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Although more addicts used drugs intravenously in Glasgow, needle distribution was not restricted, and less than 1 percent of its IDUs contracted HIV. In a similar claim, Ethan A. Nadelmann, director of the Lindesmith Center, a drug policy research institute, contends that the halting of federal funds for needle-exchange programs during George Bush’s presidential term (1988–1992) resulted in ten thousand more cases of HIV infection. However, opponents argue that needle-exchange programs do not lower drug addicts’ risk of HIV or hepatitis B infection. Psychiatrist Sally L. Satel argues, “Most needle-exchange studies have been full of design errors, the most rigorous ones have actually shown an increase in HIV infection.” For instance, a 1997 study in Montreal, Canada, concluded that those who took part in needleexchange programs were two to three times more likely to contract HIV than addicts who did not participate. Others contend that although needle-exchange programs prevent some cases of HIV, they do not minimize the other threats to physical health and personal safety involved in heroin addiction. One University of Pennsylvania study followed 415 IDUs in Philadelphia for four years. Although 28 people died during the study, only 5 died from HIV-related causes. The majority died from other factors related to their high-risk behavior, including overdoses, kidney failure, and homicide. Besides failing to protect drug 15 Introduction users’ health, challengers believe that supporting needle-exchange programs sends the message that society condones drug abuse. Barry A. McCaffrey, former head of the Office of National Drug Control Policy, insists that such programs should be abandoned because drug addicts should not be given “more effective means to continue their addiction. . . . The problem isn’t dirty needles, it’s injection of illegal drugs.” Supporters of harm reduction programs contend that minimizing the harms of drug addiction is imperative in directing addicts away from high-risk conduct. They view drug abuse as spanning a spectrum of behaviors and phases, some of which are less dangerous than others. Because abstinence is the final step, harm reductionists support every movement away from addiction and the harm of us ing drugs. In contrast, critics of harm reduction argue that many of the programs are ineffective at lowering the risks of drug use. Moreover, they claim that the harm reduction philosophy abandons the hope that abstinence can be achieved for every addict and warn that removing the negative legal consequences from drug abuse will fuel addiction. Harm reduction is just one of the topics discussed in Drug Abuse: Current Controversies. Throughout this anthology, drug abuse experts, health care professionals, and others attempt to define the causes and effects of drug abuse and debate the effectiveness of drug laws and regulations. In doing so, the authors provide valuable insights into one of society’s pressing social problems.