Can Theology Support Needle Exchange Programs?

On March 3, 2008, I spoke in Washington, DC with our congressional representatives' health staffers on the moral imperative to lift a 20-year ban on federal funding of needle exchange programs for the prevention of Hepatitis B and C, HIV, and other blood-borne infections. I continue to advocate for this and other HIV-protection protocols. At the close of 2009, Congress and President Obama lifted the federal funding ban on NEPs, welcome news to many communities that were not able to initiate programs that could reduce Hepatitis and/or HIV infection by 10 percent or more.

I have long believed, as a theological ethicist, that one of my responsibilities to my own and other faith traditions is to articulate clearly the ways and means of reasoning about human choices and moral agency. I do not take this responsibility lightly, and, in fact, I rarely speak publicly on questions of morality except in tightly controlled academic settings. I have spoken on the so-called gay marriage debate, the removal of hydration and nutrition in cases of irreversible and near-term illness, and needle exchange programs.

Theological ethics in a Christian perspective and in my own Catholic tradition considers the popular 'what would Jesus do' and much more. To the extent that Jesus did not encounter questions of gay marriage, end-of-life care, or needle exchange, that popular question offers little in the way of convincing argument. Instead, theological ethicists look to Jesus' ministry to locate questions that seem to pertain to the contemporary concern.

Consider the case of the Gerasene demoniac (Mark 5:1-20), in which Jesus exorcised "Legion" from the man with the unclean spirits and sent him home to tell the good news and mercy that God had done for him. Of what did that exorcism consist? Rather than a dramatic "Come out of the man!" imagine instead that Jesus spoke more intimately to him, counseling him, praying with him, and in that intimacy the man was freed from the burdens of madness. Not unlike this kind of counseling, needle exchange programs provide opportunities for gentle conversation, counsel, and even prayer with those whose demons include injecting-drug-dependence. And with needle exchange comes more than the potential of this freedom; needle exchange also reduces the risk of infection by needles contaminated with Hepatitis B or C and HIV. (The swine into which Legion entered jumped to their deaths, to prevent the demons from taking up residence in another.)

Consider also the commands of God for the widow, the orphan, and the sojourner among the homesteaders. Today, this command extends to all those people who are vulnerable, especially those without voice or power to bring their concerns to the public arena for a hearing. In the Catholic tradition this command is met by a preferential option for the poor, for injecting-drug-users and those with whom they are intimate. Academic and professional organizations and religious institutions have endorsed needle exchange programs for their effectiveness to reduce and prevent harms to those who are vulnerable (including the Society of Christian Ethics, Institute of Medicine, American Academy of Psychiatrists in Alcoholism and Addictions, Episcopal Church, Presbyterian Church USA, United Church of Christ, Unitarian Universalist Association, Union for reform Judaism, Central Conference of American Rabbis).

Needle exchange saves at least some lives from blood-borne infection by providing fresh, uncontaminated, disease-free needles to those who use them and opportunities to engage injecting-drug-users in health counseling and to initiate rehabilitation and recovery programs. Needle exchange relieves the low-income economic burdens of those on Medicaid, Medicare, or VA assistance in regard to decisions on how this month's monies will be spent -- on fresh needles or housing, food, transportation, clothing, or emergency healthcare. And sex with a person who uses fresh needles includes a reduced risk of infection that could be present from a syringe supporting viral strains.

Before thinking that needle exchange will increase the use of illicit drugs, consider who is at risk not only of death by drug overdose but also of Hepatitis and/or HIV by association through sexual relations or familial and social bonds. Do you really want to leave your daughters and sons, mothers and fathers, veterans and friends, or yourself vulnerable? According to the CDC, the primary route of most blood-borne infections is heterosexual intercourse. If you are an active heterosexual, you are at risk. Every sexual encounter with someone who shares needles presents risk to the uninfected partner; and, once infected, that partner can infect unsuspecting others and others and others and.... Needle exchange is one fairly straightforward way to reduce this series of infection. Moreover, no scientific or sociological evidence supports the myths that needle exchange increases illicit drug use, or that people who share needles are an unworthy part of the American social fabric, or that having sex with people at risk compounds already morally suspect sexual and social intercourse.

Further, many in our religious communities and professional academies support the claims to justice that belong to everyone; these claims derive from the belief that basic needs for human flourishing are the same for everyone and that these needs ought not to be dependent upon income, desert, or merit. Many also tie these needs to harm reduction if not complete protection. Hence, most will recognize the physician's credo, confirmed by imperative of the Hippocratic Oath, primum non nocere ("first, do no harm"). How then can people of faith as well as those who ascribe to the equality basis of democracy respond to both needs and protection in regard to the risks of blood-borne infection? Provide better access to the means of human flourishing and to protections from the risks and harms of infection. The CDC recognizes the access/protection characteristics of "using a new sterile syringe for each injection and the importance of avoiding the sharing of injection equipment." Surely, needle exchange programs can begin to address personal responsibility and basic education about health while reducing the incidence of infection through syringe sharing. Even, the Catholic Diocese of Albany Office of Catholic Charities operates a needle exchange program, "Project Safe Point," as an extension of its mission to serve those who are poor and vulnerable.

Persons who use injecting drugs and those who are related to them as co-users, sex partners, or children deserve the equal protections of the law to reduce and/or remove the potential harms of preventable blood-borne infections. To do anything less is to fail to act to save human lives, to fail to acknowledge the dignity of every human life, and to fail to respond in solidarity to those who are marginalized on account of an addiction that places them and their associates at risk of life, limb, and love. The God of Abraham and Sarah and Hagar, Isaac and Rebecca, Jacob and Leah, Rachel, Zilpah and Bilhah, the house of Jesse from David to Jesus and to those of us identifying with this lineage expects no less.