NEEDLE EXCHANGE SPARKS SHARP DEBATE

A bumper sticker inside the offices of executive director Renee Cox.
summarizes the beliefs of her countywide organization, Prevention
Point Pittsburgh. Cox feels that the number of people with
transmittable diseases drops when a needle exchange program is
offered for addicts.

Every Sunday, drug addicts enter the Allegheny County Health
Department's headquarters in Oakland through a back entrance.

They present an anonymous identification number, hand over a
biohazard container full of used needles and leave with enough
sterile syringes to shoot up for the rest of the week.

Pennsylvania law prohibits the distribution of syringes to drug
addicts, calling the needles drug paraphernalia, but for the past
four years, the nonprofit group Prevention Point Pittsburgh has
quietly exchanged dirty needles for clean ones with permission from
the county Board of Health.

That all changed several days ago when Allegheny County Councilman
Vince Gastgeb turned a spotlight on the program.

"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."

On March 21, Gastgeb introduced legislation to shut down Prevention
Point Pittsburgh until County Council adopts an ordinance approving
the program. The bill will go to council's Health and Human Services
committee for review. Gastgeb expects council to take action on the
bill this summer.

About 3,000 people have enrolled in the needle exchange program since
it began in 2002, and it has helped 550 people seek treatment,
according to the organization. Participants report a 64 percent
decrease in the use of shared needles, which the federal Centers for
Disease Control and Prevention says are responsible for 20 percent of
HIV infections and almost all hepatitis C infections in injection drug users.

The needle sharing program is just a small part of Prevention Point
Pittsburgh. The majority of its $215,000 operating budget provides
counseling, drug treatment and health care referrals, housing
assistance and overdose prevention.

Those numbers don't sway James Dodson, 41, of Bethel Park. For three
years, he said, a relative of his has been a heroin addict. Dodson
believes the money going into the program -- even though it is all
from private sources, not taxpayer dollars -- should be going to
treatment centers and keeping drugs from getting to addicts in the first place.

"If (addicts) can get referred to a treatment center at the needle
exchange, fine, but let's face it, the main reason they're coming
there is for the needle. They have to want help, and when they do,
they can find it anywhere, there's a number of different places," Dodson said.

Renee Cox, executive director of Prevention Point Pittsburgh, said
opponents of needle exchange programs need to look beyond their
emotions and face the facts.

Prevention Point Pittsburgh actually has cleaned up areas where
discarded needles were found. Studies also found that needle exchange
programs reduce risky behavior as much as 80 percent and bring about
a 30 percent reduction in HIV.

"I understand it doesn't feel good," Cox said. "I understand the
concerns of the message we are sending, but if sterile needles aren't
available, people will be forced to use contaminated needles they
find on the streets."

Because it believed high rates of hepatitis C and HIV constituted a
public health emergency, the county Board of Health unanimously voted
at the end of 2001 to give Prevention Point Pittsburgh permission to operate.

Since the 2002 start-up, the annual number of hepatitis C cases went
from 149 in 2002 to 393 in 2005. Because of reporting delays, the
county does not have firm HIV numbers for the same time period.

Those numbers can't be taken at face value because more people are
being tested, Cox said.

Health Department Director Dr. Bruce Dixon concedes that better
testing might contribute to the rising hepatitis C numbers, but he's
"not totally convinced" the program is working. He said he wants to
know how many people Prevention Point Pittsburgh has tested, and how
many of those people were positive.

"We need to get better data," Dixon said.

If council decides not to permit a needle exchange program, Dixon
said his legal staff found it could continue to operate as long as
the Board of Health believes there is a public health emergency.

Antoine Douaihy, medical director of addiction medicine services at
Western Psychiatric Institute in Oakland, said needle exchange
programs need to be looked at as a vital public health service.

"These programs help stop the spread of HIV and hepatitis C. That
saves lives. It's important that people understand what that really
means," Douaihy said.