Cover Story

Needle in a haystack

The reams of "science, science, science" to support needle-exchange programs were hard to find. But in the end, what killed the Clinton Administration proposal to spend taxpayer dollars passing out needles to drug addicts was "politics, politics, politics," and the president's decision to back off. But some 100 needle exchange programs are in effect around the country, and some in Congress hope to slow the spread.

Issue: "Just say clean needles," May 9, 1998

(in Washington) - Donna Shalala and her scientific advisers looked distinctly uneasy. Conservatives watching her April 20 press conference might have been excused for diagnosing her discomfort as an unaccustomed bout with conscience. After all, the HHS secretary-long an advocate of giving clean needles to intravenous drug users to slow the spread of AIDS-was now passing up the opportunity to pass out more. To the consternation of AIDS activists and many public-health officials, Ms. Shalala announced that the Clinton Administration was opposed to federal funding of needle-exchange programs (NEPs).

Republican leaders on Capitol Hill were as surprised as anyone at the news. Sensing a political opening, they had prepared to blast the president for encouraging drug use in the name of AIDS prevention. "The ammunition was loaded," confided a high-ranking Republican aide. "We were ready to go with a news release essentially blasting Shalala and the administration if they were to support federal funding."

As press secretaries scurried back to their computers to fashion an updated response, AIDS activists were hastily organizing a demonstration for the following morning outside HHS headquarters. Everyone in Washington, it seemed, was taken aback by the announcement.

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Including Ms. Shalala herself. The cabinet official had started her day looking forward to unveiling the administration's "progressive" new policy on needle exchanges. Huddled with her advisers at 8:30 a.m., she was going over talking points that would stress that the decision to support federal funding of NEPs was based on "science, science, science." Yet just hours later, there she was, announcing instead that states and cities would be on their own if they wanted to provide clean needles to addicts.

According to AIDS organizations, there are already over 100 needle exchange programs in existence. San Francisco, not surprisingly, has America's most active program, exchanging some 2 million needles each year since 1988. Of the estimated 17,000 injection drug users in the city, approximately 5,000 use the NEP. A private organization runs the exchange, but it has received public funds since 1993, when then-mayor Frank Jordan declared a local state of emergency, allowing him, under California law, to appropriate city funds to take whatever steps he saw as "necessary to provide for the protection of life."

Just up the coast in Seattle, the city's Department of Health runs its own NEP at a cost of about $500,000 per year. The city insists that it merely exchanges new needles for used ones on a one-to-one basis, which the state supreme court ruled was acceptable under Washington law. Five publicly funded sites are currently in operation, and this city is doing its best to get the word out: Nearly 33,000 hits have been recorded on the NEP Web site, which includes phone numbers and addresses.

But Ms. Shalala was on record as wanting more. She had said repeatedly in the past that she favored federal tax dollars in support of NEPs, so when her office contacted AIDS organizations telling them to expect good news from the press conference, there was little doubt as to what was planned.

The abrupt turnabout left friends and foes alike searching for an explanation. Was someone in the administration actually listening to that still, small voice? Not quite. Instead it was the persistent nagging of drug czar Barry McCaffrey that managed to get the president's ear. Published reports say Mr. McCaffrey tipped off Rep. Dennis Hastert (R-Ill.), chairman of an anti-drug task force in the House, that HHS officials were about to severely undermine the war on drugs. Mr. Hastert's spokesman confirmed that the drug czar and others had informed the congressman about administration plans.

Mr. Hastert, who had been chosen to accompany the president on last month's trip to South America, faced down Mr. Clinton in Chile and told him to back off his plans to fund NEPs. On the return flight from Chile, the president heard more of the same from Mr. McCaffrey, who seized the opportunity to speak his mind without immediate opposition from HHS officials. Thousands of miles away from his pro-NEP advisers, Mr. Clinton began to waver.

Back in Washington, meanwhile, the threat of political fallout from a decision to fund NEPs was becoming reality. Grassroots organizations and conservatives on Capitol Hill gave President Clinton a taste of what he might expect if he used taxpayer dollars to provide drug addicts with clean needles. "If Secretary Shalala falls for the clean-needles pitch, it would be a tragic new example of the administration's cease-fire in the 'War on Drugs,'" warned Sen. John Ashcroft (R-Mo.) in a press release. "And the casualties are our children." Meanwhile, Gary Bauer's Family Research Council called federal funding of NEPs a "national disgrace" and blasted the administration for seeking to "promote a culture of death by condemning addicts to the killing fields of heroin." Mr. Clinton, hearing political footsteps, changed his mind.

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