No fly, no buy: still a terrible policy

After the Orlando nightclub shooting at Pulse, there was an increased call for gun control or gun reform laws.  The most prevalent call was the idea of “no fly, no buy.”  This policy would entail that people who are on the “no fly” list would not be allowed to buy guns.  Quinnipiac University found that 86% of registered voters back this type of proposal when they polled this issue at the end of June.  A Suffolk University poll taken around the same time found that 76% of likely voters supported such a measure.  The idea has quite a bit of popularity.  It has a “bumper sticker politics” feel to it where it sounds really good on bumper stickers.  What’s more is that it is very easy to say to someone on the no fly list should not be able to buy guns.  It appeals to your gut.  It’s designed to attack those who oppose it.  But it’s terrible policy.  The amendment offered by Dianne Feinstein that would prevent those on the “no fly” list from purchasing guns failed as did Senator Susan Collins’s compromise amendment.  The amendments would include those within the Terrorist Identities Datamart Environment which includes the Terrorist Screening Database of which the no fly list is a subset.  I don’t think it will be brought up again, anytime soon in terms of actual legislation, but I do think people will continue to have discussions revolving around this issue.

Due process problems

There are some Constitutional arguments that we can have over whether or not gun control laws violate the 2nd Amendment.  I, for one, believe that the Constitution does allow for regulations of firearms but for those that disagree with me, I certainly understand.  But I do believe that regulations of firearms have to follow the other Constitutional amendments that we have and the principles found within the Constitution.  We do have principles of due process, equal protection, privacy, and unlawful searches that are equally entrenched and protected in our Constitution.  We must follow through with these principles.  So, you must provide for reasoning as to how or why someone is prevented from purchasing firearms and/or a remedy for them if they are prevented from doing so by either a mistake or inaccurate information.

In 2003, in the immediate aftermath of the 9/11 terrorist attacks, President George W. Bush expanded the screening of suspected terrorists.  The FBI Terrorist Screening Center (TSC) was created.  The TSC houses the consolidated Terrorist Watchlist.  This watchlist is a “single database of identifying information about those known or reasonably suspected of being involved in terrorist activity.”  We’ll get back to the “reasonably suspected” portion of their statement in a bit.  This database is what helps create screening agencies to prevent people from obtaining visas, enter the the country via aircraft or seacraft, or travel via air or sea around the country. The American Civil Liberties Union (ACLU) has been a critic of this agency and process since the onset.  They noted in their report that the TSC  also contains “the selectee list) which identifies “individuals who are subjected to additional questioning, inspection, and screening before being allowed to board flights to, from, or over U.S. territory.”  The ACLU writes that 875,000 individuals as of December 2012 are on the consolidated terrorist watchlist.  The Associated Press reported in February of 2012 that there were about 21,000 individuals on the “no fly list” alone.  The ACLU has since reported that 47,000 people are on the no fly list as of 2013.

The authors for the ACLU write about what it would take to be placed in the Terrorist Screening Database.  The TSC defines a reasonably suspected terrorist is an “individual who is reasonably suspected to be, or have been, engaged in conduct constituting, in preparation for, in aid of, or related to terrorism and terrorist activities based on articulable and reasonable suspicion.”  As the authors of the ACLU write, this is “broad enough to include First Amendment-protected speech and association…mere proximity to a suspected terrorist should not make one a suspected terrorist, but that is what the standard allows.”  The Government Accountability Office (GAO) acknowledged that “agencies utilizing watch list records recognize various definitions of [terrorism].”  That’s just the standard to be included on the database.  The no fly list and selectee list, though, are subsets of that database.  Government representatives acknowledge that there are “additional derogatory requirements.”  These requirements have not been disclosed.

As the ACLU has found in their efforts of representing clients that most of the people do not find out that they are on the no-fly list until they try to fly and are barred from trying to fly.  Previously, the government had not confirmed or denied if people were actually on the no-fly list.  This has since been changed.

What’s more startling is that there are a number of mistakes with the terrorist watchlists and what is not surprising is that people are placed on the watchlists based on discriminatory factors.  The ACLU found that 280,000 on the master watchlist who have “no recognized terrorist group affiliation.”  The city of Dearborn, Michigan which has one of the largest Arab American communities in the country has more people on the terrorist watchlists than any other city in the country except New York City.  There are less than 100,000 people in Dearborn, Michigan.

