International Journal of Drug Policy 12 (2001) 45–57
Point Defiance: a case study of the United States’ first
public needle exchange in Tacoma, Washington
Susan G. Sherman
a,
*, Dave Purchase
b
a
John Hopkins School of Hygiene and Public Health, Department of Epidemiology,
614
N. Wolfe Street, Baltimore,
MD
21205
, USA
b
Point Defiance AIDS Projects,
535
Dock Street, c
112
, Tacoma, WA
98402
, USA
Abstract
The first publicly funded needle exchange program in the United States began in Tacoma, Washington, in August
1988. The exchange’s history is characterized by a series of firsts: the first American publicly funded exchange; the first
pharmacy exchange; the first American needle delivery program; and the first state Supreme Court ruling not only
supporting the existence of a needle exchange program but superseding existing drug paraphernalia laws. It is also
unique because it began outside of the public health system and was not compromised by political feasibility. This
article documents the events and personalities which led to the exchange’s establishment and its expansion over time;
the program’s local, state and legal challenges and advocates; its portrayal in the local and national media; the
research that documented its successes; and its important contribution to the fight for drug users’ unencumbered
access to sterile needles. © 2001 Elsevier Science B.V. All rights reserved.
Keywords
:
Needle exchange program; Harm reduction; Tacoma; Case study
www.elsevier.com/locate/drugpo
Introduction
Injection drug use continues to be the sec-
ond leading risk factor for becoming infected
with Human Immunodeficiency Virus (HIV)
in the United States (Centers for Disease
Control and Prevention, 1999). It is directly
or indirectly the source of HIV in over half of
heterosexually transmitted Acquired Im-
munodeficiency Syndrome (AIDS) cases.
Needle exchange programs (NEPs) are a cost
effective method of disseminating clean
needles and have been shown to be effective
in reducing the spread of HIV among injec-
tion drug users (IDUs) in the United States,
Europe, and Australia (Hartgers et al., 1992;
Watters, 1994; Des Jarlais et al., 1995; Nor-
mand et al., 1995; Vlahov et al., 1997; Dias et
al., 1998). In spite of this scientific evidence,
as well as seven US government reports that
endorse NEPs as a method of reducing the
spread of HIV, the US Federal Government
has banned the funding of needle exchanges
* Corresponding author. Tel: + 1-410-5025368; fax: +1-
410-5025385.
E-mail address
:
ssherman@sph.jhu.edu (S.L. Sherman).
0955-3959/01/$ - see front matter © 2001 Elsevier Science B.V. All rights reserved.
PII: S0955-3959(00)00074-8