PREVENTION POINT PITTSBURGH GOES UNDERGROUND TO GET CLEAN NEEDLES TO ADDICTS

In the culture of despair, death often pivots on the point of a syringe. It
is not always the $50 bag of heroin that kills, as much as the 7-cent
needle that's been passed from one addict to another.

For this reason, Caroline Acker, a Carnegie Mellon University assistant
professor of history, and Stuart Fisk, a registered nurse and HIV
specialist, are on the front lines of an illegal needle exchange program
that is taking thousands of sterile syringes a week directly to drug
addicts in Allegheny County.

The group, Prevention Point Pittsburgh, made headlines two years ago when
it set up card tables on Hill District sidewalks to pass out clean syringes
and other materials to addicts. Complaints by residents who worried that
the program attracted pushers and users and increased crime to their
neighborhood spurred police to shut down the public exchange.

But the program continues underground -- at a rate of roughly 310,000
syringe packets distributed a year -- bolstered by a cadre of dedicated
volunteers and $30,000 in annual grants and donations. Contributions come
from individuals and organizations such as the Three Rivers Community Fund,
the Maurice Falk Medical Fund and the Pittsburgh AIDS Task Force.

Two weeks ago, the Drug Policy Foundation, a Washington-based think tank,
provided a $25,000 grant, which will enable the group to hire a part-time
staff person who will help write grants and administer the program.

And the group recently received a pledge from Beth Israel Hospital's
Chemical Dependency Institute in New York City to fund a study of the
effectiveness of its exchange effort.

"We're public heath workers," says Acker. "We're not about drug addiction,
we're about stemming the spread of infectious disease."

Fisk, a nurse for 10 years agrees.

"We need to look at the global picture, of promoting the health of
individuals and the health of communities."

When Prevention Point Pittsburgh started five years ago, the spread of HIV
infection among the estimated 13,000 to 20,000 intravenous drug addicts in
Allegheny County dominated its concerns.

But the alarming increase recently of hepatitis C, a blood-borne pathogen
that lives longer on stray surfaces, has prompted the group to intensify
its efforts.

Most new hepatitis C cases come from sharing needles, since the virus is
more difficult to transmit sexually than the one that causes acquired
immune deficiency syndrome, Fisk says.

At least 60 percent of IV drug addicts, if not more, are believed to have
hepatitis C, he says. "Most of them will develop a chronic, lifelong
infection, and ultimately get liver cancer or liver failure, and die."

The virus infects more than 2.7 million Americans. This year, in fact, more
people are expected to die from hepatitis C than from AIDS.

Among illegal drug users, there also is the risk of abscesses developing at
injection sites and bacteria traveling to the lining and the valves of the
heart.

Some addicts are so outside the mainstream, they never go to hospitals,
Fisk says, while others are treated "like dirt and don't return. We'd like
to integrate these people into the health care system."

Each week, Prevention Point Pittsburgh volunteers deliver about 6,000
"outfits" or "works" to shooting gallery managers and others in McKeesport
and the Hill District. The outfits include syringes, bottle caps in which
heroin powder is "cooked," cotton filters through which the solution is
drawn into needles, alcohol prep pads, condoms and empty biohazard
containers. The managers and others exchange these containers with those
filled with used needles, which the organization arranges to have
destroyed. The volunteers also take supply orders for the next week.

A typical heroin addict uses four to six needles a day, since the drug
produces a five-hour high. Cocaine users binge and may go through dozens of
needles a day.

Addicts will sometimes do a "speedball" -- injecting cocaine to give their
heroin shot a boost.

Prevention Point Pittsburgh purchases the outfits -- which cost about $1
apiece -- from the North American Syringe Exchange Network, a Tacoma,
Wash., buyers' club founded by a former user turned drug counselor. Acker
and other volunteers pay out of their own pockets for incidentals, such as
postage, and transport supplies in their cars.

The group is hoping to raise enough money to purchase a van to help in its
distribution.