People are erroneously placed on the No fly list and the list is not updated.  The ACLU writes in their report:

Rahinah Ibrahim, a Stanford PhD student and Malaysian citizen, was prevented from boarding a flight in San Francisco, handcuffed (despite being wheelchair-bound at the time), and held in a detention cell for hours in January 2005 based on what turned out to be a bureaucratic error by the FBI that placed her on the No Fly List. The government fought to avoid correcting the error for years, even invoking the state secrets privilege in an unsuccessful effort to prevent judicial scrutiny. She was permitted to leave the country, but to this day, she has been barred from returning, even though the government admits that she should not have been placed on the No Fly List.

The ACLU reports the Department of Justice Inspector General wrote in 2008 that watchlist records are not appropriately generated, updated, or removed as required by FBI policy. In 2009, the same Inspector General found that many people were not removed from the watchlist and tens of thousands of names were placed on the list without a factual basis. Some of the other more notable names that have been included on the watchlists include Nelson Mandela, Ted Kennedy, and John Lewis.

Those on the watchlists have very little opportunities to be able to get their names off of the list as they are not offered a chance to make their case in front of a neutral arbitrator.  In Feinstein’s amendment would require the attorney general to draft measures to make sure that national security is not compromised which would prevent an individual from finding out why they were denied the ability to buy a gun.   Unless the government provides reasons as to why an individual is on the watchlist that is preventing them from purchasing a gun and allows for a real ability to correct the issue, it fails basic due process standards.

 

 

 

 

 

 

 

 

 

 

 

Legislative Priorities: Voting Rights

 

Legislative goals:

  1. States that require voter registration should make same-day voter registration available at the polling place on the day of the election
  2. Allow the use of a single absentee ballot application for subsequent elections
  3. Prohibit election officials for requiring identification that has a cost as a condition to vote or register to vote
  4. Require states to automatically register individuals registering with DMV’s for driver’s license.  Require states to follow pre-registration for individuals who are 16 to ensure that they are registered to vote by the time that they are 18.
  5. Change election day to  Friday, Saturday, and Sunday for the first Friday after the first Monday in November on even number years, as well as every fourth year for presidential elections.  Election day Friday should be declared a federal holiday.
  6. Create a new determination for preclearance by the Department of Justice for any changes made to voting laws and regulations.  This new determination will be for states if there there were at least 5 voting rights violations in the last 25 years and 3 voting rights violations during the previous 15 years, if at least one of the violations were committed by the state itself.  The preclearance requirement for districts and states would also be triggered if it was determined that less than 50% of those who are of voting age are registered to vote on November 8, 2016.
  7.  Restores the right to vote for non-violent felons provided that they are not in a correctional facility at the time of the election.  For those on probation, the right to vote will be restored at the end of their probation.  This will also apply retroactively.  Those affected will be automatically registered to vote and will be notified that their voting rights are restored and that they are registered to vote.
  8. Redistricting after a census can only take place once after each census and can only be done by an independent district commission.

Information for legislative goals:

Our goal is to try to make voting even easier than it currently is.  The hope is that when people do not have as many roadblocks in their way, it will increase voter turnout and provide a more representative electorate.  I’m not naive enough to believe that a more representative electorate will elect politicians that share my views.  I do believe that having a more representative electorate is a worthy goal in and of itself.

In the 1980 book, Who Votes?, the authors concluded that the voter registration date was the single largest impact on voter turnout.  They recommended a move to same-day voting registration.  Same-day voting registration allows voters who are not registered to vote to go to their polling place and fill out the voter registration form and then be able to vote.  The authors predicted that if same-day voting registration was enacted in all 50 states, voting turnout would be 9% higher.  This prediction held on rather nicely.  In a study titled “Election Day Registration’s Effect on U.S. Voter Turnout” the authors Craig Leonard Brians and Bernard Grofman project based on their studies that moving to same-day registration would product about a 7 percentage point boost in the average state.  Laura Rokoff and Emma Stokking looked at the effect of same-day registration in “Small Investments, High Yields: A Cost Study of Same Day Registration in Iowa and North Carolina” for Demos and write that average turnout in states with same day registration are 10-12 percentage points higher than states without same day registration.  In 2008, same-day registration states led the nation in turnout by 7 percentage points and by nearly 6 percentage points in the 2010 elections, they write.  Brians and Grofman conclude that it may be a higher turnout boost in states with higher urban populations.  By looking at past elections, they found that those in the low and high portion of the socioeconomic spectrum have a 3% boost by moving from voting registration from 30 days out to same day registration.  The middle socioeconomic status which has more people in it had a 5% increase when moved from a 30 day deadline to same day registration.

