The nation's first experiment in giving clean hypodermic needles to drug addicts is to begin next month in Portland, Ore., testing a controversial AIDS-control strategy that has proven too politically unpalatable to be tried anywhere else in the country.
The needle exchange program, announced Thursday, is modeled on similar experiments abroad. The Oregon plan has won the cautious acquiescence of state health and law enforcement officials, who say it represents a rational, if regrettable, acknowledgement of the disturbing realities of acquired immune deficiency syndrome.
"The way of looking at it is we're at war," said Dr. Mervyn Silverman, president of the American Foundation for AIDS Research, which is financing the research project. "In wartime you do things you don't do in peacetime, hopefully for the good."
The experiment, which is not without critics, is seen by some as exemplifying the state's and city's often innovative approach to a number of social and public health problems ranging from homelessness to AIDS.
The project is aimed at controlling the spread of the AIDS virus among intravenous drug users--the fastest growing category of people affected by the fatal disease and the principal route by which it is reaching heterosexuals and infants.
The Portland social service agency running the project intends to exchange sterile needles and syringes for used, possibly contaminated, equipment. By eliminating the need to buy new needles, the agency hopes to reduce the needle-sharing that has been implicated in the spread of the blood-borne virus.
But the agency will also use the opportunity to educate needle-users, a group that has been difficult to reach through traditional AIDS prevention programs. All participants in the program will be counseled about AIDS and encouraged to enter drug treatment.
"It is easy to think about this as simply a mechanical process of exchanging needles," said Hugo Maynard, a Portland State University psychologist. "But really the most difficult part . . . is having some kind of effect on the social psychology of intravenous drug users."
The project will also be a scientific research effort aimed at answering questions that researchers hope may prove useful to other cities: Does a needle exchange program slow the spread of the AIDS virus? Does it increase or decrease intravenous drug use?
The researchers, led by Maynard, will track the participants, testing their blood and examining their drug habits every three months. They will compare the results from a study group of 125 people who complete the program to those of users in two other cities where no such program exists.
Maynard said he does not expect there to be a limit on the overall number of people allowed to get needles.
"We are not willing to support this kind of program without some evidence that this is an appropriate and positive thing to do," said Norma Jaeger, manager of the Multnomah County Alcohol and Drug Program. "But we are willing to support finding out."
Began With 2 Women
The project was developed quietly by a private nonprofit agency in Portland called Outside-In. More than a year ago, two pregnant women visiting the agency's prenatal clinic tested positive for exposure to the human immuno-deficiency virus, which causes AIDS.
Because both cases involved intravenous drug use, the agency began examining the AIDS risk among drug users in the Portland area, where officials estimate that there are 7,000 to 10,000 intravenous drug users injecting such drugs as heroin, methamphetamine and cocaine.
But when the agency's director asked about needle exchange programs elsewhere in the United States, she found that none had ever gotten off the ground. Political opposition has blocked attempts in San Francisco and New Jersey and is now stymieing efforts in Boston.
Only in New York City, where 60% of the estimated 225,000 needle users are believed already to be infected, has a small needle exchange effort received tentative approval. But the city has yet to receive its final go-ahead from the state.
In other parts of the world, by contrast, needle exchange programs began as early as 1984. They now include programs in the Netherlands, Scotland, England, Australia, Italy and Sweden. Initial results show no rise and perhaps a decline in drug use, at least as measured by drug overdoses and entries to treatment.
Finds Itself Alone
"It was surprising to us when we were unable to find any other program in the country distributing needles," said Kathy Oliver, the executive director of Outside-In. "Because, to us, it did seem like a very rational thing to do."
The agency's board voted unanimously to try the project. Donors--from the United Way to the First Unitarian Church--did not object. Over time, tentative assent came from state and local bureaucrats, drug treatment programs, even law enforcement officials.