Michael Gerson, one of the primary architects of Bush’s big-government “compassionate conservatism”, defends needle-exchange programmes for heroin addicts:

They are also at the center of a controversy. Needle-exchange programs have always been politically controversial, with opponents arguing that they send a mixed moral message about drug use. The House of Representatives recently passed an amendment banning exchanges in the District within 1,000 feet of places where children gather — which, if approved by the Senate, would effectively put programs like PreventionWorks out of business. Staffers joke that they could work only in graveyards and the middle of the Potomac.

This restriction might make sense if needle-exchange programs increased the number of addicts. But they don’t.

Gerson’s argument is absolutely correct. This is the sort of “compassionate conservative” proposal that I can wholeheartedly support, in part because it’s about smart public policy rather than simply bribing voters with new spending programmes.

Consider the benefits of needle-exchange programmes. The problem they are designed to tackle is a serious one. In developed countries, transmission from dirty needles is one of the primary causes of HIV; often around 30% in major cities. It also spreads other diseases, such as Hepatitis C, which infects (to use one example) 90% of intravenous drug users in Vancouver. Intravenous drug users are much more likely to die from these blood-borne pathogens than from overdosing on the drugs themselves, and needle-exchange programmes have been effective in reducing these diseases. According to some studies I’ve read, they can reduce the rate of HIV transmission by 30% or more.

What about the downside? A common criticism is that needle-exchange programmes will promote increased drug use. But studies have found that this is not the case, which makes intuitive sense. There are already high costs to becoming a heroin user, including the severe social stigma against intravenous drugs (which exists even amongst users of other, milder drugs) and the cost of obtaining the drugs themselves. It is these costs, not the cost of obtaining needles, that prevent people from becoming heroin addicts. Would you start shooting up with heroin just because you found out that you could get the needles for free? Similarly, people who have chosen to become addicts have already borne those costs, and they’re not going to stop using heroin just because they can’t find a clean needle.

In short, the state can not use needles as a policy instrument to reduce the prevalence of drug use amongst the population. However, the availability of clean needles does play a significant role in accelerating or retarding the spread of HIV and Hepatitis C. So why not increase the availability of clean needles and retard the spread of HIV? That won’t solve the drug problem, obviously, but at it might keep the addicts alive long enough to be rehabilitated.

There is also the matter of the cost of such programmes. Some taxpayers may justifiably resent having their tax revenue used to buy paraphernalia for drug addicts. On the other hand, needle-exchange programmes are very cheap to implement, and in countries that provides some form of public healthcare system (which is pretty much all the developed ones) providing AIDS treatment to drug addicts is extremely expensive for the state. What makes more sense: giving an addict a $1 needle now, or thousands of dollars of AIDS drugs later on? Implemented correctly, needle-exchange programmes can save the government money.

So, to sum up, we have a public policy that saves lives, saves money, and does not promote drug use. So why don’t more national and city governments do it? Because, as Megan McArdle points, of the ick factor. Needle-exchange sounds weird and counter-intuitive at first, and governments in a democratic system don’t want to incur the anger of the public by adopting policies that will provoke gut-feel resistance. However, conservative governments are somewhat less susceptible to this sort of public criticism, and theoretically have more freedom to introduce good drug policies. So it’s more of a pity that Michael Gerson wasn’t able to convince more people that he was right on this issue when he was working for the Bush Administration.