The biggest stumbling block for this policy is the idea that same day registration would advantage one political party.  While intuitively it would make sense that voters taking advantage of same-day registration would tend to be Democratic voters, they did not find any significant evidence that same-day registration would help one way or the other for either major political party.  The University of Wisconsin-Madison’s Jacob Neiheisel and Barry Burdern found that there was a slight increase for Republican voters with the same-day registration rules. The other stumbling block that I can think of is that it is cost prohibitive.  Rokoff and Stokking looked at North Carolina and Iowa in their paper.  In 2008, over 250,000 citizens used same day registration in 2008 and 45,000 used it in Iowa in 2008.  Rokoff and Stokking found that the majority of counties in Iowa reported little to no additional costs.  The costs that they discovered were primarily due to printing and mailing the forms.  North Carolina, likewise, did not see that much of an increase in spending but did need additional staffing at smaller counties.

Voter ID is a very common response called on for trying to fix our electoral woes.  On the one hand, conservatives and Republicans argue that voter ID is necessary to ensure that the electoral system is not abused by fraud.  On the other hand, liberals and Democrats claim that voter ID unfairly target minority voters and the poor.  In an investigation of over 1 billion votes cast, Loyola Law School professor Justin Levett found only 31 credible incidents of voter impersonation.  In a study by the Government Accountability Office (GAO) where they reviewed 10 studies regarding voter ID, they found that 5 studies showed that there was not a statistically significant effect on voter turnout.  In 1 study, there was an increase in voter turnout nationwide of 1.8 percentage points.  The 4 other studies showed voter turnout decreased by 1.5-3.9 percentage points. More than half of the population of the United States now lives in states that require ID’s to vote, as 34 states have passed some type of voter ID law.  The strictest voter ID laws have been passed since 2008.  Justice Ruth Bader Ginsburg has called the laws “purposely discriminatory.”

It’s fairly difficult to pin down the exact percentage of the population does or does not have proper identification to be able to vote.  The Washington Post reports that there’s an estimated 1-11% of registered voters who do not have valid photo identification.  The GAO looked at various studies to help determine this information.  In a 2012 study that they looked at, 86% of all registered voters had a driver’s license, state id card, or gun permit.  Yes, a gun permit is a valid ID for voting purposes in Texas.  89% of registered whites had valid voting ID.  This compared to 83% of Hispanic registered voters and 79% of African-American registered voters.  Comparatively, a similar study showed that 84% of all registered voters had valid photo ID in Indiana.  In a nationwide study in 2013, they found that 84% of white registered voters had a valid driver’s license.  This compares to 73% of registered Hispanic voters and just 63% of registered black voters.  That seems like a problem as Zoltan Hajnal, Nazita Lajevardi, and Lindsay Nielson present in a working paper from the University of California-San Diego note that there is clear evidence that they “tend to emerge in states with larger black populations.”  If we couple that with the fact that minorities are disproportionately asked for identification by poll workers, we can see the problem for voter id’s.

The studies show that there is not a statistically significant effect on voter turnout, overall.  However, as Nate Silver points out that is giving deference to the null hypothesis.  Or to paraphrase former President Bill Clinton, it depends on what your definition of statistical significance is.  In the working paper by Hajnal, Lajevardi, and Nielson they tried to identify the impact on voter id compared to states without strict voter id laws.  What they found is fairly striking.  In general elections, they found that Latino turnout was 10.3 points lower in states with photo ID than in states without strict photo ID regulations. For multi-racial Americans, turnout was 12.8 points lower under strict photo ID laws. For blacks, the turnout was 4.8 points lower in general elections with states with stricter voter id laws.  Multi-racial Americans voted at almost the exact same predicted rate as whites in non-photo ID states but were 9.2% less likely than whites to participate in general elections in photo ID states.  The GAO’s study looked at turnout in Kansas and Tennessee compared to a list of other states that did not implement voter id laws.  Turnout declined by 1.9-2.2 percentage points more in Kansas and 2.2-3.2 percentage more in Tennessee.  Nate Silver noted in that FiveThirtyEight piece that photo id decreased turnout by about 2% as a share of the registered voting population.

