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.

Sergeant Danielle Newman, a spokeswoman for the San Francisco Police Department, said that crack pipe distribution is something her agency would back.

"If the Department of Public Health brought the matter up and felt that it was something that needed to be changed from a public health perspective," and the Board of Supervisors, the mayor, and city attorney "were all behind it, then it would definitely be something the San Francisco Police Department would support."

Asked about whether the SFPD would intervene on an event such as Jackson's, Newman indicated the agency would not.

"We want to follow up on felony violent crimes," she said. "That's where our priorities are. Everything else follows."

She said, "I can't say we're not going to arrest somebody" for possession of a crack pipe, but that would likely be if there was "an extravagant case," such as one where police have had dozens of contacts with a person who is generating complaints from neighbors.

"We're not going to go out and look for" people with crack pipes, said Newman. "We don't have the manpower."

"I can't even tell you the last time somebody confiscated a crack pipe and booked it and charged somebody," she said. " ... I'm not saying it doesn't happen, but our focus really isn't on those individual users."

In a recent interview with the B.A.R. , before Garcia came out publicly against distributing pipes to crack users, District Attorney George Gasc-n said that he would support the idea if health officials proposed it.

"The health professionals really have to take the lead" on such decisions, and they understand "the best strategies to reduce the harm," said Gasc-n.

Drug use and abuse "should be treated more as a health problem than a criminal justice problem," he said.

Criminal justice officials "have to be willing to follow the lead of the health professionals," he added.

Supervisor Weighs In

Asked whether he'd support distributing crack pipes in the city, gay Supervisor Scott Wiener said, "This is an issue that I need to learn more about. ... I'm not prepared to say I'm supportive or opposed. I will say it's good to consider new, innovative harm reduction strategies to try to reduce disease transmission among drug users, so I think it's terrific that our public health community is considering ways to reduce disease transmission among crack smokers. I'm certainly open to hearing about specific proposals, including the pros, the risks, [and] the legal issues."

He added, "If folks are interested in moving forward, I would be happy to meet with them to hear more and discuss the issues with them."

Wiener said he hadn't heard about Garcia's opposition to crack pipe distribution, and said, "I'm sure there are a lot of different views on the topic. " He reiterated, "Before I would decide what my view is, I would want to hear from all sides what the pros and cons are on this kind of project."

Reached by phone, gay Supervisor David Campos said he'd call back in a couple minutes. He didn't call back, and he didn't respond to a subsequent call for comment.

Board of Supervisors President David Chiu, who is running against Campos for the 17th Assembly District seat soon to be vacated by gay Assemblyman Tom Ammiano (D-San Francisco), didn't respond to requests for comment.

Sunny Angulo, an aide to Supervisor Jane Kim, whose District 6 includes the Tenderloin neighborhood, which is home to many crack users, didn't make Kim available for an interview, and Kim didn't respond to a text message requesting comment.

HPPC members remain positive

HPPC member Laura Thomas, who's also on the HIV Health Services Planning Council and deputy state director for California for the Drug Policy Alliance, said she's hopeful that the HPPC can change the health department's policy to be supportive of crack pipe distribution

"I'm optimistic," said Thomas. "This is San Francisco, and San Francisco and the San Francisco Department of Public Health in particular have a long tradition of following the evidence, of looking at the research, and listening to the community, so I think we'll come up with something that will be both based in the evidence and meet the needs of the community."

In an email this week, HPPC member Paul Harkin and Alli Kraus, who together delivered the crack pipe presentation, said that "crack pipe distribution, as part of a comprehensive outreach program," fulfills health department objectives that include eliminating new HIV infections "through prioritization of high prevalence populations and evidence-based programs that prevent HIV transmission."

Harkin and Kraus wrote, "Crack smokers in San Francisco are at significant risk for HIV, hepatitis, tuberculosis, pneumonia, and a number of other serious infections and injuries."

Referring to the action plan, they added, "The HPPC voted to review effectiveness data on the issue of crack pipe distribution as harm reduction, direct DPH to explore legal issues, identify ways to improve engagement with crack users, including capacity building for clinical and community providers, and finally, to assess treatment needs and resources. The HPPC is convening a work group to oversee these recommendations."