A 30-year drug user who goes by his street name, Mookie, was the group's
first customer in 1995. Now 52, Mookie, a manager of a Hill District
shooting gallery, continues to place his weekly orders.

"I need 800 more 'pogos,'" Mookie told Acker on a recent Sunday, referring
to the insulin syringe most addicts prefer because of its bigger barrel and
finer point. These will be added to his standing weekly order of 1,600
"pogos," 700 "blues," so-called for their blue tip, which is long and fine
enough to hit deeper veins in the neck, groin and chest, once surface veins
are spent, and 100 smaller needles for newer injectors and those with good
blood vessels.

Once the sterile needles are distributed, some may show up on the black
market, where they are sold for as much as $5 a piece. The fact that some
people are making a profit off of the free, clean needles doesn't bother
Acker and Fisk so much, because the ultimate goal is to get the clean
needles to those who really need them, they say.

Since the operation was forced underground, Acker and Fisk say police are
aware of its activities, but have not intervened.

"It's the church ladies I'm afraid of," Acker says. When the group held the
more open exchanges on the sidewalks on Sundays, "about the time church let
out, a car would pull up and a woman would say, 'I know you and I'm going
to get you out of here.' She made one call to the police and that did it."

Prevention Point Pittsburgh now has a phone number addicts can call to
arrange needle drop-offs.

In 1988, Congress -- fearful that needle exchanges could promote drug use
-- banned use of federal money for such programs unless they could be shown
to reduce the spread of HIV and not promote illegal drug use.

Still, there are about 150 needle exchange programs nationwide, many
supplied by the Tacoma operation. Some operate legally, some are illegal
but tolerated, and many operate underground.

Pennsylvania sanctions no needle exchange programs and makes nonprescribed
syringe possession a misdemeanor, technically punishable by a year in jail.

"The most effective response to illegal drug use is drug treatment," says
Gary Gurian, deputy secretary for public health programs with the
Pennsylvania Department of Health. "The problem with needle exchange is
that it exchanges one dependency with another. It's really not solving the
problem."

Philadelphia, however, operates a clean needle exchange program that has
been funded through the city's Health Department. Throughout the week,
clean syringes are distributed to about 5,000 drug addicts at designated
sites throughout the city.

Acker says Prevention Point Pittsburgh would like to see Pennsylvania law
changed "so that addicts could buy syringes, either over the counter, or
with a prescription from their doctor, which would probably make it a
little more palatable."

Now, only diabetics and others who need to inject legal prescription drugs
can obtain syringes from pharmacies.

Acker argues that state laws regarding syringe sales do not apply to needle
exchanges since the intent of these programs is to prevent the spread of
disease, and that Allegheny County has the authority -- and a public health
responsibility -- to let Prevention Point Pittsburgh openly do its work.

Jim Roddey, Allegheny County's new manager, says he supports needle
exchange, but sees it as a matter for the state Legislature.

"Everyone knows it's going on, so it should either be legalized or
enforced, and I think it should be legalized," he says. "...The important
issue is to stop the spread of infection, and denying needles is not the
way to get rid of drugs. The way to do that is to be tougher on the drug
pushers.

"I've just made a note to myself to talk to the [state] delegates in
September," he says.

Prevention Point Pittsburgh is striving for consensus among all government
agencies. "Then we could meet a greater need, which would include having a
drop-in site with a nurse, where people could come for [disease] testing
and treatment," Acker says.

Program volunteers also are eager to participate in the Beth Israel study.

"The study will tell us what our work means to the people we serve," Acker
says. "It could also allow us to test for HIV and hepatitis C to determine
how many of the people we reach are HIV positive and whether there's any
connection with those numbers and what we do.

"Our philosophy is, you build relationships of trust with people. Needle
exchange gives us entree [into the drug world], so we can begin to address
other issues, like intolerance toward blacks and gays, more equal access to
health care and treatment, housing, and prostitution.

"There are public health care agencies that would like to work with us,"
she says, "but their hands are tied, because we're illegal."