Possibly a bigger effect on voter turnout would be the restoration of voting rights who have completed their sentence and probation.  According to The Sentencing Project, 2.5% of the total US voting age population is disenfranchised due to a current or previous felony conviction.  Taking away voting rights from those who are felons effects African-Americans disproportionately.  1 out of every 13 African-Americans of voting age is disenfranchised.  In some states including Florida and Kentucky, more than 205 of African-Americans are disenfranchised.  In a study of felon voting patterns, the authors found that on average about 30% of felons and ex-felons would vote, if given the chance.  Not surprisingly, based on the racial disparities of this laws, the vast majority (about 3 our of 4) would vote for the Democratic nominee for President.

Taking away the right to vote of a criminal has a long tradition going back to ancient Greece and Rome.  However, I don’t believe it does anything in our modern society.  The Brennan Center for Justice argues in numerous amicus briefs that “permitting individuals the right to vote upon release from prison substantially promotes” reintegration mechanisms.  In their amicus brief for Griffin v. Pate LVW, they argue that continued disenfranchisement “undermines the process of reintegration by treating individuals who have served prison sentences as second-class citizens.”  In McLaughlin v. City of Canton, the court argued:

Disenfranchisement is the harshest civil sanction imposed by a democratic society.  When brought beneath its axe, the disenfranchised is severed from the body politic and condemned to the lowest form of citizenship, where voiceless at the ballot box…[he] must idly by while others elect his civic leaders…choose the fiscal and governmental policies which will govern him and his family.

As we see with voting and most political issues, how you choose to vote is generally based on discussions that you have with your family or with other members of your community.  Giving felons the right to vote gives them an additional way of conversing with their neighbor to be able to help reintegrate into society.  Further, voting is an acquired trait.  In their amicus brief, the Brennan Center argues “taking one’s children to vote…is seen as a simple and effective way to demonstrate to them the function and importance of American democracy.”  They argue that this is a ripple effect.  If one person is disenfranchised, they will not take their children to vote and an entire family can become discouraged.  If the family is discouraged, they may not show up to vote.  Their voices are weakened and not heard.  It continues on until an entire community is weakened from their voices not being heard.

Changing the registration date deadline, not requiring ID to vote, and restoring felon’s voting rights would have the biggest impacts on voter turnout.  Our goal for a democracy is to have as many people turn out to vote to allow their voices to be heard.  We believe that out democracy and our communities are strengthened when there are more voices heard.  Much like the Brennan Center for Justice argues, is a ripple effect.  We will have more people interested in strengthening their communities.  These three ideas are relatively simple to implement and should be implemented as soon as possible on a national level to maximize turnout.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Legislative priorities: Reforming opioid and heroin laws

Policy goal: The ultimate goal of reforming these laws is to focus on harm reduction rather than penalization, decrease the atmosphere of fear, and help prevent unnecessary death.

Specific policy aims:

  1. Support Good Samaritan laws
  2. Provide standing prescription for naloxone and opiod overdose reversal medications
  3. Work towards creating safer injection sites for drug users
  4. Extend legal clean needle exchange programs to cover all 50 states and rescind the ban on federal funding for syringes
  5. Work with general practice physicians and pain-specialists to rewrite the guidelines for prescribing opioid painkillers

Information for specific policy aims:

The leading cause of accidental death in America is drug overdoses, specifically opioid overdoses.  As prescriptions for these types of painkillers have risen over the years, as has the death toll from overdoses.  This was brought up in the presidential primary in New Hampshire with stories from candidates including New Jersey Governor Chris Christie and at least a passing mention of the other Republican contenders.  In 2014, there were 28,647 deaths from opioid drugs.  This represents 61% of all drug overdose deaths in 2014.  The number of overdoses from opioids has more than tripled since 2000.  Unfortunately, the epidemic is growing as opposed to slowing.

With that in mind, we need ways to be able to get victims of drug overdoses to the hospital so that they can be treated as soon as possible.  As in most medical emergencies, time is of the essence.  More than half of drug overdoses occur in front of another witness but only 10-56% of individuals are willing to call 911 for help.  Even with that in mind, people are only willing to call 911 after efforts of reviving the victim are unsuccessful.  In most cases this fear comes in the form of penalties to those who are witnesses to the overdose.  Law enforcement can, in most states, charge people with drug or paraphernalia possession and/or being under the influence when they arrive on the scene.

