In the 1980s, Dave Purchase was hit while riding his motorcycle by a drunk driver who ran a stop sign. He was disabled for several years. When finally ready to return to his job directing a drug treatment center, AIDS among injection drug users (IDUs) had reached epidemic proportions. Why bother with drug rehab, he wondered, if his patients would soon be dead? Needle-exchange programs were successful in Europe, and because Purchase wasn't working, he was poised to try something similar in North America. During the summer of 1988 - with funds of his own, donations, and health-department funds - he set up a table on a downtown corner of Tacoma, Washington. North America's first public syringe-exchange program was up and running.

"I originally intended to do this for a summer before returning to drug-treatment work; now I'm 15 years into it. In the early days, we attracted reams of attention in the national media and people from San Francisco, Boulder, Seattle, everywhere really, came to see what we were doing. Now there are 183 North American cities with needle-exchange programs, and besides running Tacoma's program, I'm the chairperson of a network providing supplies and support services to all these programs.

"Critics of these programs say we're supporting the wrong people and sending the wrong message. Well then, just who are the right people? And what is the right message? I believe the right message is that health services support everyone. I tell critics that, because of our work, drug users might get over being stupid - they'll never get over being dead.