world.

Contrary to popular impression, the Dutch population is not a homogeneous one of blonde, blue-eyed ice skaters. Large minorities of Indonesians, North Africans and West Indians add to the diversity of the Dutch citizenry. In fact, it is predicted that by the year 2001 a majority of births in the Netherlands will be in these growing minorities. While lacking the extremes of poverty seen in the U.S., the Dutch population does range from rich to poor with a significant minority dependent on public assistance."


I do not get the reasoning for handing out crack pipes .. the only thing you can catch from sharing crack pipes i would think is burnt lips??!!

haa

[fretboard]

I won't argue with anyone's opinion but let me ask you this, HRS gives out condoms do you think they are promoting sex?  They do it because they are helping to stop the spread of STD's and unwanted pregnancies.  By giving out syringes they are helping to stop the spread of HIV and HCV.  I won't bring up the crack pipe's though, that's a tough one for me to co-sign.  God Bless  

[HARRYBEADS]

  Harm reduction just prolongs the inevitable. It's like going to the LCBO and handin out shot glasses, in an attempt to reduce alcohol related liver disease! Hep runs rampant in Africa,India,Brazil and the list goes on. Aids another one, how do we control that one.
  We have to find the root causes, like stopping the access to pandora's box, and proper punishment for those that benifit. This can only be done by changing the views of what is acceptable, then the Governments will follow. Governments only do what the people demand, demand nothing and prolong and enable by creating needle exchange programs and the like, then you your self become part of the problem. Stand up as a group and demand change then your part of the solution.
  How many people OD and die or would be better off dead, probably more than get Hep or Aids. We all have seen drugs destroy families,and everyone has the ability (it's all circumstancaul to become an addict, just ask the smokes industry or the alcohol producers or the poppy growers.
  The big picture.
  
Harry

[Trish77]

Well, keep in mind that this is "harm reduction" regardless of how you feel about it.  It's not cure.  And perhaps that is all they are trying to do.

Perhaps they have no illusions of preventing anyone from using.  Perhaps they are simply doing what it's called.. reducing harm. Sometimes it's better to achieve a little bit rather than sit back and wait for the perfect solution and accomplish nothing along the way.  

My concern is does this sort of initiative make the problem worse in some way as in somehow impeding someone from getting help by making it just that much easier to keep using.  Perhaps that's a naive thing to say but others will wonder the same thing.

I am okay with harm reduction.  Sometimes that is the best we can do.  What I am not okay with is initiatives that don't actually reduce harm at all OR insignificantly in the big picture, using resources that could be applied to REAL harm reduction initiatives... IF people could agree what they are and actually implement them.

Trish

[sldb]

Totally agree with you.  I dont have anything to add, but worked in a state hospital for years and enabling these people is not the answer.  Many go through tx programs just as soon as d/c'd  they are on the street hunting again.  The only programs ive seen that work are the in house yr. long programs designed to make you take a deep long look at what youve done and own up to it.  you must work at the facilities, and if you do not follow the rules your time at that facility is extended.  They dont throw you out, that just makes it easy to return to old habits.  These tx facilities are few and far b/w, so maybe funding towards these facilities is a better option.  flguy, what you have done is truly inspiring.....Leah  

[gauf]

Well said!

[Andiamo1]

You certainly have that right.  In my view, mandatory life in prison for dealers, napalm for the farms and no penalty for the users that are lost souls and have very little control over their disease.

Eric

[Trish77]

Fret ... thank you deeply for your response and I'm humbled by it.  I'm beginning to understand.  

The crack pipe issue came up particularly in Ottawa I think .. the fed government pulled the funding for it and the provincial government stepped in and provided it instead.  It's a bad problem in the downtown core in our capital city.  

Harry ... you are one of a kind.  You certainly have a way with words and you paint the picture very well.  I would say that I would not disagree with much of what you have said.  Thank you for that, Harry.

