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ASHP Urges President Clinton to Provide Federal Funds for Needle Exchange Programs



April 24, 1998 

The Honorable William J. Clinton
President of the United States
The White House
1600 Pennsylvania Avenue, N.W.
Washington, D.C. 20500

Dear Mr. President: 

The recent announcement of the Administration's decision not to provide federal funding for needle exchange programs was deeply disturbing. This was especially so, given: 

  1. The reality that acquired immune deficiency disease is a major public health problem and is a fatal disease often spread by drug abusers to non-drug abusers,    
  2. The evidence that needle and syringe exchange programs work in reducing the spread of infectious disease, and    
  3. The evidence that needle and syringe exchange programs do not lead to increased drug abuse.
The American Society of Health-System Pharmacists (ASHP) is among many professional groups that have given this matter serious deliberation. ASHP has a formal professional policy on the matter that reads: "ASHP supports the use of needle and syringe exchange programs, drug abuse treatment, and community outreach programs for substance abusers to reduce the risk of transmission of the human immunodeficiency virus (HIV), hepatitis B virus, and hepatitis C virus in intravenous drug users."

Health-system pharmacists practice collaboratively with other health professionals throughout the nation's hospitals, long-term care facilities, staffed managed care facilities, and home-care services. Their professional mission is to help people make the best use of medications. They respect the power and beneficent intent of medications. Therefore, it is hard to imagine a group of professionals to whom drug abuse is more abhorrent. Health-system pharmacists would be the last group to suggest an action that they believe would lead to more drug abuse. In their professional work, health-system pharmacists constantly care for the patients (including many that have never been drug abusers) who are infected with major (often fatal) infectious diseases that are traced to the sharing of contaminated needles and syringes among drug abusers. Health-system pharmacists believe it is imperative to use every opportunity to stop this unnecessary suffering and dying, and we believe it is an appropriate priority of government to assist in this. 

We must accept, regrettably, that the Administration finds it necessary not to support funding of such programs at this time due to the current political climate in Congress. We concur with Secretary Shalala's determination that needle exchange programs can be effective in reducing HIV transmission and do not encourage the use of illegal drugs. Furthermore, we agree that states and local communities play an important role in reducing the incidence of HIV transmission. Even so, we believe it is especially important, now, for the Administration to demonstrate further leadership, courage, and responsibility and to engage in visible, positive action on this issue. In that spirit we offer some suggestions about further actions. 

  1. First, we urge the Administration to find prominent ways to declare publicly the firm belief that well operated needle and syringe exchange programs are good for the nation. There is much misinformation and much fear in the general public about such programs. We believe more public education is crucial to developing a wide-spread public attitude of acceptance and support for this activity.   
  2. If federal funds cannot be provided at this time, then vigorous federal leadership should be exerted (with the participation of state public health programs, professional organizations such as ASHP, and others as appropriate) to develop an aggressive, time-specific, measurable, and publicly reported process for the initiation of needle and syringe exchange programs using alternative funds.
We urge the Administration to take forthright, assertive action on this matter. If ASHP or the nation's health-system pharmacists can provide advice in developing further plans, please call on us.


Henri R. Manasse, Jr., Ph.D., Sc.D.
Executive Vice President and Chief Executive Officer

cc: Donna E. Shalala, Secretary of Health and Human Services
     David Satcher, Surgeon General of the United States
     Eric P. Goosby, Director, Office of HIV/AIDS Policy