by Philip J.Hilts - New Youk Times - August 7, 1991 -

WASHINGTON, Aug. 6 - In a report that sharply criticized the Bush Administration's drug control efforts, the National Commission on AIDS today endorsed needle-exchange programs to reduce the spread of AIDS among drug users.

The commission said the Administration had failed to recognize the link between AIDS and drug use, a failure it called "bewildering and tragic". Drug users make up a rising proportion of people infected with the AIDS virus.

It also criticized Congress for failing to finance drug treatment programs requested by the Administration, and state governments for not providing more money for drug treatment.

The report is the first time the commission has taken a position on programs in which drug abusers exchange their used hypodermic needles for clean ones, and it provoked immediate criticism from the Administration.

The Director of National Drug Control Policy, Bob Martinez, said the commission offered "no clear scientific evidence" that needle-exchange programs reduce what he called "risk-taking behavior" related to transmission of the AIDS virus.

Dr. Herbert Kleber, deputy director of the drug policy office, said he did not believe that any of the demonstration programs were conclusively positive. "There are extremely good intentions in all these studies" Dr. Kleber said, "but they all have weaknesses, and we cannot support needle-exchange programs until enough evidence is there for the Surgeon General to certify them."

Dr. Don C. Des Jarlais, a member of the AIDS commission and director of research on chemical dependency at Beth Israel Medical Center in Manhattan, said there were "tens of studies that give evidence that needle-exchange programs work."

"The case is not scientifically proven," he added, "but the evidence is surprisingly clear and consistent." At the same time, he said, there is no evidence at all for the claim that needle-exchange programs increase drug use.

REACTION IN NEW YORK

In New York City, where Mayor David N. Dinkins has criticized needle-exchange programs as a surrender to drug abuse, officials would say only that they were interested in the commission's report and would review it. But in response to it, the Mayor asked the city's acting health commissioner, Dr. Margaret Hamburg, to review the evidence from what appears to be a successful needle-exchange program in New Haven, and then report to him.

Researchers released their favorable report of the New Haven experiment last month. The Federal panel's endorsement of similar programs so soon afterward was coincidential.

Recommendations from the commission, whose 15 members are appointed by the President and Congress, have no legal force, but today's report, one of a series the commission is doing on national AIDS policy, is expected to be influential as states localities consider the issue of needle exchanges.

The report said one of the most important factors in curbing the spread of AIDS was to get drug users into drug treatment programs, because data show that those who get treatment are less likely to become infected with the HIV virus that causes AIDS.

It also called for more money from Federal, state and local governments for drug treatment on demand to eliminate situations like that in New York City, where there are only 38,000 publicly financed treatment slots to handle the city's estimated 200,000 intravenous drug users, about half of whom are believed to be infected with the AIDS virus. It is estimated that 75,000 of those drug users would seek treatment it if was available.

Needle-exchange programs have been at the center of a debate over how to prevent AIDS among drug users, who can become infected by sharing needles. They can then transmit the virus to their sexual partners and unborn children.

The Administration has barred the use of Federal money to pay for needle exchanges, and 11 states, including New York, New Jersey and Connecticut, outlaw the sale or possession of hypodermic needles without a prescription. Advocates for people with AIDS have repeatedly been arrestes in New York City and elsewhere for openly defying the law by distributing clean needles.

Researchers reported last month that the New Haven program, authorized by the Connecticut Legislature and carried out in a partnership between the state drug program and the Yale University medical school, reduced the rate of infections among drug users in the city by 33 percent.

'LAWS ARE OBSOLETE'

Dr. Des Jarlais said laws restricting the purchase or free distribution of clean needles simply do not prevent any drug use, but rather increase the spread of AIDS. "These laws are obsolete and dangerous to the public health," he said.

And Dr. June Osborn, a pediatrician who is chairman of the AIDS commission, said: "The flash-fire potential of HIV transmission through injection drug use has been demonstrated repeatedly in this country and around the world. It is an issue of the greatest urgency."

One of the strongest Congressional opponents of needle-exchange programs is Representative Charles B. Rangel, Democrat of Manhattan. "There is no guarantee that these free, or exchanged needles won't be shared as well," a member of Mr. Rangel's staff said today in explaining the Congressman's view.

Dr. Des Jarlais said he believed that the reason a person opposed both needle-exchange programs and treatment on demand for drug users was: "People just believe that drug users are 'not like me' - they are just bad people, and they should be punished."

"But", he continued, "in reality that approach doesn't work. There are too many of them to put them all in prison, imprisonment costs far too much, you can't keep them in prison for ever and, besides, putting them in jail won't treat their drug dependence."

The commission report pointed out that the Administration has proposed spending $ 332 million to increase the size of prisons by 3,600 inmate beds but only $ 99 million for additional drug treatment slots, even though the prison beds cost nine times what each drug treatment slot costs.

But Dr. Kleber took the commission to task for its criticism of the Administration, which he said has steadily worked to increase the availability of drug treatment.