Letter From Dallas
The Damage Done
Texas is the only state in the country that won’t allow needle-exchange programs for drug addicts. It’s time for that to change.
“HEY, TED!” NO ANSWER. “HEY, TED!” No answer. The lack of response didn’t surprise me, since the modest house appeared to be unoccupied. The shades were drawn and there were no obvious signs of life, but my guide kept walking along the driveway. “Hey, Ted! It’s Michael.” This time, a muffled voice behind a shuttered window asked, “Who you got with you?”
“It’s okay,” Michael said, glancing at me. “He’s cool.”
“Go round back,” Ted answered after some hesitation.
The back door was unlocked, leading to a small, empty room, but the door that led from that room to the rest of the house was blocked with iron burglar bars, as were all the windows, creating the appearance of an inverted jail. DeeDee, a cigarette-thin black woman in nondescript pants and T-shirt, peered around the edge of the burglar door, then unlocked it and threw her arms around Michael Lesley, a longtime volunteer with DANSE, the Dallas Area Needle-Syringe Exchange program (he asked that his real name not be used). At DeeDee’s direction, I stepped past Ted, a cinnamon-colored man in his fifties clad only in shorts. He was sitting on the edge of a king-size bed next to a bright lamp with the shade removed, poking his left leg with a syringe as he searched for a non-collapsed vein underneath the scabrous stretch of blue-black leathery skin between his knee and his ankle.
Ted was in charge here, “working the package,” selling $5 caps of heroin and heroin-cocaine “speedballs” he’d bought from a higher-level dealer and providing users a place to shoot up in relative safety. Business seemed to be good. A sturdy young black man followed us in and went into a darkened adjoining room where a grainy TV was flickering. A few minutes later a white couple who appeared to be in their mid-forties and looked as if they might have just gotten off work at Wendy’s or Pep Boys passed through and joined him.
On the other side of the big bed lay Rosetta, her skinny forearms covered by raw abscesses at least three inches wide and six inches long. Her groggy state indicated that she had been more successful than Ted at finding a vein. The space between them was littered with cigarettes, a large ashtray, several $20 bills, an elastic band, and a few loose syringes. At the head of the bed, under Rosetta’s oversight, sat a cardboard box containing what was left of the two hundred BD brand syringes that Michael had brought on his last visit. DANSE, like an estimated 185 programs around the country, supplies sterile syringes to drug addicts in exchange for used ones and serves as an important bridge to treatment and rehabilitation. The point is not to facilitate their habit—they are going to shoot up anyway—but to keep them from getting infected with HIV/AIDS or hepatitis C and spreading it to others, ruining lives and costing taxpayers billions of dollars in medical bills.
Addicts may not be models of prudent forethought, but they recognize the value of clean needles and are jealous of their supply. I asked why they thought it important to have new needles. Without looking up, Ted said, “To keep from getting diseases, like AIDS.” Do users know that? “They know it,” DeeDee replied, “but sometimes they forget.” Since lack of funding had kept DANSE off the street for most of 2006, where had they been getting their needles? Ted explained that, because he is a diabetic, he depends on Walgreens. “They know me,” he said. “I get what I need, and I sell some to people that come in here.” If needle exchanges were legal in Texas, making it easy for users to get sterile syringes, would most do so? “Definitely. Definitely!” Rosetta said, with notable conviction.
They were obviously pleased that Michael was back in action and promised to give him some used needles when he returned the next day with a sharps container. I asked if they ever picked needles off the street to exchange for clean ones. “Yes,” said DeeDee. “And that keeps children from getting hurt.” After a few more questions, I thanked them for being so candid, and Michael and I left. For me, it was a new experience. For Michael, it was just another stop in his regular weekend rounds, operating on the edge of the law but at the heart of sound and compassionate health care.
An estimated one third of HIV infections in this country can be traced to injecting drug users (IDUs), their sexual partners, and their offspring. Hepatitis C, the most destructive variant of that disease, is present in the blood of more than 70 percent of all adult IDUs. A contaminated needle is an extremely efficient transmitter of a blood-borne disease. In the mid-eighties, as public health officials in the Netherlands and Australia realized that HIV and hepatitis were spreading at alarming rates among IDUs, they began experimenting with programs to supply addicts with clean needles in exchange for their used ones. The immediate and obvious success of these programs in reducing the incidence of both diseases—it was estimated that 25,000 cases of HIV and 21,000 cases of hepatitis C were prevented during the nineties—led authorities in Canada and numerous European, Asian, Middle Eastern, and Latin American countries to follow suit. In some locales, sterile syringes can be exchanged at pharmacies, police stations, and even specially designed vending machines. At St. Vincent’s Hospital in Sydney nuns operate the exchange.
