DRCNetDrug Reform Coordination Network


Cleveland Needle Exchangers Facing Arrest

In a continuing nationwide pattern of reprisal against the successful needle exchange movement, The Xchange Point needle-exchange program in Cleveland, Ohio has faced dishonest, bureaucratic stalling tactics by the city and is now threatened with the prospect of legal sanctions if they continue their lifesaving operation. We are asking supporters of the freedom to perform AIDS prevention to write letters on behalf of The Xchange Point to help resolve the situation in a positive way.

On January 27, 1995, the City of Cleveland issued an Emergency Order "Permitting and Encouraging Needle Exchange Programs". Since July 11, 1996, The Xchange Point has worked diligently to obtain approval from the City of Cleveland to operate a needle exchange program. Despite the fact that The Xchange Point was in compliance with the terms of the Emergency Order, the City of Cleveland Department of Public Health has continually refused to acknowledge the capacity of this organization to provide scientifically-based state of the art harm reduction services to injection drug users and others most at-risk for HIV/AIDS.

Following three months of frustrating negotiations with the City of Cleveland, as well as numerous discussions with experts in the field of needle exchange policy and research, The Xchange Point's Founding Director, Kenneth A. Vail, MA, MPH, could no longer in good conscience stand by and watch individuals risk HIV infection by sharing used needles. On October 2, 1996, after receiving unanimous support from The Xchange Point's Board of Trustees, staff began operating the organization's needle exchange program without the City's approval.

Since the needle exchange program was implemented, outreach workers have enrolled 140 participants, exchanged 975 clean, sterile needles for potentially HIV-infected needles, distributed over 1,000 bleach kits and over 12,000 condoms, as well as referred individuals to various drug treatment services, HIV testing/counseling sites and medical facilities. In addition, staff have also provided more than 30 individuals with emergency clothing and food.

On December 18, 1996, one day after a positive editorial about The Xchange Point, entitled "Free condoms, clean needles -- no lectures", appeared in The Plain Dealer, Director of Public Health Robert O. Staib, scheduled an emergency meeting with The Xchange Point's founding director. At the meeting, which was held on December 20, 1996, Director Staib stated that The Xchange Point must cease all needle exchanges immediately because it was not in compliance with the January 27, 1995, Emergency Order. Three reasons were given for non-compliance: (1) handling of needles/syringes by volunteers; (2) lack of a local physician familiar with Cleveland's health care system to supervise the needle exchange program; and (3) organizational capacity. It is important to note that 1) needles were being handled by independent contractors, not volunteers; 2) the order didn't require a local physician to be involved in program supervision, and the program was being supervised by Dr. Peter Lurie, one of the leading experts on needle exchange; and 3) organizational capacity was never part of the emergency order at all.

However, as a show of good faith, The Xchange Point provided documentation of its independent contractor agreement, retained the services of a local physician familiar with Cleveland's health care system, and obtained a letter of collaboration from one of Cleveland's two central intake units for drug treatment, stating that "The Xchange Point has referred clients to the CIU that are interested in breaking their cycle of abuse and in need of treatment. Consequently, The Xchange Point has been a reliable source for clients seeking treatment for heroin and other addictive IV drugs. We look forward to continuing our linkage with The Xchange Point so that individuals who are both at risk for HIV infections and in need of substance abuse treatment are afforded every opportunity to access treatment."

After The Xchange Point had worked with the City of Cleveland for three months and had demonstrated they were having a positive impact on HIV-related practices, City of Cleveland officials revised the Emergency Order in a way that makes it literally impossible for The Xchange Point to be able to comply. For example, section 3 (a) of the "Revised Emergency Order" states that "NEPs shall be operated by an organization which has been in existence for five years or more" and "The organization shall also operate primarily as a medical facility ..." Limitations such as these would prevent the majority of needle exchange programs in the United States from operating. In addition to revising the Emergency Order, the City of Cleveland has threatened the staff, the volunteers and the board members with legal action if the organization continues its needle exchange program.

The dishonesty and bad faith displayed by city officials is eclipsed by their callous disregard for human life. Actress Elizabeth Taylor, a champion for the AIDS movement, has called the denial of sterile needles to addicts an act of "premeditated murder". It is a sad irony that Cleveland's leading public health official has taken actions that are certain to lead to more AIDS cases, not only among injection drug users but among the rest of the population with whom they interact, including newborn children. Sharing of needles by injection drug users is now the leading cause of new AIDS cases in the United States. The research on needle exchange demonstrates overwhelmingly that 1) needle exchange programs reduce the spread of HIV; and 2) have not been found to increase drug use. (See the addendum in "Needle Exchanges Advancing Under Fire", http://www.drcnet.org/guide10- 96/underfire.html on the web.) The controversy surrounding needle exchanges is not scientific or medical, but political. The stance taken by the city's Dept. of Health places them at odds with virtually the entire public health field.

We are asking you to write to Mayor White, Director Staib, and the Plain Dealer newspaper to express your support for needle exchange and your outrage at the city's bad faith anddisregard for life. We have included information for some other newspapers, for those of you who are especially motivated. Please send a copy to The Xchange Point (477 Overlook Rd., Suite 4, Cleveland, OH, 44106, phone: (216) 556-4114, fax: (216) 321-9855, [email protected]), to aid in their lobbying and PR efforts. And please send a copy to DRCNet (4455 Connecticut Ave., NW, Suite B-500, Washington, DC 20008, fax: (202) 362-0032, [email protected]), to help us gauge our reach and effectiveness and demonstrate them to potential funders. Letters from physicians and public health professionals are especially needed, but everyone is encouraged to participate. We are not sending a sample letter, because the letters are directed at a small number of newspapers that are likely to be put off if they receive multiple copies of the same letter.

Since press coverage is likely to turn needle exchange into a statewide issue, residents of Ohio are urged to contact the Governor and their state legislators:

(Call or use the web sites to get the names of your state Representative and Senator.)

While you're at it, visit http://www.drcnet.org/letters.html to send a letter on needle exchange and/or other drug policy topics to your Senators and Representatives in Congress.

Online Resources:


DRCNet's Needle Exchange Page, with links to many other relevant sites.


Web site of the Harm Reduction Coalition, a national organization promoting strategies for reducing the harm related to substance abuse and sexual behavior.

Harm reduction and Needle Exchange discussion groups. Send e-mail to [email protected] with the lines "subscribe harmred your name" and/or "subscribe nep your name" in the body of the message (not the subject).


Directory of needle exchange programs' web sites, on the web site of Safeworks AIDS Project in Minneapolis, MN.

Health Emergency 1997: The Spread of Drug-Related AIDS Among African Americans and Latinos, by Dawn Day, PhD, with a foreword by former US Surgeon General Joycelyn Elders. Available for $7 from the Dogwood Center, P.O. Box 187, Princeton, NJ 08542, (609) 924-4797 (voice), (609) 252-1464 (fax), [email protected]. Will soon be available on the web; check the DRCNet needle exchange page for a link.

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