(1) A few years ago in my small Massachusetts town, the Board of Selectmen (5-person popularly elected executive branch of the government) were persuaded one day to OK the set-up of a regional needle-exchange center (permitted by Massachusetts law, but barely instantiated anywhere in the state). My mostly rural town lies between two cities (adjoining one, separated from the other by a much tonier, much more “suburban” town); the site of the proposed center was on the state highway joining the cities, in a slightly residential but overwhelmingly commercial district (mostly used-car lots, peppered with a few failing mini-malls and the like; miles and miles from any of the town schools, churches, etc.). In practical terms, access by the clients would have been almost exclusively by regional mass transit bus (the state highway is the one part of town served by the bus, and that only because of the cities it runs between) or (much less likely, I think) by private car. That is, even assuming the worst stereotypes of the needle exchange’s prospective clients, there would have been a negligible chance that out-of-town clients would be wandering around the neighborhood wreaking havoc to any extent greater than they might already be. Nonetheless, there was an immediate public outcry against the Board of Selectmen for their decision: public pressure forced them to reverse it nearly immediately; they were condemned by great numbers of the townspeople at the next Town Meeting (legislative branch of town government; in our town it’s not representative–any citizen of town can attend and vote); and at the next election three of the four who had supported the exchange were voted out of office. Some of the reaction was (I am sure) orchestrated by people who had other axes to grind, and some was based (rightly, though unfortunately) on procedural errors in the original decision. But most of the reaction was blind hysteria, including willful blindness of the townspeople-at-large to the numbers of injectors *in town*. I don’t in fact think that anything approaching rationality even as remotely as “I object to paying to maintain people in their addiction” was significantly in play–I think almost all the (non-procedural) objections came down to “I’m afraid of junkies, they’re ICKY, keep them away from me!!!”

(2) A new epidemiological study relating Parkinsonianism with pesticide use has been published in BMC Neurology, as reported today by the BBC at news . bbc . co . uk / 2 / hi / health / . stm (let’s see if spacing out the U R L gets it past the blog’s filter). I have serious (though purely amateur) methodological quibbles about the study, but I’m really bringing it up here only because of a pharase it contains, in a quotation attributed to the lead researcher. “What we noticed in our research was that recreational pesticide use in the home and garden was more of a source of exposure than occupational use.” OMG, recreational pesticide users!

Elizabeth comments: I knew there was a reason I hated gardening. URL for the full text of the study in the (wonderful, open-access) BMC Neurology is: http://www.biomedcentral.com/content/pdf/1471-2377-8-6.pdf.
Re: Icky junkies. I think you town’s reaction is pretty common. It’s really hard to think of a way to “destigmatise” drug injection, because the truth is that junkies can be pretty icky, when they are in your life, your family, your wallet. (So can most teenagers.) The point for me is that junkiedom does not generally last for ever or even for very long. I’d rather people emerged from it without a fatal disease.
Perhaps what we need is for more former injectors and former addicts to come out of the closet, so people can see that people who are now icky can turn into valuable members of society, and even get elected to the highest offices. Not that those two things are synonymous, of course.

I used to work less than a block from the location of the current needle exchange. I can attest to the effect of the exchange on the character of the neighborhood. Despite the negatives that everyone discusses, perhaps there is something positive that results from having the needle exchange centrally located: increased community awareness. The scope of the problem would be less visible to “the punters” if the exchange were to be pushed to a remote location or forced into a mobile service. I wonder if it might be useful for people to be confronted daily with the impact of addiction, homelessness, and the issues around access to social services. Unpalatable, but useful in terms of creating awareness and the momentum for evidence-based strategies that address the real health issues.