Dare To Do Something About Drugs

By Maia Szalavitz

One effort -- let's call it program A -- was found to be effective in hundreds of research studies and is supported by every major medical organization which ever examined it, including the American Medical Association, the Centers for Disease Control, the National Institutes of Health, and the American Public Health Association.

The other -- let's call it B -- was found by over a dozen studies to have either no long term effect or a slightly harmful result, and is not listed as being among the programs that are considered effective by government experts.

Guess which one has more political support and funding in New York City.

As is sadly typical of American drug policy, politicians often oppose effective programs while supporting and funding programs that sound good but actually do little. Program A involves efforts to provide clean syringes to intravenous drug users to prevent the spread of HIV and other diseases; Program B is the school-based drug "prevention" program, DARE (Drug Abuse Resistance Education).

IMAGE IS WHAT COUNTS

In New York City, clean needle programs have struggled for decades to gain funding and legal support. But Mayor Giuliani simply placed DARE into the city schools in 1996 with no public debate, even though several major studies had concluded that it was ineffective.

Why is drug policy so backwards? Politics, unsurprisingly. Drug policy in New York has little to do with helping addicts, saving lives, or even preventing children from taking drugs. Its main point is to make politicians look like they care about these things -- and so the first litmus test for any program is whether it "sends the right message" and makes its proponents look "tough on drugs."

This doomed needle exchanges. Give needles to addicts? That tells kids that it's OK to take drugs and that the government supports shooting up. Allow syringes to be available without a prescription? That can't possibly be tough on drugs.

NEEDLE EXCHANGES WORK

It didn't matter to opponents of needle exchange that studies as early as 1988 found that states with laws hindering access to clean needles actually had both more IV drug use and more blood-borne disease than those that allowed easier access. Nor did it matter that over three-quarters of heterosexual AIDS -- and three-quarters of AIDS in children -- originated from people infected by dirty needles. The idea of "sending the right message about drugs" trumped efforts to save lives.

The first New York needle exchange program, started by Mayor Koch, was shuttered by Mayor Dinkins in 1990, because, as his health commissioner Woodrow Myers put it in an article in Spin Magazine, "Eliminating IV drug use is a higher goal than preventing the spread of AIDS."

Street-based activist programs started mainly by ACT-UP to replace it had to battle in the courts against a drug treatment provider who said the city needed to wait for a "gold standard" HIV prevention effort and that (in 1991) "The spread of AIDS has leveled off... A lot of those people are going to die. It's unfortunate. I deeply regret it."

The judge didn't buy this callous calculus, and the activist programs eventually gained state and private funding. In these programs, addicts bring dirty needles to exchange sites and are given clean ones in return. They also get information on safer sex, safer needle use and referrals to health care, including drug treatment if they wish. Interestingly, it is actually easier to get addicts to use clean needles than it is to get almost anyone to use a condom for sex. Clean needles actually provide a better "high," because they are sharper and more likely to hit the vein, while condoms can diminish sexual sensation.

As a result, research since has consistently found that needle exchange and other syringe availability programs reduce the spread of HIV and do not have such negative effects as increasing the number of IV drug users or keeping them away from treatment. In fact, in some cities, needle exchanges are the biggest source of referrals to drug treatment. Yet, despite their effectiveness, they are still banned from receiving federal funding and in many places, including New York, do not have the money to serve more than a small proportion of those who need help.

DARE TO BE TIMID

Compare this to the saga of DARE. Created in 1983 by infamous L.A. Police Chief Darryl Gates (who once said casual drug users should be "taken out and shot"), the program brings cops into the classroom to educate kids about drugs. It is now used by over 75% of American schools, and receives an estimated half billion dollars in federal funding.

In the 17-week class, specially trained police officers tell fifth and sixth graders about the dangers of drugs. From DARE's perspective, all drugs are equally bad -- from marijuana to alcohol to heroin. DARE also teaches "resistance skills" which include practicing numerous ways to say no if asked to try drugs. Since its inception, however, DARE supporters have been unable to prove that it works. The researchers whose work was adapted to create the DARE curriculum now say that the hypothesis on which they based it was wrong. There have been over a dozen studies (Drug Reform Coordination Network)of tens of thousands of schoolchildren which found that DARE doesn't prevent them from trying drugs.

Almost all of this research was conducted before New York City brought DARE in -- and it was readily available to those who were considering the program. New York's adoption of DARE came at a time when several other school districts were pulling the program because of its ineffectiveness.

THE POLITICS OF PREVENTION

DARE has two key advantages that keep it rolling. First, since it is funded from the police rather than education budget, it helps schools cut corners. This is what allowed the Mayor to mandate the program without input from the Board of Education -- he wasn't spending their money on it.

Second, DARE's bumper stickers and tee-shirts and "just say no" pledges are very popular with the 10 and 11 year olds who take the classes and with their parents. Pre-teens tend to be conservative; they don't like change and support law and order. Unfortunately, the same kids who gleefully dismiss drugs as bad and look up to Officer Friendly in fifth grade dismiss DARE as childish and see drugs as cool when they hit high school.

Surveys show that nearly 55% of 12th graders have tried an illicit drug; 80% have used alcohol. Over a quarter used an illicit drug in the month before they were surveyed. Though this generation has received more drug education than any other, daily use rates for marijuana, cocaine and heroin are as high as they were in 1975 during the boomers' youth.

The proponents of DARE originally said that the program could prevent kids from ever trying drugs because they would be reached early enough to make an impact. Now, faced with the facts, diehard DARE supporters say the reason it doesn't work is because it needs to be expanded into high school.

What's missing from DARE and every other prevention program is a pragmatic approach which might prove more effective. All of the current programs have as their basic aim to prevent any and all experimentation, which is normal behavior for more than half of today's youth, by using a model based on what motivates addicts -- ie, abnormal users -- rather than the typical young person.

Ignored are any programs that would try to prevent users from becoming addicts, and prevent addicts from killing themselves. That might be effective, but it wouldn't be politic. Right now, drug policy does more to reduce election-related harm to politicians than it does to reduce drug-related damage to our communities

THE FUTURE

There is hope, however, for saner drug policy in New York. A bill allowing pharmacies to sell needles without a prescription was recently passed by the state legislature and signed into law by Governor Pataki, after years of previous defeats. The difference this year was that the bill was slipped into the budget proposal. This gave legislators political cover: they didn't have to vote on a stand-alone bill which could tar them as "soft on drugs" They simply voted on the budget, and could claim to have allowed the provision in simply in the interest of ending years of budget delays

And late last month, the state court system announced a plan to help channel non-violent drug offenders out of the prison system. Repeat non-violent offenders found to be addicts -- like shoplifters, prostitutes, public order offenders -- will be offered the option of drug treatment instead of incarceration. According to the state, 10,000 offenders will be affected each year -- and the program could save $500 million annually.

Unfortunately, these changes don't affect the thousands subject to the state's tough Rockefeller laws. Addicts caught for many drug sale crimes still face 15-life if convicted -- and judges have no discretion, even for first offenses.

Still, some progress, however timid, is better than nothing-better, in other words, than it has been for a long time.

Maia Szalavitz is co-author of "Recovery Options: The Complete Guide: How You and Your Loved Ones Can Understand and Treat Alcohol and Other Drug Problems." (Wiley, June 2000). She has written on health and public policy for the NewYork Times, New York Magazine and other publications.

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