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We Can't Let Politics Keep Trumping Science on Drug Policy

If Obama wants to promote public health -- over politics -- on substance abuse, there are many more bold steps his administration should take.

Policy wonks and deficit hawks weren't the only ones paying attention when President Obama signed the Fiscal Year 2010 Consolidated Appropriations Act last week. HIV activists, public health experts and communities of drug users celebrated--not for what's in the appropriations bill, but for what's not in it: a ban on federal funding for needle exchange programs, which has appeared in the federal budget every year since 1988.


After two decades, this change is a historic achievement. Obama had already missed one opportunity to lift the ban, neglecting to pull it out of his budget in May. Still, that same month former Seattle chief of police Gil Kerlikowske was sworn in as the director of national drug control policy, calling for a new common-sense approach to drug addiction. When the drug czar calls for an end to the war on drugs, it's clearly the start of a new era.

Unlike during the Clinton administration, when there was only mixed support for needle exchange--in 1998, drug czar Barry McCaffrey convinced Bill Clinton to renege on his stated intention to lift the ban--all of the top brass in the Obama administration are on record in favor. Kerlikowske supported Seattle's program of exchanging needles. FDA Commissioner Margaret Hamburg and CDC Director Tom Frieden both served as New York City Health Commissioner, and both used that position to actively promote needle exchange. Still, drug policy watchers agreed that the president didn't want to force the question of needle exchange on members of Congress. The White House was "concerned about making sure that when Congress deals with the issue, that they can win it," says Harm Reduction Coalition Policy Director Daniel Raymond.

That left it up to members of Congress to lift the ban themselves, and in November, the House did just that--sort of. In an attempt to broaden political support for lifting the ban, Congressman David Obey, a Democrat from Wisconsin and chair of the committee whose conference report contains the language, introduced a "thousand-foot rule," which would have maintained the ban on funding for exchanges within 1,000 feet of a school, park, library, college or video arcade. Obey himself acknowledged at the time that the thousand-foot rule was "unworkable"--since it would simply be a ban by another name, especially in densely settled urban areas. He said, however, that he hoped the language could be changed when the House and Senate versions of the bill went to conference committee. That's precisely what happened last week.

The new provision prohibits federal funding of needle exchanges "in any location that has been determined by the local public health or local law enforcement authorities to be inappropriate for such distribution." But because needle exchanges "have been operating for over twenty years with community support and buy-in already," says Jirair Ratevosian, deputy director of public policy for amfAR, the Foundation for AIDS Research, this new language essentially ends the ban. Exchanges "already have support from law enforcement agencies; they already have support from public health groups, from local planning committees," Ratevosian noted.

In addition to the much-needed dollars that will start flowing to needle exchanges, lifting the ban is also of huge symbolic importance to a presidency whose commitment to a public health approach to drug addiction has at times amounted to more talk than substance. But needle exchange is only one intervention among many that have come to be known as "harm reduction"--taken together, this approach to addiction is pragmatic rather than punitive. Instead of attempting to eliminate addiction altogether, it seeks to mitigate the harms--HIV, hepatitis C, overdose and criminality, among others--that addiction can cause. Many harm reduction programs have been studied extensively and are widely understood to be effective but continue to be stymied by politics, even under Obama and Kerlikowske. That, until recently, was the fate of needle exchange itself.

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