“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