A few years ago, Roseanne Scotti traveled from New Jersey to New York City to buy clean needles. At a busy pharmacy in Manhattan, Scotti told a pharmacist that she was not a drug user, but a reform activist. She wanted to see the process involved in buying syringes in New York, where, like most other states, it's legal to buy a limited number of clean syringes over the counter without a prescription. In New Jersey, Scotti told the pharmacist, a prescription is required.

“She looked at me, horrified,” said Scotti, remembering the pharmacist's reaction.

Without access to clean needles, the pharmacist replied, people would have to reuse them, or worse – share dirty needles.

That's exactly what Scotti and a broad coalition of public health groups have spent years telling lawmakers in New Jersey, where injection-drug policy has lagged behind the rest of the nation. About 37 to 40 percent of HIV transmissions in New Jersey are attributed to sharing dirty needles. That's more than twice the national average, which has dropped from 31 percent to about 17 percent since 1993 as more states made clean needles more accessible to drug users.

In 2009, New Jersey had the fifth-highest HIV rate in the nation and the highest rate of women living with HIV, according to the state health department. New Jersey is also facing a growing hepatitis C epidemic, with about 60 percent of infections resulting from injection drug use.

Scotti, who serves as director of the Drug Policy Alliance (DPA) in New Jersey, said she brought “countless” policy makers to New York City to show them that the world doesn't turn upside down when drug users have access to clean needles.

Now, victory is finally in sight. Republican Gov. Chris Christie is expected to sign a bill lifting the ban on syringe sales within a week, leaving Delaware the last state with a syringe ban.

Christie conditionally vetoed the original bill, which aims at reducing the spread of blood-borne diseases, on Monday, January 9, the last day of the state's legislative session. Legislators quickly approved the changes, which include requiring purchasers to have a photo ID or otherwise assure a pharmacist that they are 18 years of age or older.

Christie's last-minute changes to the New Jersey bill are intended to keep syringes out of the hands of young people, but his own officials have acknowledged that drug addiction does not just plague legal adults, especially in New Jersey, where the Drug Enforcement Administration's (DEA) 2011 threat assessment lists heroin as the top drug threat.

“Heroin and other opiate use among New Jersey youth has risen drastically over the last decade,” said John Hulick, director of Governor Christie's drug and alcohol abuse council, during a November 2011 address, “a fact reinforced at hearings held in June by the State Commission on Investigation, where experts testified that prescription pills were easily accessible to teenagers, and a 'gateway drug' to heroin.”

Hulick said opiate and heroin abuse among New Jersey youth has reached “epidemic proportions” and called on residents to safely dispose of unused prescription painkillers.

The DPA reports that New Jersey has the third-highest rate of pediatric HIV cases in the country. Requiring a photo ID may also be a roadblock to clean needles for some drug users. But Scotti called Christie's photo ID provision “workable,” noting that most states do not allow sales to minors and, because little data is available on teen drug use, it's unclear how many young opiate users are actually shooting up pills and heroin.

While the final bill is not perfect, Scotti said it's certainly a victory. Reform activists have spent two decades fighting to give New Jersey residents trapped in the physical hurricane of injection-drug addiction access to clean needles, and now their efforts are finally paying off.

Republicans Reinstate Funding Ban

For Scotti and her allies, the past month and a half has been a political roller coaster ride. Soon after New Jersey lawmakers passed a final bill to legalize syringe sales in mid-December, House Republicans tacked on a provision to the controversial 2012 omnibus spending bill that reinstated a ban on federal funding to syringe exchange programs.

Syringe exchange programs are fairly self-explanatory: drug users come to clean, welcoming facilities and exchange their used needles for a limited number of new ones. This prevents users from resorting to sharing and reusing needles, which an overwhelming body of scientific evidence, including eight federal studies, has shown saves lives by preventing the spread of blood-borne illnesses without increasing drug use. Syringe exchanges are considered a “harm reduction” strategy. Advocated by human rights groups and health groups worldwide, harm reduction strategies accept drug addiction as a fact of life and aim to reduce the amount of harm drug users can inflict on themselves and society.

