Three Million Needles But Not a Single Pipe

A union town through and through, San Francisco even sports a workers' assembly for self-destructive behavior.

At the San Francisco Drug Users' Union, a small storefront on Turk Street bounded by Aunt Charlie's Lounge, a mosque, and a rescue mission — pure Tenderloin diversity — a small and dedicated staff hands out 18,000 fresh, sterile hypodermic needles every month for those relics of a bygone drug era: intravenous drug users.

Except that even in this age of methamphetamine and prescription opiates, the days of shooting heroin aren't bygone at all: Every year, public health workers dole out 2.7 million needles through various needle exchange programs, many of which are directly funded by your tax dollars. That number, steady for the past 10 years or so, means San Francisco is responsible for about 10 percent of all needles exchanged in the entire United States.

If you don't like needles, San Francisco is not the town for you. Once considered outrageous fringe behavior when they were foisted upon an unwilling public during the AIDS crisis 20 years ago, needle exchanges are now standard procedure, endorsed by the American Medical Association as well as the World Health Organization as surefire ways to cut down on the spread of HIV and hepatitis C. The theory behind this is also a pillar of the San Francisco Department of Public Health's real-world approach to healing. Instead of “don't do drugs,” it's “do drugs in a way that's less harmful to you and the people around you.” Not enabling — harm reduction.

DPH says it's proven to be effective, and studies conducted by the WHO concur: Needle exchanges lead to more addicts entering and staying in treatment (and despite the many urban horror stories, there aren't millions of needles littering the streets).

None of this is any good for the crack addicts who are 20 to 25 percent of the Drug Users' Union's clients. Crack smokers don't get needles, but they do get, free of charge, almost everything they need to make the crack-smoking experience less risky: a fresh ball of Brillo (which keeps the crack in place, and which can break off and burn throats and spread respiratory diseases when old), a pipe-stem (sort of a cigarette-holder for crack users, which makes lips less likely to burn on old, cracked shards) and a small wooden stick called a pusher (to clean the whole setup out when a clean pipe isn't handy).

They can get everything except the crack and the crack pipe itself — because the same city that's eager to hand out needles has a serious problem with issuing a cheap glass tube.

Public health advocates and AIDS crusaders have been pushing the idea of free crack pipes for years, for all the same reasons: It cuts down on the spread of diseases such as pneumonia and tuberculosis, which can be spread with an untimely cough on Muni, and it brings crack users closer to getting help.

“We're totally behind it,” says the union's Johnny Lorenz, who adds that they can't start without the same change in policy from lawmakers that allowed needle exchanges: Handing out crack pipes today would almost certainly lead to a bust tomorrow from police.

A few weeks ago, harm reductionists in the Tenderloin managed, after six months of trying, to present the idea to public health officials at the HIV Planning and Prevention Council. They used all the same arguments the city itself uses to promote needle exchange — plus the evidence of years of successful crack-pipe exchanges in Vancouver, where crack use declined since pipes were given out free, and also in Seattle, where the Drug Users' Union's local equivalent, the People's Harm Reduction Alliance, simply started giving away pipes without politicos' say-so.

But after the crack idea, first noticed by the Bay Area Reporter, was picked up by CBS-5 last Friday, the condemnation from city leaders was swift and total.

Mayor Ed Lee “is not supportive,” said his spokeswoman, who added that there are “better ways” of fighting HIV. DPH director Barbara Garcia's answer was even more final: “absolutely no.”

An odd stance for proud needle-pushers, but the same kind of resistance that preceded needle exchanges — and one that causes harm. Politicos are shutting a door to getting crack smokers into treatment, and leaving crack smokers with $5 in their pockets the choice between buying a fresh pipe from the smoke shop or buying a fresh rock from the pusher the police have given up arresting.

Guess which one they pick. Meanwhile, the needle exchange is open.

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