Crack started rocking America in the 1980s. The form of cocaine, which provides a brief, intense high, peaked in popularity by the end of that decade, but big cities are still struggling with the fallout—including how to curb the spread of diseases like HIV and Hepatitis C among users. In San Francisco, a controversial new experiment by a group called Urban Survivors Union is hoping to reduce harm among users by giving away some 200 free crack pipes. Unsurprisingly, not everyone agrees that’s a good idea.
Though it has also been done in a few other cities, including Seattle, the idea of doling out crack pipes caused a media frenzy when it was first floated at a city health department meeting in January. In response, the city stated they do not support the practice. “We aren’t doing it because there is no evidence that demonstrates that it’s effective,” Rachael Kagan, spokesperson for the Department of Public Health, tells TIME. “Our harm-reduction programs are evidence-based and part of a comprehensive program of care. ‘Let’s start handing out crack pipes’ is way too reductionist and too narrow for the department to take on.”
Why crack pipes? Many users glass fashion pipes out of whatever they can get their hands on (including broken glass, lightbulbs, vials and other tube-shaped things), which can cause cuts and open sores in the mouth, which can then spread disease to anyone sharing that pipe.
There’s no research on the effect of handing out free crack pipes in the United States, but north of the border, an intriguing pilot is underway. In British Columbia, Vancouver Coastal Health provides healthcare to about 1 million people in that city, including crack users. As part of a pilot study started in late 2011, officials have been handing out 7,500 “safer smoking kits” per month. Each kit comes with information about detox and places to seek help as well as heat-resistant glass stems and disinfecting alcohol swabs. The aim was threefold: use demand for the kits to gauge how widespread crack use is; find out if free, safe pipes do in fact lessen the spread of disease; and use the moment of contact with a user as an opportunity to discourage drug abuse.
Though their sample hasn’t been big enough to provide concrete results about the spread of HIV, Vancouver Coastal Health spokesperson Anne-Marie D’Angelo says, they have found the giving out the kits reduces the number of wounds people experience and the amount that people share pipes. Despite their lack of data on disease transmission, she adds, “if you reduce the number of wounds and you reduce the sharing, you can extrapolate.”
Research on needle exchanges has found that free drug-paraphernalia programs do not lead to more drug use, according to the CDC. While the data bank for crack pipes is still being built, if the same holds true, there may be a cost-based argument for setting up pipe exchanges like needle exchanges. The advocates in San Francisco, led by the activist Isaac Jackson, say their kits cost less than $1 each, a fraction of the money taxpayers might pay to account for disease or injury that those kits might be avoiding.
Despite the city officially washing its hands of the effort, Jackson has said they expect to expand. “Our goal is to demonstrate that you can do this,” Jackson told the San Francisco Examiner, “and all hell won’t break loose.”