Welcome to the pathetic world of public health in Allegheny County.
A needle-exchange program can have hopeless side effects. Allegheny County Council recently approved its continuation but it sends the wrong message about self-destruction.
The goal is a countywide reduction of hepatitis C and HIV cases. The privately funded needle-exchange program of Prevention Point Pittsburgh has been using a room in the Allegheny County Health Department in Oakland since 2002.
Junkies who care about public health -- or at least their own -- come to the Oakland building from noon to 3 p.m. on Sundays to trade dirty needles for clean ones. Of the county's 12,000 or so junkies, between 50 and 100 drop in each week, according to Prevention Point Pittsburgh.
But the numbers of new confirmed cases of hep C and HIV in the county have shot up since 2002.
According to the Allegheny County Department of Health, in 2002 there were 149 confirmed cases of hepatitis C. In 2003, 298 cases. In 2004, 266. In 2005, 393. In 2006, 691. In 2007, 679.
The county had been averaging about 100 new confirmed HIV cases annually from 2002 to 2005. But in 2006, there were 122. In 2007, 126.
Neither the health department nor Caroline Acker, president of the board of directors of Prevention Point Pittsburgh, can say why there have been increases.
"No needle-exchange program has the resources to carry out effective research about needle exchange," Ms. Acker says. "Moreover, it would be a waste of money and unethical because a lot of research already exists that shows needle exchange to be effective."
She cites a 1995 study, and says there are many others, that claimed junkies who exchange dirty needles for clean ones generally are not as sick as those who don't. She calls it a "settled" question.
But a healthier high can numb hope.
The services offered by Prevention Point Pittsburgh include syringes (in four sizes), alcohol pads, cookers, cottons, Band-aids, antibiotic ointment, condoms (male and female, when available), as well as literature on safer injection techniques, abscess care, vein care, HIV and hepatitis C transmission and overdose prevention. Testing and counseling are also available.
A needle-exchange program alone is "a statement of failure," according to Michael T. Flaherty, executive director of the Institute for Research, Education and Training in Addictions. The nonprofit organization, which tries to enhance the quality of addiction treatment and recovery services by providing the most current information, is part of a network of 14 regional centers around the country and U.S. territories.
"You must carry the message of treatment and recovery with you into the trenches -- into the shooting galleries. If a needle exchange doesn't go there, that's my problem with it," Dr. Flaherty says.
They don't go there, according to Renee Cox, executive director of Prevention Point Pittsburgh.
Studies of needle exchanges indicate a reduction in transmission of infectious diseases within that tiny population but don't indicate improved access to treatment or recovery, Flaherty says. "Survival of the fittest should not be part of public health. Just handing out needles could say that it's OK to use.
"Here's the needle, go do it" -- that alone should not be the message, Flaherty says.