Exchange clinics can act as a bridge to drug treatment programs, and studies show that many users enroll after visiting exchange sites. Syringe exchanges also save society money. In Australia, for example, health officials estimate the country saved $1 billion in health care costs from 2000 to 2009 by preventing infections with syringe exchange programs.

Social conservatives in Congress, however, have opposed using federal money to fund syringe exchange programs since the late 1980s. In 2009, after years of fighting for reform amidst the HIV/AIDS epidemic, Congressional Democrats and President Obama successfully lifted a 21-year ban on federal funding for exchange clinics.

But in December, with all eyes on the economy, payroll tax cuts and the Keystone XL pipeline, House Republicans tacked a measure onto the omnibus 2012 spending bill that reinstates the ban, throwing the federal policy toward HIV/AIDS prevention back into the dark ages. The mainstream media made little mention of the reinstated ban. (See Truthout's analysis here). After days of political deadlock over issues perhaps more pressing to most Americans than clean needles, President Obama finally signed the compromise bill to the dismay of public health advocates.

“Congress and the president are reversing a major public health gain at a time in the AIDS epidemic when we cannot afford to take steps backward,” said David Ernesto Munar, president of the AIDS Foundation of Chicago. “We are dismayed that this year Congress threw in the towel when it comes to HIV prevention. They beat back provisions restricting abortion, workers' rights and pollution enforcement. Why aren't people at risk of HIV just as important?”

Obama and Clean Needles

Munar called on the Obama administration to condemn the ban, but with so many other controversies swirling in Washington, the administration has remained largely silent. The Obama administration does support syringe exchange programs, at least in theory, but don't expect the White House to go out on a limb to ensure drug users have clean needles.

The president endorsed syringe exchange as part of his 2010 HIV/AIDS reduction strategy, but the report admits that HIV prevention services have never been “sufficient.” Because federal resources are “limited” and many states have reduced prevention budgets due to the economy, the Obama administration recommends simply re-evaluating how existing resources are distributed.

Funding for needle exchange programs has plummeted in recent years, with 10 percent of clinics closing or drastically reducing services due to state budget cuts in 2008, according to an international survey. The United Nations (UN) currently estimates that there is one exchange site for every 10,000 injection drug users in the United States.

Advocates like Scotti know that supporting funding for needle exchange programs is a tough political sell. She said politicians shy away from the cause because they fear being perceived as soft on drugs or crime. Drug addiction, and the health risks that come with it, is more prevalent among stigmatized minorities and the poor, who have little political voice of their own.

“In terms of money and power, it's not one of those issues that has that behind it, but it's got science behind it,” Scotti said.

Look no further than a pilot program that finally established five urban needle exchange sites in New Jersey in 2006, more than a decade after clinics were approved in other states and Western countries across the world. An interim report on the program claims it holds “great promise” for reducing the spread of blood-borne pathogens. The program helped more that 5,000 people use clean needles, with 10 percent of participants enrolling with the explicit intention of quitting drugs. Nearly 1,000 drug users were successfully enrolled in treatment programs. Exchange workers in Camden helped 12 pregnant women enter drug treatment and find housing. Three of them gave birth to healthy babies, and nine others successfully quit using drugs and were receiving prenatal care when the report was issued.

If the pilot continues to see success, the clinics will become permanent fixtures in some of New Jersey's toughest neighborhoods and pave the way for similar programs. Perhaps then New Jersey will begin to see its HIV and hepatitis C rates fall in line with the rest of the country.

Scotti said the exchange programs stand to take a hit from the reinstated ban on federal funding. The programs were not getting a lot of money to begin with, but it was enough to expand their hours and hire more people, and now they may have to cut back. But at least they are operating, and people are getting clean needles.

“I'd like to save thousands and thousands of lives,” Scotti said, “but if you can save hundreds, that's a good thing too.”