Trish

[HARRYBEADS]

Eric hit it right on Trish.
  Ten users sittin round an ounce of coke, pulled from someones "A" hole and only two fits among them selves, no one will leave for clean fits, they're freaks. Maybe they'll due without smokes even untill a cab is called to deliver some.
  Get this,hours later a knock on the door, ten paranoid jacked up freaks try to find a way out of the appartment,some are clawing at the exhuast vents till their fingers bleed, others hidin in closets, some are climbin over the balcony and jumpin to the one below, while one guy is wrappin the rest of the bag up in tape to hide in his hooper, another mixes up whats left layin round quick like, for one last one before the bust, and picks up a fit from the floor still red from the last user. One brave sole looks out the peep hole with his glock ready, it's the friendly neighborhood needle exchange lady come to save their soles.LOL
  That needle exchange lady can not reach the users that are'nt on the "street"!!! Most hide because it's illegal. If most or even a few don't always get clean kits then it's a bust, the virus's wins again.
  Just had to put this in perspective, they're junkies, they have a deeper than life it's self need to get the rush again, clean, used, dull or found.
  In Canada the liberal thinking "FUZZY" types are tryin to ban hand guns, because of gang warfare. Hand guns are banned now!!! The black market that brings in everything from fake CDs to sex slaves, continues on because the Fuzzy types want to feel good and tell the neighbor they did good by ignoring the root causes.
  Even after 911 and the tightening of the borders, the black market continues, in fact heroin is flooding the streets, and as a result it's cheaper than ever and most comes from  Iraq!!! Hows that possible????????
  It's the illegal importation of drugs that is the issue, no drugs, no gangs, no gang killings, no junkie freaks robin and stealin and wasting the cops time, no junk to spread the virus's.
That is the root problem!


Just my perspective.

Harry

[fretboard]

I don't think their services affected my using one way or the other as I went there very seldom.  Also I usually bought my own syringes and I got them from HRS very seldom,  but there was a small window of time, when I did utilize their services and was glad they were there.  They don't just provide medical care for drug addicts, they provide health care for all people who are in need.  Do I think it prolongs others' addiction, that's a good question, I believe the answer is no, at least it was "no", in my case.  About the free crack pipes, I just looked at my local area site and that would be very counter-productive as the HRS in my area is located in a "ghetto", part of town.  In fact one of the sleaziest parts in Northern CA, and it's well known that there's loads of crack and crack heads around that area.  Another thing is I have never used crack cocaine in my life, ever.  Also, I couldn't be around them even years ago in my active addiction and I surely wouldn't be around them now.  I can't say it's better to be this kind of addict rather than that kind of addict but I have a brother who uses that krap (crack), and it has reduced him to a total sleaze, and unfortunately a mindless person.  He wasn't that bad on other drugs, I hope this helps as once again I have spoken tooooo much.  Only for you, Trish.  
God Bless  

[Trish77]

Fret, if it's not too intrusive to ask this ... after reading your comment, I'm wondering if the contact with "warm and caring doctors/interns" eventually contributed to you or others you knew eventually getting off the drugs in some way?

You were glad these programs existed.  Because it was at least less harm?

Can I ask you .. do you think this kept people ON the drugs longer because it made it easier to keep using them (that is what I think opponents of this think and I admit, I wonder or am concerned about that myself) or do you think they would have stayed on just as long only used drugs in more unsafe ways?

I very much appreciate your contribution to this thread, Fret.  Thank you.

Trish

[Trish77]

I should have checked if the article was in the online edition of the newspaper and it is:

http://www.nationalpost.com/todays_paper/story.html?id=411240

[Trish77]

IF the question I've posted is too personal for some to discuss out in "public" so to speak but you wouldn't mind discussing it with me in private, please, do email me here.  

Regards,

Trish

[fretboard]

Wow!  Hot topic, very interesting, I have frequented Harm Reduction Services in my area as they have very good and caring doctors/interns.  With that said, I even used to get syringes from their underground needle exchange before that program got the blessing to do it above board.  Of course I don't need their services any longer but I am glad they exists.  With that said, free crack pipes!!  I don't think they do that in my area and I hope not.  Guess I'll have to Google away cause I'd like to read that story.  In closing there was one lady in my area who someone would contact when they needed syringes and she would stop by your house and give you some.  It was set-up on a two-for one idea but if you didn't have any to give her she would gladly supply you with them.  I didn't see anything wrong with that, the sad thing is that "angel", of a lady got arrested for doing that.  Of course that was prior to the (above board), blessing and implementation.  Anyways, like I was saying I need to get off of here and go read the article.  Free crack pipes!!  Yikes!!  Good post Trish and God Bless.

[Trish77]

MS:  I will also point out that this subject doesn't seem to fit the description found at the top of the page which clearly sets forth the subject matter that is appropriate for this side of the board. I hope I am not being disrespectful by pointing this out to you.
---------------------------------------------------------------------------------------------------

Hey Mike, Thanks for the comment.  I actually never comprehensively read those descriptions at the top of each forum until reading this comment from you.  I guess I don't find it clearly setting for the subject matter that is appropriate for each side of the forum as you do.  In each case, the wording is identical except for the following:

On the Social side:  If you have a medical question, comment or research study pertaining to Hepatitis, please post it in our Hepatitis Forum

On the Hepatitis C side:  If you would like to communicate with other people who have been touched by Hepatitis, please visit our new Hepatitis Social/Living with Hepatitis forum.

