DPH Backtracks on Crack Pipe Idea
Just weeks after some San Francisco health officials and advocates expressed support for distributing crack pipes to drug users in order to aid the city’s HIV prevention efforts, the city’s public health director has come out against the idea.
One group is preparing to distribute pipes anyway, and law enforcement authorities say they would support distribution if the Department of Public Health backed it.
At their early January meeting, members of the HIV Prevention Planning Council, an advisory group to the health department that sets priorities for HIV prevention in the city, voted unanimously to support an action plan that includes collecting data and exploring legal issues around crack pipe distribution.
Shortly after the meeting, HPPC Co-Chair Tracey Packer told the Bay Area Reporter, "Our job as the HIV Prevention Planning Council is to explore the most appropriate ways to prevent HIV, and the information that was shared [at the meeting] needs to be explored."
But last week, after KPIX reported on the possibility of crack pipes being distributed in the city, Health Director Barbara Garcia told the station, "That recommendation has not come to me. And I’m telling you that if it did, I would say ’absolutely no, we are not going to distribute crack pipes.’ We have a lot of things to consider for those who are using crack for improving their health. And the distribution of crack pipes is not something I’m going to consider."
Packer, who also serves as director of community health equity and promotion for the health department’s population health division told KPIX, "It is inaccurate to say we are ’considering’ the program. We are at the exploration point. We are looking at data and information."
After the B.A.R. called Garcia and Packer, Packer emailed a statement that says city health department policy "does not support distributing crack pipes to users of crack cocaine in San Francisco."
"Over the last several months, the HPPC has heard public testimony about the health needs of people who use crack cocaine," the statement continues. "In response to concerns" brought to the panel, it "agreed to review data on health issues among crack cocaine users," among other topics addressed in the action plan. "... The nature and extent of crack cocaine use and its related health concerns must be reviewed comprehensively and in the context of all of the HIV prevention and substance use issues facing San Franciscans."
The B.A.R. followed up with an email to Packer and Garcia asking why the public health department’s policy doesn’t support crack pipe distribution, and why Packer hadn’t previously mentioned that, and what other city officials’ reaction had been to the paper’s January 16 story that included Packer’s statements.
In response, Packer emailed, "I don’t have any additional response beyond what is in the statement. ... As the last line states, a comprehensive look at this issue in context is necessary."
Before the January 16 story, the B.A.R. emailed Christine Falvey and Francis Tsang, spokespeople for Mayor Ed Lee, to see whether Lee would support crack pipe distribution in order to aid the city in combatting HIV. Neither Falvey nor Tsang responded.
But last week, Falvey told KPIX, "Mayor Lee is not aware of this exploration and is not supportive. There are many other HIV interventions that could and should be explored before ever considering this."
Falvey did not respond to the B.A.R. ’s requests for comment this week.
Among other benefits, distributing crack pipes could help city and nonprofit staff connect people that aren’t otherwise being reached with HIV and other health care services, according to a presentation at the January 9 HPPC meeting. One presenter called crack cocaine use "a significant driver" of HIV infection in San Francisco. Risks include crack smokers being likely to engage in unprotected sex. Distribution could also help prevent transmission of hepatitis C.
The city already provides clean syringes to injection drug users, which has been credited with cutting the number of local HIV infections.
Not Planning to Wait
As the San Francisco Examiner reported this week, the Urban Survivors Union plans to start distributing pipes in San Francisco in March.
Isaac Jackson, the union’s president and a harm reduction advocate, told the B.A.R. that his group would begin distributing pipes March 6. He said the first location would "probably" be Hemlock Alley, between Polk and Van Ness streets. He said the distribution would be from 7 to 9 p.m., when another group regularly operates a needle exchange program nearby. The group would then rotate locations.
Jackson, who’s gay and HIV-negative, is a former crack smoker and current intravenous drug user. He referred to risky sexual practices and said, "Somehow we think we can deal with this issue of trying to reduce rates of seroconversion, particularly among black gay men" and other gay men "without talking to crack users. ... It’s insane we don’t build this into our model of intervention."
Along with pipes, he said his group would offer rubber mouthpieces and other smoking equipment, condoms, and health information.
"We might give out 50 to 100" pipes, said Jackson. "I don’t know how many people will show up."
He estimated the pipes would cost between 25 and 50 cents each. No money from city taxpayers would be used, he said, and his group’s "looking for avenues of funding." For now, "We have a private donor who has agreed to give us seed money to get going. That person doesn’t want to be named."
Law Enforcement Support
Two city law enforcement agencies differ from DPH on the issue.