For much of its history, the needle-exchange program at Prevention Point Pittsburgh operated much like the drug users it served: underground.
Since a Sunday in 1995 when Caroline Acker and James Crow set up a card table on a Hill District sidewalk to hand out free syringes, the group has been met with apprehension and suspicion. Occasionally clients were leery that bringing back used needles could lead to criminal charges; skeptics, meanwhile, would argue that needle-exchange programs enable drug use. But Prevention Point and advocates stress they are presenting options for a population desperately needing health care.
"There's been the misunderstanding that needle exchange or providing clean syringes encourages drug uses or enables drug use," observes executive director Renee Cox. "But this issue has been studied for 20 years and there is overwhelming scientific evidence that needle exchange ... reduces the spread of blood-borne disease without increasing rates of drug use." Such diseases can be easily spread when users opt to share needles.
Acker, the organization's president, says that while the program was controversial, there was a clear need for it. "People thought of it as a strange form of drug policy, where we're giving needles to people to use dangerous drugs," says Acker. "We tried to recast that as public health policy."
Now, 15 years later, the only needle exchange in southwestern Pennsylvania has survived, achieving authorization to operate legally and openly. And with public perception of needle-exchange shifting, the organization is expanding services and reaching more people.
Not that it's been easy.
The organization that now serves 120 drug users a week -- and that exchanged a total of 400,220 syringes in 2009 -- started off with just a sidewalk table. But a neighborhood association, fearing the service would attract junkies, asked the group to relocate. In the years that followed, the group sometimes operated out of volunteers' houses. The county board of health approved the program in 2001 as a pilot project.
Prior to that, "We did it anyway," Acker says. "We saw it as a form of civil disobedience. ... Here was an inexpensive, highly cost-effective, safe way to prevent the spread of infectious disease that has arguably been the public-health challenge of the 20th century, AIDS."
A syringe, on average, costs 9 cents. Cox compares that to the cost of lifetime care for someone with HIV ($600,000) or hepatitis C ($100,000). Even so, many drug users can't afford to buy syringes -- and that's just one of the challenges they face. Treatment programs are available, but waiting lists are long, and many programs require health insurance addicts are unlikely to have. And often, Cox says, it takes an addict multiple attempts before he or she can break a drug habit. Add the threat of disease and overdose, she says, and that makes a larger problem than addiction.
"That makes needle exchange even more important," she notes. "It's our goal to give them the tools and health information they need to stay as healthy as possible when they are in the active phase of using."
In 2008, Allegheny County Council passed an ordinance to regulate the operation and give the program more legal standing. Prevention Point now has a staff, offices in Wilkinsburg and operates the needle exchange from a van in the Hill District on Wednesdays, and in an Oakland building next door to the county's Department of Health on Sundays. In the Hill, the program sets up next to the Operation Safety Net van, which provides medical care for the homeless.
Support for needle exchange appears to be building on the national level. A ban on federal funding for needle-exchange programs was recently lifted (though one still exists for state funding), and through Prevention Point's advocacy efforts with other public-health agencies, the state now allows the over-the-counter sale of syringes at pharmacies. Needle exchanges are also supported by the American Medical Association and National Institutes of Health. In a 2005 study, the Center for Disease Control cited research from an NIH panel that "evidence suggests powerful effects from needle-exchange programs." According to earlier studies, the report found, such programs helped reduce HIV incidence among injection-drug users by 30 percent or more.
The programs can also be a bridge for treatment: Last year, 21 percent of PPP's needle-exchange clients -- roughly 1 in 5 -- successfully entered treatment, Cox said. About 1,300 clients have sought help over the program's history.
According to a 2004 article in the Journal of Urban Health, there are an estimated 12,000 injection drug users in Pittsburgh area. Cox estimates the organization has reached 5,500 drug users since its inception.
In addition to exchanging syringes, the group provides other supplies -- bleach for cleaning syringes, alcohol pads, condoms, biohazard containers. The Oakland site offers a prescription program for Narcan, the antidote to opiate overdose, as well as education: proper disposal techniques in accordance with Allegheny County's health department, and overdose-prevention training and intervention.
Alice Bell, overdose-prevention coordinator, says that such training is necessary in a county "where more people die of overdoses than of homicides and traffic fatalities combined."
Prevention Point also takes a non-judgmental approach toward working with clients, who remain anonymous when they receive services. But trust is built with each visit, helping volunteers lead more users to treatment. Many in the field note that success in treatment is easier when the client is not dealing with a severe disease.
"The bottom line is it saves lives in reducing HIV and AIDS," observes Antoine Douaihy, a professor of psychiatry at Pitt's School of Medicine. "It does not harm the public health. It's about providing a safe setting where drug addicts can get information for a harm-reduction approach."
And, he points out that the threat of transmitting diseases like HIV or hepatitis C affects more than just injection drug users.
Challenges still lay ahead -- the biggest of which is funding. The organization's $300,000 budget receives help from state and county government, but only for educational and other programs that don't involve needle-exchange itself. Private foundations and donations fund the syringe program. To help with costs, Prevention Point Pittsburgh is hosting an anniversary fundraiser on May 8 at the Shadow Lounge.
Cox and Acker would also like to expand the office to accommodate drop-in services for needle exchange, counseling, prevention and nursing, and wound-care services.
But for now, they vow to remain in their trusted locations, providing clean syringes for those that need them.
"They are a worthy population to reach, and not just a group you can just sort of draw a line around and say, 'We'll let them absorb their own consequences,'" Acker says. "We're there. If Christmas is on a Sunday, we're open and there are cookies on the table. ... We're giving them something they want."
Put the Needle on the Record II; Sat., May 8, Shadow Lounge, East Liberty; $5-20 pay-what-you-can donation to benefit Prevention Point Pittsburgh; 6-9 p.m. Mix and Mingle, Food, Raffle; 9 p.m.- 2am Vipers Soul Club Reunion Dance Party with DJs Justin Hopper (Pandemic, Soulcialism) and Gordy G. (Titletown)