pressure to show evidence of their ability to effectively treat drug abuse. Although drug abuse treatment programs are for the most part funded from sources different from those that fund needle exchange and bleach distribution programs, there is concern that the latter will become attractive alternatives to drug abuse treatment because of their relatively low costs. These views have been publicly expressed by members of the treatment community. For example, Primm1 (1990) states:

There are some theoretical benefits, of course, in providing sterile needles. It's inexpensive, relative to drug treatment. This is why so many people are embracing it and why public health officials are talking of potential control of HIV transmission as being more important than drug treatment. … Needles, syringes, and drugs have been destructive forces.

For some drug treatment professionals and indigenous outreach workers who are attempting to help clients in their struggle to remain drug free, the increased access to needles dispensed by needle exchange programs represents a threat that attention will be diverted from their efforts. The major initial objection of the treatment community to the programs appears to derive from its primary orientation of strict abstinence. Needle exchange programs pose an apparent contradiction to this principal goal of treatment (Wolk et al., 1990). Critics of needle exchange programs indicate that, by implicitly condoning drug use, these programs are sending conflicting messages not only to current injection drug users, but also to those who are at risk of becoming injection drug users (Singer et al., 1991).

At the time of this writing, no empirical study of the views of the drug treatment community on needle exchange and bleach distribution programs has been published. In an attempt to obtain these views, the panel contacted 25 professional and trade associations that represent service providers and asked them to provide any policy or public statements they may have on the issue of concern. Even after mailing a remainder about the original request, the panel received responses from only 13 associations (Table 4.2).

The views of those who responded can be summarized as follows. As shown in the table, of the 13 associations (52 percent) that responded, 61.5 percent support such programs; 38.5 percent have no official or formal position on the issue. A noteworthy observation is that none of the associations that responded indicated that they were against such programs. The official policies of the American Psychiatric Association, the American Public Health Association, the American Society of Addiction Medicine, the National Association of Social Workers, and the National Association of State Alcohol and Drug Abuse Directors are the most detailed (see Appendix B). It should also be noted that both the American Medical Association and the



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