Brows were raised and eyes rolled back when needle exchange programs were first implemented to stop the spread of disease. Giving away free and clean syringes to heroin users seemed preposterous to many. Now it is a common practice and almost universally accepted as a means to prevent the spread of HIV. Could the same happen with free crack pipes?


Soon after our story was posted Friday, KPIX 5 received a flurry of phone calls and emails from city officials denouncing the idea to distribute the crack pipes.

Mayor Ed Lee was first with a statement, via an email from his spokesperson, Christine Falvey: “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.”

Barbara Garcia, Director of the San Francisco Department of Public Health, elaborated in a phone call to KPIX 5.

“This is a recommendation from a community group,” Garcia said. “And we get lots of different kinds of recommendations. 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.”

Earlier, Tracey Packer, the director of community health equity for the San Francisco Dept. of Public Health, said the city of San Francisco may examine the idea. Packer oversees the city’s HIV prevention efforts.

“It is inaccurate to say we are ‘considering’ the program,” Packer said. “We are at the exploration point. We are looking at data and information.”

Crack pipe distribution programs have been successful in Canada, said Laura Thomas, a member of the HIV Health Services Planning Council (HPPC), the group that recently suggested San Francisco consider a similar program.

“San Francisco has a long history of being at the cutting edge of things that we have turned out to be very right on… and I would like to see this one be another of those things that we were right about before the rest of the country catches on,” said Thomas.

Why give out free crack pipes? Unlike used needles, which pierce the skin and can immediately infect someone who shares it, the sharing of crack pipes doesn’t have that same likelihood of physical contamination of HIV.

Instead, officials said, the main focus of this program would be as an outreach effort. Crack users are a population identified as at major risk to have HIV and they often become disconnected from medical services and stop taking their medicine.

“It may seem counter intuitive, but it’s a great program,” said Thomas.  “Once you can bring people into your program, make them feel respected, taken care of, then they’re more likely to come back and get on HIV meds and want to be engaged and taking care of their health.”

Thomas is also the Deputy State Director of the Drug Policy Alliance. When we asked her about the inevitable negative reaction, she said it’s all part of a learning curve.

“It’s similar to the reaction a lot of people had to needle exchange in the early years where as now, it’s very well accepted that syringe access is incredibly effective and cost effective at reducing new HIV transmissions,” she said. “Unfortunately, the cost of that learning curve is often peoples’ lives and we don’t have time to waste on this, so we need to start implementing this now.”

The HPPC has put together a study group to consider whether such a program would work in San Francisco. There is also a question of legality, considering crack pipes are considered illegal drug paraphernalia.

“We rely on our community partners to bring us information on health risks in the community,” said Packer. “We will work with the council to explore the data around this issue.”

Harmeet K. Dhillon, chair of the San Francisco Republican Party, voiced disapproval of the recommendation.

“Continuing the theme of San Francisco being the Utopian petri dish of America, this is the utmost of San Francisco absurdity,” Dhillon said. “The use and abuse of cocaine in every form is a serious scourge on the most vulnerable populations in our city, but rather than fighting the problem and providing real solutions to these addicts, we just seem to be giving up and enabling their self-destructive behavior. There is zero evidence showing that handing out ‘clean’ crack pipes to addicts will do anything to prevent the spread of HIV and other diseases, and this just sounds like another pathetic idea to entertain viewers of ‘The Daily Show.’”



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