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Remove legal barriers to the purchase and possession of injection equipment. Such legal barriers do not reduce illicit drug injection. They do, however, limit the availability of new/clean injection equipment and therefore encourage the sharing of injection equipment, and the increase in HIV transmission.

National drug policy must recognize the success of outreach programs which link needle exchange and bleach distribution programs with drug treatment. The Commission has visited numerous programs throughout the country which distribute bleach and some that exchange clean needles. These programs have demonstrated the ability to get substance users to change injection practices. Most significantly, these programs, rather than encouraging substance use, lead substantial numbers of substance users to seek treatment.

For example, the Tacoma, Washington project conducts a syringe exchange and other AIDS prevention activities, as well as providing some basic services. Soon after its establishment it became the "largest referral source to treatment in [the] county." Studies of demonstration projects like these have shown that they are an immediate and effective way of addressing the public health threat of HIV and of reducing demand. Yet, state to state, and even city to city, policy and practice on this issue differs to such a degree that outreach workers may have the full cooperation of the local police in one area, and be arrested in another. There must be increased coordination between law enforcement officers and outreach workers. The very real fear that clean syringes and bleach vials will be used as evidence for arrest and prosecution may be having a "chilling effect" on drug users' practice of safer injection behaviors. These legal sanctions on injection equipment thus serve to increase the sharing of injection equipment and, through this behavior, the transmission of HIV.  It is imperative that we remove these legal barriers so that the transmission of HIV can be lessened for those who cannot stop injecting drugs.

Examples from some U.S. cities and the U.K., the Netherlands, and Australia show that cooperation of law enforcement and public officials can make a major difference in the success of outreach programs. In Tacoma, where the city and county jointly run the health department, all city and county representatives who sit on the health board have been educated about AIDS. The chief of police is also "AIDS educated" and was able to cooperate with the outreach programs in the city. This syringe exchange and basic needs outreach program in Tacoma has resulted in "approximately an 80 percent reduction in risk behavior in terms of injecting practices of the people that use the exchange as opposed to those who don't." In the documentary "Taking Drugs Seriously," a film about the Merseyside Regional Health Authorities' harm reduction approach in the U.K., Allan Parry, Director of the Maryland House in Liverpool, believes that "the main reason we're keeping down the spread of the virus is because of the police support of [syringe exchange] activity." Detective Superintendent and Drug Squad Chief Derek O'Connell explains that while they do not support decriminalization..., "because of the AIDS problem which is now recognized by the government as a very, very serious problem, it would be remiss if we didn't give support wherever it was needed." In fact, since beginning their new "cautioning" program which steers individuals toward drug dependency programs instead of prosecuting, they have seen "an 85% success rate; that is, people not re-offending."