The Need for Free Crack, Meth Pipes in Harm Reduction Programs

Source: Kelly O, The Stranger

Rarely implemented due to governmental and societal backlash, programs distributing meth and crack pipes in hard-hit communities have numerous benefits that can no longer be ignored.

In March, the United States’ largest needle exchange -- run by the People’s Harm Reduction Alliance (PHRA) in Seattle -- began distributing free meth pipes as part of their harm reduction program, reported Reuters.

The initiative, while illegal under Washington state law, has seen over 1,000 pipes handed out in just a few weeks and began after the PHRA found that around 80 percent of meth users in the area it serves would be less likely to use intravenously if offered pipes.

As one service user told Reuters: “Dude’s got something to smoke but doesn’t have a pipe, what’s he going to do? Panhandle, steal. Inject.”

The PHRA began a similar project in 2010 through handing out free pipes for crack cocaine use.

Steering people from injecting methamphetamine has enormous health benefits. For one, it reduces the risk of contracting blood-borne viruses such as HIV and hepatitis C if the user in question is sharing needles. Furthermore, by providing safe and sterile pipes for crack and meth, it ensures that people won’t try and fashion crude smoking devices which can cut and/or blister lips and increase the risk of contracting a virus if sharing the pipe.

Despite the benefits on offer, such programs are not without controversy. Part of this is of course due to the reactionary, and flawed, belief that providing these services encourages drug use. But, when it comes to free pipes in particular, much is down to the fact that research in the area is lacking compared to needle and syringe exchange. It is not non-existent, though.

Vancouver Coastal Health began handing out safer smoking kits in 2011 in the city's Downtown Eastside area for crack cocaine users. An initial review into the first 13 months of the project found that, through the distribution of 65,000 smoking kits in this period, there were "statistically significant reductions in high risk behaviour ... including obtaining stems from the street," and a decrease in the number of respondents reporting burns from smoking.

Though this is not immediately conclusive in terms of direct impact on disease transmission, a spokesperson for Vancouver Coastal Health told TIME last year that, "if you reduce the the number of wounds and you reduce the sharing, you can extrapolate."

In addition, in 2013 two crack pipe vending machines were installed in the Downtown Eastside that dispense shatterproof pyrex pipes for just 25 cents. Not only does this have the aforementioned potential to mitigate the health risks associated with crack cocaine use, it potentially has other positive societal outcomes. The director of Portland Health Society's Drug Users Resource Center stated, for example, that, “There was a time when pipes were scarce and there was a lot of violence around acquiring a pipe, so we decided to saturate the market.”

San Francisco also saw a crack pipe program implemented last year, led by the Urban Survivors Union. 

While true that the evidence base is limited for these types of initiatives, skeptics, to whom only a cost-benefit analysis may speak to, should consider this; the cost of a sterile smoking device is typically below $1. Preventing a single HIV infection, meanwhile, saves around $230,000 in lifetime medical expenses in the US, as found by a recent study. Some of this may come at a cost to the taxpayer.

The crude economic argument aside, though, these types of programs have enormous potential to impact positively on people's lives, either by steering them toward safer drug use in the first instance, or by putting them in contact with programs through which they can have access to broader social services. 

As Laura Thomas of San Francisco's HIV Prevention Planning Council told CBS San Francisco last year

“[People's reaction to crack pipes is] similar to the reaction a lot of people had to needle exchange in the early years where as now, it’s very well accepted that syringe access is incredibly effective and cost effective at reducing new HIV transmissions. Unfortunately, the cost of that learning curve is often peoples’ lives and we don’t have time to waste on this, so we need to start implementing this now.”