The principle of harm reduction in some outreach programs for drug addicts is coming under scrutiny as some of the very people trying to help addicts are getting hooked on the drugs, the Wall Street Journal reports.

Under the philosophy of harm reduction, the best way to save users' lives isn't to force them off illegal drugs. Instead, its adherents teach safer ways to use drugs — supplying clean needles to prevent the spread of disease, for example, or teaching how to avoid overdosing. The programs are credited with saving lives in cities across the U.S.

But harm-reduction leaders have struggled to address a sometimes-lethal issue: dangerous drug use by the workers who are supposed to help users. In the circles of New York and San Francisco where Mr. Morse worked, at least five harm-reduction staffers have died of overdoses. These included needle-exchange founders in both cities, as well as psychologist John Watters, a needle-exchange advocate who started a study to track how outreach programs benefited drug users. Mr. Watters died from an opiate overdose in 1995.

Worker drug abuse is "a huge problem," says Jon Zibbell, the founder of a Massachusetts drug users' coalition who is now an assistant professor at Skidmore College. "We prevent [overdoses] among our clients," he told the Wall Street Journal. "So we should try to prevent them among our workers."

Studies suggest that needle exchanges work. In San Francisco, Chicago and New Mexico, heroin-related deaths dropped after users were taught how to administer an anti-overdose medication to each other. In New York City, the rate of new HIV infections among injection-drug users dropped more than 75 percent between 1995 and 2002 as the number of clean needles distributed doubled, according to a study by epidemiologists there.

Yet needle-exchange programs can exact a toll on those who operate them. Staffers typically earn little or no money for working on bleak urban front lines with traumatized users. Programs tend to be run on the cheap, often giving little of the training and support that are standard for other social-service workers. Those dealing with other factors — depression, history of drug use or personal stresses — may find it particularly hard to cope.

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