03/20/2014 03:03 pm ET Updated May 20, 2014

The New War Between the States and the Federal Government on Health Issues

There is a new war between the states -- in the South. This is not, as some of my Southern friends call it, a "war of Northern aggression." This war is between the states and the federal government.

Comedian Jon Stewart recently joked that state governments are the "Meth Lab of Democracy." But sometimes, the states get it right long before the feds do.

Many years ago, I had the chance to drive around Washington, D.C. with a diplomat from Switzerland. It was 1992, and the federal government had just imposed the smoke-free buildings rule, just five years before the Florida Indoor Clean Air act.

As we drove around, he noticed all of the administrative assistants and clerks standing against the doorways of the federal buildings in the cold, and remarked, "I must say, you Americans have much better dressed prostitutes."

Of course, he got that wrong, but he was on right track with the rest of the discussion about the needle-exchange program in the area known as Needle Park in Zurich. The program allows addicts to obtain sterile needles and thus significantly reduce the infections addict contract when they share dirty needles.

The Swiss understood two things well: They could not reduce drug use by government mandate or a "war on drugs," and that a needle-exchange program reduces HIV and hepatitis in that population.

Several states have passed statutes that allow needle-exchange programs to be developed and implemented. As of today, 24 states have legal needle exchanges. With the exception of Louisiana, the South and many of the northwest and central states have not implemented a risk-reduction program despite the wide-spread rate of injectable-drug related fatal diseases in those states.

Florida is trying once again to follow those other states that have those programs. Sen. Oscar Branyon II (D-Miami Gardens) has reintroduced a bill that died in 2013, now called CS/SB 408, and Rep. Mark Pafford (D-W. Palm Beach) filed the House companion bill, CS/HB 491, that establish pilot syringe-exchange programs.

Both have already unanimously passed their first committees.

It's about time. While working for the Centers for Disease Control (CDC), I was stationed in South Florida just before being transferred to D.C. I saw firsthand the devastation of drug-needle related diseases from West Palm to Belle Glade to Miami.

The fight for exchange programs was a losing battle back then.

The main pushback "trickled down" from the Reagan Administration and its War on Drugs. In 1988, the federal government banned federal funding for needle-exchange programs. Opponents argued that the programs encouraged drug use, even though no data existed to verify that fear.

The ban was briefly lifted in 2009 and brought back in 2011 as a Democratic concession in the budget debate that year. In the meantime, a 2004 study of syringe-exchange programs in California found that they reduced disease, but did not increase drug use.

The same "feds versus states" attitude has increased opposition to the popular efforts to legalize medical marijuana. In 1971, federal law declared marijuana a Schedule 1 drug in the Controlled Substance Act, completely prohibiting its use. Since then, 21 states have declared medical marijuana legal, and Florida has the chance to join their ranks.

But this hasn't stopped parts of the federal government from doubling-down in their efforts to block states from giving their citizens the right to access the medicinal properties of marijuana, which are used to treat epilepsy, cancer, diabetes, glaucoma and mediate the effects of chemotherapy and intractable cancer.

The Office of National Drug Control Policy is constrained by a provision of federal law to "take such actions as necessary to oppose any attempt to legalize the use" of marijuana or any Schedule 1 drug for medical or non-medical use. The provision even prohibits ONDCP from studying legalization.

The newest players in this war come from the U.S. House of Representatives. Rep. Steve Cohen (D-Tenn) has introduced the "Unmuzzle the Drug Czar Act of 2014" (H.R. 4046) to eliminate that provision. His bill is stuck in committee.

However, last week, the GOP-lead House introduced and passed the "ENFORCE the Law Act" (H.R. 4138), which allows Congress to sue the office of the President if he does not enforce the Controlled Substance Act regarding medical marijuana and begin to arrest users in states that have legalized it.

Forget the fact that Republicans are usually adamant supporters of states' rights. When it comes to issues like syringe exchange and medical marijuana, there's a war between the states and the federal government.

What would Lincoln have done with this one?


Gary Stein, MPH, a native Detroiter, worked for the Centers for Disease Control, landed in the Tampa Bay area to work for the State Tobacco program and is now a health advocate and activist and blogger for the Huffington Post. This post was originally featured on Context Florida.