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Guilfoile came up with three options: teach drug users to bleach their works, which wasn't 100 percent effective; push them into drug treatment, which was typically even less effective; or swap their dirty, potentially HIV-tainted needles for clean ones.

Guilfoile chose the third and suggested it to the public health director, Federico Cruz-Uribe, who, she says, took a deep breath and then started a campaign to get health workers, county commissioners, the Boulder Daily Camera and then-district attorney Alex Hunter on board. It worked, and after finding little public opposition, Boulder County started the state's first aboveground (though still illegal) needle exchange program, with Hunter agreeing not to prosecute its participants.

It started out small but grew steadily, thanks in part to a model that trains current and former drug users as volunteers who collect dirty needles and distribute clean ones. Today there are 82 volunteers, and program coordinator Kyla Holcomb estimates they exchanged 40,000 needles with 437 injection drug users last year.

Former public health director Chuck Stout, who replaced Cruz-Uribe in 1990 and retired last year, says that while the needle exchange used up 19 percent of the total spent on the county's drug-user disease-prevention program, "it probably accounted for 90 percent of the success. It was the clear, compelling statement to the injection drug user that I accept you where you are, and my sole intention is to keep you safe."

Stout is frustrated that the rest of Colorado hasn't followed Boulder County's lead. Legislators, he says, are "out listening to constituents' assumptions, beliefs, opinions and attitudes. All of those are against syringe exchange programs. The only thing they're not listening to is the facts."

Stephen Koester, an anthropology instructor at the University of Colorado Denver, helped gather some of those facts in 1989 with a grant from the National Institutes of Health. His goal was to find out why drug users shared syringes. Koester interviewed junkies around Denver and soon discovered that sharing wasn't, as previously thought, part of an "exotic drug-using culture." Rather, it was a necessity: Although being busted in Denver for carrying a syringe with the intent to inject drugs carries only a small penalty — in most cases, a citation and a fine of under $100 — Koester found that most drug users don't risk it because it's a charge that can lead to more trouble. They may be unable to pay the fine, or they may forget about their court date and wind up in jail, which means they're likely to go into withdrawal.

Nationally and internationally, Koester's study made a difference. Municipalities in the United States and even overseas changed paraphernalia laws to allow syringe exchanges. Other researchers cited it, and Koester gave several talks to the CDC.

His study isn't the only one to praise the efficacy of needle exchange. Between 1991 and 2001, seven federal agencies, including the CDC and the General Accounting Office, conducted studies. All showed that needle exchanges help prevent HIV and other diseases from spreading and that handing out clean needles doesn't create more junkies. A 1997 report by the National Institutes of Health concluded that syringe exchange programs "show reduction in risk behavior as high as 80 percent in injecting drug users, with estimates of a 30 percent or greater reduction of HIV."

International research reached similar conclusions. A 2002 study of programs in 103 cities worldwide showed that the number of users contracting HIV in cities with exchanges decreased by nearly 19 percent each year, while the number in cities without them increased by 8 percent. Studies also show that those who use exchanges say they're less likely to share syringes, a sign that the crucial message is being heard.

There are also studies that prove the opposite, though they're few. A 1997 study of drug users in Vancouver, Canada, found that those who used needle exchange programs were more likely to be HIV-positive than those who didn't. Other researchers have countered that it could be because the programs tend to attract high-risk drug users.

Most often, arguments against syringe exchange are moral: Drugs are bad, and needle exchange programs send the message that using them is okay.

Those were many of the arguments heard at the Colorado State Capitol in 1998, the last time lawmakers faced a bill seeking to create a needle exchange loophole.


Paul Simons grew up in Fort Collins in the 1960s, the son of a university professor. When he was eighteen, he moved to New York City for college and found heroin. "It was the late '70s, and I was really into the punk movement," Simons says. "It was a lifestyle choice. I was interested in the effects of chemicals on the body. Heroin was the hardest drug, and I wanted to follow substance abuse to its logical conclusion. And I did."

But Simons, who describes himself as a twenty-year "on and off" heroin addict who's been in recovery for nine years now, also helped found a syringe exchange on the Lower East Side and began working on public health projects.

In 1994, he returned to Colorado to run an HIV-prevention program for Denver Public Health. He applied for federal grant money to start an organization aimed at bringing needle exchange to the state.

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