For years, volunteers associated with the harm reduction group Prevention Point Pittsburgh have been providing sterile syringes to injection drug users in Pennsylvania's Allegheny County. Beginning in 1995, the group operated an open, if officially unsanctioned, needle exchange program (NEP) in Pittsburgh's Hill District, and in 2002, after the county health department declared a public health emergency over the spread of HIV and Hepatitis C, it began a legal, privately funded, once-weekly NEP in suburban Oakland.
Although Pennsylvania state law prohibits the distribution of needles without a prescription and considers them drug paraphernalia, Allegheny County is one of two localities in the state where authorities have declared a public health emergency in order to allow NEPs to do their work. The other is the city of Philadelphia, where a publicly-funded program has existed since the city declared an HIV public health emergency under then Mayor Ed Rendell.
Some 3,000 people have enrolled in the Pittsburgh NEP since then and more than 550 have been referred to drug treatment, according to PPP. Drug injectors in the program report a 64% decrease in the sharing of needles, which according to the Centers for Disease Control and Prevention is the cause of 20% of HIV infections nationwide and more than 90% of all Hep C infections among dope shooters.
On any given Sunday, a hundred people will show up with their anonymous ID cards to exchange used needles for clean new ones. Prevention Point Pittsburgh also provides referrals to drug treatment and other social services, overdose prevention information, educational pamphlets, and other services for its clients. But now, despite years of successful operation, the program is under challenge from an Allegheny County councilman.
For Councilman Vince Gastgeb, the health department's permission is not sufficient to allow the program to be lawful, and on March 21, he introduced legislation to halt the program until and unless the county council adopts an ordinance approving it. He also raised doubts about the program's efficacy. "A state law is a state law, and the state looks at needles as being drug paraphernalia, same as a bong or a pipe," said Gastgeb, a Bethel Park Republican. "If we're going to do this program, we should do it right, which is one issue. The second issue is should we do it at all?"
In the meantime, the program can continue to provide weekly services, Gastgeb allowed.
"No one is attempting to shut it down in any fashion, but we're attempting to craft a better ordinance," Gastgeb said. "At least I am." Still, he added, the council could vote against the NEP after examining the issues.
The process could play out for months. The legislation has been referred to the council Health and Human Services Committee for review and hearings. If it survives a committee vote, it would then go before the county council as a whole. PPP plans to be directly involved.
"This really came out of nowhere," said PPP executive director Renee Scott, "but I'm pretty confident we won't get shut down. We enjoy significant community support for a harm reduction method that is proven to save lives," she told DRCNet. Even though we think the council shouldn't even have to deal with this, we will educate them and cooperate with them as well as with the Board of Health."
The NEP has the editorial support of the Pittsburgh Post-Gazette, which this week asked: "What's the harm in allowing a privately funded needle-exchange program to continue? Taxpayers aren't paying for it now, but they might pay later with an overall increased threat to the public health and staggering costs to treat those sick with and dying from diseases they may not have contracted otherwise." The solution was simple, the Post-Gazette said: "Allegheny County Council should draft an ordinance giving the program its blessing or, better yet, state legislators should clarify state law specifically to allow needle-exchange programs."
The Pitt News, the campus newspaper at Pitt University, also came out strongly in support of the NEP. "What good can come of this?" it asked, referring to the program. "Actually, a lot," it editorialized.
The Gastgeb attack may end up improving the situation, Scott suggested. "We hope to end up with an ordinance that gives us firmer legal standing -- and funding would be nice! -- or at least says that Board of Health declaration is sufficient."
Opposition to NEPs includes people who find the very notion of supplying needles to drug users abhorrent, but they need to overcome that, Scott said. "This is going to be Needle Exchange 101. There are a lot of people who just don't fully understand the intent or the benefits of needle exchanges, not just for injectors, but for the whole community. We'll meet people where they're at, and I know some people object, but if we don't have sterile needles available, people will be using contaminated needles they find on the streets."
That translates into new HIV and Hepatitis C cases, both of which continue to rise, according to the county health department. New HIV cases increases from 82 in 2003 to 100 in 2004, with no 2005 figures available yet. New Hepatitis C cases increased from 238 in 2004 to 393 last year. The department estimates that 14% of the new infections through 2003 were associated with intravenous drug use.
The dispute may be as much about political power as opposition to NEPs. While Gastgeb argued that the program had gone on too long without a council-passed ordinance, Health Department Director Dr. Bruce Dixon begged to differ. He told the Pittsburgh Tribune-Review last week departmental legal staff had concluded needle exchanges could operate as long as the Board of Health believes there is a public health emergency.
"I suspect what this is really about is a power struggle between the county board of health and the county council. There is a long history of them going head-to-head over who controls health policy in the county," said Scott. "Before this, they were fighting over bus idling clean air regulations."
The hope is not just that the NEP and the public health avoid becoming collateral damage in a bureaucratic struggle, but that the program actually come out of it with firmer legal standing and maybe even funding. As a well-established operation with a proven track record, science on its side, and friends in the community, Prevention Point Pittsburgh is in a good position to turn this challenge into an advance.