Twenty states and the District of Columbia provide some type of immunity for people acting as “Good Samaritans” and are calling the authorities to handle a medical emergency.  They are offered protection from being charged with being under the influence, drug possession, or possession of paraphanaelia.  They are not immune from trafficking drug charges or large quantities of drugs (intent to sell).  This is a commonsense practice that can save hundreds, if not, thousands of lives.

Another practice that can be effective in reducing the number of deaths related to opioids would be to allow for standing prescriptions of the opioid reversal drug, naloxone.  Naloxone is an injection that is available at 0.4 mg/ml to 1-mg/ml solution.  It can be administered into a vein, into a muscle, or under the skin.  There is work being done to make naloxone into a spray.  There is also a tablet that may be created for naloxone, as well.  It only produces effects if opioids are present in the body.  A dose of naloxone will compete with an opioid on the receptor and will partially or completely reverse the opioid effect.  Naloxone will produce withdrawal symptoms within minutes and will subside after about 2 hours.  But because it does not last very long, there may be a need for repeated doses of naloxone to be able to positively reverse the drug overdose.  It is not a habit forming drug.

While there are those who think that prescribing Naloxone will further the drug overdose epidemic, I find this line of argument mainly unfounded.  The National Institutes of Health (NIH) found that 35% of those surveyed would feel more comfortable using greater amounts of heroin if Naloxone were readily available.  In the same study, 90% of users had reported witnessing an overdose and providing lay remedies to revive the victim.  While the 35% of those who may feel more comfortable using a greater amount of heroin, the ones who have tried to revive a victim would be able to save many lives if Naloxone was available.  87% reported that they would be willing to participate in a training program and 84% would carry naloxone after training.

The American Medical Association (AMA) has endorsed policies that would strengthen community programs to both train and educate health care workers and opioid users about the use of naloxone.  The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) found evidence that take-home naloxone programs decrease overdose-related mortality.

The CDC has provided training for people to use this drug since 1996.  They’ve trained over 53,000 people and have used it to reverse over 10,000 drug overdoses.  The most successful program has been San Francisco which has over 3,600 prescriptions filled since 2013 and have saved 916 lives.  Some states, such as Washington, have passed laws that allow for anyone at risk of having or witnessing a drug overdose to obtain a prescription.

We should adopt this practice of providing those at risk of witnessing an overdose to have a prescription of Naloxone and to allow for a standing prescription of Naloxone on pharmacies.  In order to do so, we will need to put in rules so that doctors cannot be held liable if a patient overdoses and naloxone is not administered in time to be able to save the patient.  The availability of the prescription would not be enough, we would need to provide additional community training to overcome the potential risks of take-home Naloxone.  The NIH study found that 62% of heroin users would be less likely to call 911 for an overdose and 30% might leave an overdose victim after naloxone revival.  We would need to work with specialists and the medical community to provide additional training so that the Naloxone resuscitation will be as effective as humanly possible.  West Virginia has expanded the use of Naloxone to reduce deaths with opioid overdoses and we will have to look to West Virginia to see how their programs work to ensure that any similar programs will be administered correctly.

While we are in the middle of an opioid abuse epidemic, there are a number of opioid addicts who move to use heroin.  The dangers of heroin include the danger of needles, specifically dirty needles.  Dirty needles can lead to outbreaks of HIV, hepatitis, and other blood-borne pathogens.  Needle exchange programs allow people to trade dirty needles in exchange for free sterile needles.  Beyond that, they serve as safe spaces for drug users to try to access medical care and referrals to drug treatment programs.  Federal funding for these programs have been banned since 1988.

In January of 2016,a new omnibus budget was passed to allow public health departments and nonprofit organizations to use federal funding for needle-exchange programs in high risk areas, as flagged by the CDC.  The budget would not allow these health departments and public health organizations to be able to pay for the syringes.

The CDC stated a health goal for 100% coverage providing all injections are performed with a sterile syringe.  The Drug Policy Alliance found that we are far short of this goal.  The estimates of sterile syringe coverage in major metropolitan areas are from 0.03% to 22% with a mean of 3.2%.  There are about 0.9 to 2 billion injections nationally each year but there are only about 43 million sterile syringes distributed by needle exchange programs annually.