In light of that, I'd have to say that my post is a "comment" AND a "study" pertaining to prevention of Hepatitis C .. seems entirely relevant on this side and that's why I posted it here.  Seems a rather heavy topic for socializing over.

I find it a bit ambiguous really, which side to post on and it gets a bit blurry knowing whether something is considered social or less so .. just as it's blurry knowing whether a comment someone makes is sincere or facetious.

And no, it's not disrespectful of you to point that out to me.  Thanks for your thought, Mike.  Considerate of you.

Trish

[Trish77]

Eric:  I'm not suggesting nor do I think that providing clean needle/crack kits is a "gateway" activity.  I really don't think someone will decide to shoot up (is that an older term?) because they can get a free needle kit to use.  These things are going to people who are already well into using.  If they were going to "newbie" drug users, frankly, I'd be really p.o.'d by that.  Yes, it will save lives.  I guess .. what about the life of that drug user?  Sacrifice his life to save others?  Perhaps it's saving his/her life also to at least provide clean paraphernalia.  Some things are lesser shades of evil rather than being good.  I don't know.

dsrt:  "Please clarify how you see this is "prolonging the other problem, substance addiction."

I said "seems as if "and that really is more of a question on my mind, IF this prolongs substance abuse.  Seems to me .. that if you can make substance abuse more of a comfortable experience where you get friendly chat, a sandwich and a coffee and a clean needle kit for dessert, you make it almost a social event OR you get people who .. sure, they'll take your paraphernalia and not have to rustle it up themselves and whatever else you've got to give and carry on.  Whether it actually contributes to helping anyone get OFF the drugs .. I don't see it.  Perhaps though that's why they call it harm reduction.  Maybe that's all they're trying to do.  Reduce harm.  If they can't get people off the drugs and keep them from killing themselves that way, then perhaps they can reduce the spread of communicable disease at the least.  I don't know.  I don't know how I feel about this and I only have my limited perspective to go on....and felt others opinions would broaden my insight on this.  

FlGuy:  I appreciate your bravery and honesty.  In another life, the person who used to inhabit this body, stole the needle sharps from the doctor's cabinet at each visit while waiting for him, until he got wise and locked his cabinet.  This was, however, only for comparatively benign shooting up but enough to perhaps get that person her HCV.  Even with that comparatively benign sort of use, I don't think any of us would have gone to a government program for our supplies. I appreciate your perspective.  Perhaps that's why they're now going to mobile programs, they'll now bring the kits TO the user.  Seems to back up your assertion that the miserable have greater needs than a clean set of works from the government or they'd go and get them rather than the government resorting to delivery.  I want harm reduction .. but am having a hard time with this being the right approach.  However.  Now they have mobile needle exchange programs that are almost downright homey .. at the recent HCV workshop I attended for service providers, they were joking about how pleasant and approachable the one program's van was and they wanted one like that.  I dunno.  

That's where I'm at. I know I lack enough insight on this and I'd like to understand the implications of it better, both pros and cons.  My mind is open and that's why I asked the question. I'd really like to have a better grasp on it.

Trish

[mikesimon]

I agree completely with Eric.
I will also point out that this subject doesn't seem to fit the description found at the top of the page which clearly sets forth the subject matter that is appropriate for this side of the board. I hope I am not being disrespectful by pointing this out to you. Mike

[FlGuy]

A very long time ago there was a different person inhabiting my body, he's long gone but he left a few reminders of his occupation, one being hcv.  Back then, that guy would survey the landscape for what he needed.  Once found, whatever the place and whatever the conditions, he'd take matters into his own hands and arms. Burned out shooting galleries, little light except for those bunched matches under the bowl of a spoon and cellulose from a cigarette filter.
That guy would never turn to his cronies and say, 'hey, let's go over to 125th St, they've got a neat place with flouresscent lights, new works and some help'.  No, never would.  At that point the guys were invincible and even if they weren't they didn't care.
I think this world needs a little less enabling.
I read the BC article you mentioned and remember thinking at the time that the program was designed to give the those who thought of it a warm and fuzzy feeling for reaching down to the poor miserables of the world.  The miserable have greater needs than a clean set of works from the government.  What they need cannot be provided by a government at all.