Nationwide, nearly a quarter million intravenous drug users may already be infected.⁷¹

It is difficult to say what the long-term effect of AIDS on narcotic addiction will be because developments in AIDS are occurring very rapidly, both in the spread of the epidemic and in research on ways of potentially controlling or treating it Nevertheless, several studies on the reactions of intravenous drug users to AIDS show that the epidemic has had an effect and hint at the possibility of reducing the practice of illicit drug injection, or at least of making it more circumspect. Death has always been common among intravenous drug users, but AIDS forces a radically different psychology of death in the group. Involving a protracted and painful death, often with stigmatization and social isolation, AIDS conjures up none of the escapist fantasies associated with overdose deaths. The virus may also develop long after a person has ceased injecting drugs; one cannot be certain that stopping drugs will prevent the development of AIDS. Finally, there is the possibility of infecting friends and family, through sexual or in utero transmissions of the virus. These considerations have apparently prompted changes in the behavior of intravenous drug users in the New York area, where addicts have increased their use of sterile needles and reduced the number of persons with whom they will share drug injection equipment.⁷² It is possible that "safer" needle use will become the norm for intravenous narcotic addiction in the future. Fear and natural selection are both operating in that direction.

Another potential for change in narcotic addiction may be in the recruitment of new intravenous drug users. Novices usually learn to mainline through contact with experienced users whom they admire and depend on for the equipment for their first injection.⁷³ Over time, the fear of AIDS is likely to reduce both the admiration felt for experienced intravenous users and the willingness to borrow or experiment with their needles and syringes. No one wants to borrow death, especially death by AIDS.

The threat of AIDS could reduce illicit drug injection to the point where not enough new persons are recruited to replace those intravenous users who die or quit. This would not necessarily eliminate narcotic addiction, however. It would still be possible to become addicted by sniffing or (more rarely) smoking heroin, or by the regular use of a synthetic opiate. Thus, even if AIDS should virtually eliminate intravenous drug addiction, there is no guarantee that other forms of addiction will disappear. They may even expand, as has happened with cocaine smoking.

One last point about AIDS: although there is some evidence that intravenous drug users are motivated by fear of the disease to seek treatment,⁷⁴ most addicts remain at large, as noted earlier. The danger they pose to themselves and to others underscores the fact that a large