According to the Substance Abuse and Mental Health Services Administration, there are an estimated 350,000 regular injection drug users in America.  Drug users still deserve to be able to be safe from diseases and not risk contracting blood-borne pathogens.   After taking out mother-to-child HIV transmission cases, about 35% of all AIDS infections can be attributed to injection drug use.  This can almost directly be linked to the lack of availability of clean needles.  The CDC has reported that the one-time use of sterile syringes remains the most effective way to limit HIV transmission associated with injection drug use.

HIV and AIDS are not the only diseases that injection drug users are at risk of contracting.  The most prevalent other diseases are hepatitis B and hepatitis C.  While these diseases are not as common in the United States as they are in other portions of the world, there are an estimated 800,000 to 1.4 million people in the United States with chronic hepatitis B and hepatitis C, according to the National Institutes of Health.  According to the Hepatitis B Foundation, about 40,000 people will become newly infected with Hepatitis B each year.  The death rate, according to the CDC, is 0.7% from the cases that they studied.  From the same set of cases, the CDC found that 61.6% of cases caused hospitalization.  Hepatitis C actually seems to be more dangerous.  The CDC found that in 2007, the number of deaths associated with hepatitis C surpassed the number of deaths by HIV.  This number has only increased since 2007.  The CDC believes that this number is even underestimating the actual death total.  They noted that the “mortality burden is likely much greater than these numbers suggest because death certificate validation studies have concluded that only a fraction of HCV-infected decedents have HCV listed on their death certificate, even when pre-mortem evidence of serious liver disease is present.”  In 2014, a total of 2,194 cases of acute hepatitis C were reported to the CDC from 40 states.

In a 2000 report by former United States Surgeon General David Satcher, “there is conclusive scientific evidence that syringe exchange programs, as part of a comprehensive HIV prevention strategy, are an effective public health intervention that reduces transmission of HIV.”  In a study cited by the World Health Organization (WHO) found “an 18.6% annual decrease in the HIV rate in 36 cities with [needle exchanges] compared to an 8.1% annual increase in 67 cities that did not contain [needle exchange programs].”  In a study by Don C. Des Jarlais et. Al in the American Journal of Public Health, they found that over a 12-year period in New York City there was a decrease in new cases of HIV among injection drug users while the number of syringes exchanged in the needle exchange programs increased from 250,000 to over 3 million.

Needle exchange programs are cost effective programs to help reduce public risk.  The cost of treating a person with HIV is estimated at $190,000 according to the CDC.  There is another estimate of treating HIV patients from the US Conference of Mayors.  They estimated that the lifetime cost would be $120,000 from diagnosis to death.  The average city cost to run needle exchange program would be about $131,000.  Unfortunately, that current estimation might be understating it.  The needle exchange program would have to be expanded to provide adequate syringe coverage and would need to be expanded from its current setup.  Franklin Laufer in his article Cost-Effectiveness of Syringe Exchange as an HIV Prevention Strategy estimated that 87 HIV infections were averted as a direct result of the needle exchange program.

As previously mentioned, needle exchange programs do not only exchange clean needles for dirty needles.  97% of these programs provide public health services such as substance abuse treatment, counseling, sex education, HIV counseling and testing, tuberculosis screening, and primary health care.  Because of the various treatment and services they offer, they seem to be leading to a more conducive environment to reduce drug abuse.  The NIH found that needle exchange programs lead to a “reduction in risk behaviors as high as 80 percent in injecting drug users.”  In a Seattle study, they found that needle exchange participants were five times more likely to enter drug treatment than drug users who do not participate in the program.  Surgeon General Satcher concluded that needle exchange programs successfully refer clients into substance abuse programs.

Based on the evidence, needle exchange programs are a cost effective way to reduce the harm for drug users limiting their chances of contracting HIV, AIDS, or hepatitis while providing health care and substance abuse counseling for injection drug users.  There does not seem to be any scientific evidence that there is an increase in drug use because of these programs or that drug users feel more empowered to be able to use drugs because of these programs.  Absent substantial evidence that this is the case, we should be increasing federal funding for these programs and rescind the ban on purchasing syringes for these programs.  We should also be funding community outreach programs to work with local law enforcement, teachers, health care providers, and community activists to essentially help design needle exchange programs that are specific to each community.  The single biggest driver of success of these programs is the extent to which the community buys into the program.  Getting local organizers and activists to help design the program will help with the success of the programs.