With few exceptions, American medical and public health personnel also support making sterile syringes available to IDUs. Regardless of this near unanimity, Congress continues to prohibit federal funding of any such effort. State laws vary widely, but it appears that, after both Delaware and New Jersey passed legislation authorizing needle exchange programs (NEPs) in 2006, Texas stands alone in its refusal to legitimize any method for providing sterile syringes to IDUs, despite their proven utility in preventing disease (some states without NEPs at least allow for sales or exchanges at pharmacies). Programs like DANSE operate in some of the state’s major cities, almost always under a “don’t ask, don’t tell” cover, but paraphernalia laws that criminalize supplying or possessing needles for illegal drug use make it difficult to persuade addicts to participate in a program sure to be known to the police and leaves NEP staff members and volunteers subject to arrest. (Because of that risk, workers in the state’s largest and most successful program declined to be interviewed for this article.)
DANSE traces its origins to the early nineties, when Dr. Martin Krepcho, an assistant program manager in the STD/HIV section of the Dallas County Department of Health and Human Services, became aware that HIV was spreading among IDUs in the area and that facilitating access to sterile syringes could slow the epidemic. “Since we could identify the pathways,” he told me, “we had an ethical responsibility to try to do intervention.” The administration at the health department wanted nothing to do with such an effort, so Krepcho and two colleagues dropped the subject but not their commitment. In 1993 they founded DANSE and obtained a grant from the North American Syringe Exchange Network (NASEN).
Krepcho then spoke with several police department and precinct officials, explaining what he and his associates wanted to do and where and when they’d be operating. They agreed and provided access to key officers who saw to it that DANSE workers were not hassled as they exchanged needles from the back of a pickup in areas rife with drug users. I asked Krepcho if any of their clients had shown interest in treatment to help break their habit. “Oh, Lord, yes!” he said. “We would take them to facilities for assessment and treatment and medical care.” Echoing NEP workers around the country, however, he noted that available treatment slots fell far short of the need. “If they asked for help, we weren’t sure we could get them in, so it was imperative to keep them safe and clean until they could get in, to try to preserve lives as much as we could until we could link them up with a treatment program.”
Shortly after Krepcho launched DANSE, a Dallas TV news station aired a brief report that caught the attention of Jack Taylor, an active Episcopal layman. “It was one of those things that my wife and I immediately snapped on,” Taylor recalled. “So we looked up Marty, and we’ve been involved ever since.” He explained the simple approach the DANSE volunteers used. “We’d go to a site, open the door, and put a red sharps container on the sidewalk. That was our ad. We’d go at a specific time; they would know. We’d exchange anywhere from a few hundred to the low thousands. At one time, we were exchanging so many that we had a contract with a company to pick up and dispose of the used ones.” Having lost a son to a cocaine overdose, Taylor admitted it was hard for him to give needles to people he suspected were dealers, who would use them in their shooting galleries. “But Marty helped me focus on the task,” he said. “Serve the IDU population, get needles off the street, stop the sharing, stop the spread of diseases.”
DANSE never had more than a handful of volunteers, and since Krepcho moved away in 2004, Taylor has served as managing director, raising funds, buying supplies, and keeping records. He leaves most of the actual exchange work to Michael Lesley, who knows the streets and operates exchanges in several neighborhoods on weekends. A fifty-year-old former addict, Michael got involved with DANSE in 1996 as a volunteer, and he is clearly disappointed at the recent funding drought. “We had four sites in the nineties and gave out over one hundred fifty thousand needles some years. We had thirty thousand to forty thousand dollars a year to work with. I had hot spots I had developed. I might collect one to two thousand needles at a time. We had it going real, real well. Then the funding went short. In 2005 I didn’t have but maybe ten thousand needles to give out all year. And last year, none. Now we got a small grant, and I have to start from scratch to get my clientele back.”
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