By EMILY GREEN, Street Roots, Portland
In the back room of an anarchist bookstore in North Portland, past a rack of zines and a chalkboard list of upcoming punk shows, volunteers with the Portland People’s Outreach Project (PPOP) set up shop each Saturday afternoon.
On Friday evenings, they make rounds on their bicycles, making deliveries to people sleeping under bridges downtown and to drug users hanging out in East Portland.
These 10 volunteers, most of whom are former or current drug users, offer free syringes, hygiene kits, socks and, starting Jan. 15, meth pipes to Portland-area drug users.
While it’s rumored that a handful of other U.S. syringe exchanges unofficially offer meth pipes to their clients, the move to do so publicly will make the Portland metro area the second region in the nation, after Washington’s King County, with an official meth pipe program.
Portland police Sgt. Pete Simpson recommended that anyone planning to hand out free meth pipes have a lawyer review the law to determine if they are open to legal penalties.
Oregon’s paraphernalia statute still prohibits the sale or delivery of items such as “water pipes” and other mechanisms for smoking marijuana — along with all other items used for consuming drugs. The only exception is hypodermic syringes or needles. Head shops and corner stores in Portland have been openly selling paraphernalia, including meth pipes, for years.
“As far as enforcement,” Simpson said, “I can’t say we would or would not take enforcement actions. It’s all dependent on calls for service.”
Volunteers at PPOP said that, by offering meth smokers clean pipes, they will reduce the spread of diseases such as Hepatitis C and prevent some meth smokers from moving to a far more dangerous form of consumption — injection.
But most important, the volunteers said, they will be showing an ostracized group of people love by telling them they want them to be the best person they can be — and that might mean being the best drug user they can be.
More than the actual distribution of pipes, “it’s about treating drug users with compassion and respect,” said Sam Junge, a community health worker who’s been with PPOP (pronounced “P-pop”) since its inception 11 months ago. “Other places will give you that compassion, but it’s contingent on being sober.”
PPOP is a branch of Seattle-based People’s Harm Reduction Alliance, which has been handing out meth pipes since February. As of December, it had distributed 5,781 meth pipes in urban and rural King County through its pre-established syringe exchange program. It’s providing the funding for the first year of PPOP's meth pipe program in Portland, which is roughly $3,000.
People’s Harm Reduction Alliance recently announced it would open the nation’s first safe injection site in Seattle.
Shilo Murphy, executive director of this avant-garde nonprofit, said his organization decided to distribute meth pipes after numerous syringe-exchange clients said they were only injecting because they didn’t have access to a glass meth pipe. People’s Harm Reduction Alliance started distributing glass stems for smoking crack cocaine six years ago.
In November, the organization conducted an annual voluntary survey of its University District syringe exchange clients, and 93 out of 253 of the survey takers self-reported meth use.
The surveyors asked the clients who reported that they both smoke and inject meth if they injected more or less frequently since the organization began distributing meth pipes. While 5 percent reported that they injected more, 46 percent said they injected the same amount, and 49 percent said they injected less often. Asked if they were smoking more often than before pipes were available at the exchange, 26 percent said they were.
While it wasn’t a scientifically sound survey, it suggests that offering pipes to users who both smoke and inject meth may encourage less injecting.
“Injecting any drug can be more dangerous than smoking any drug because of the immediate issue of breaking the skin and introducing the risks of abscess, blood infection, nerve damage,” said Kim Toevs, harm reduction manager at Multnomah County. “And, if one shares injection equipment, one is at very high risk for Hepatitis C infection, as well as Hepatitis B and HIV.”
In Oregon, 21 percent of intravenous drug users test positive for Hepatitis C, with 58 percent of users ages 50 to 54 testing positive, according to a May 2015 report from the Oregon Health Authority.
Hepatitis C is a liver infection that, according to the Centers for Disease Control and Prevention, becomes a long-term illness in 70 to 85 percent of people who contract it. If it becomes a chronic infection, it can lead to serious health problems and in some cases death.
Studies show people who smoke methamphetamine and crack also have a higher prevalence of Hepatitis C than the general population, which has led to the “supposition” that disease transmission is occurring through pipe sharing, said Daniel Raymond, policy director at Harm Reduction Coalition in New York. The coalition advocates for harm reduction and offers training on a national level.
“They may have cracked lips, they may have burnt lips from the heat of the pipes, and there may be some blood that gets transferred on the pipe from one person to another,” he said. While there’s no slam dunk study showing access to meth pipes cuts down on disease transmission or that it will prevent people from transitioning to injection, he said his organization considers it a “promising intervention that we’re interested in.”
Lauren Gabrielle, 26, has been volunteering with PPOP since she moved to Portland four months ago. She’s a former meth smoker.
She said glass pipes are safer than the common alternatives – broken light bulbs and aluminum foil – which she often used to smoke meth.
“I constantly had cuts and burns on my lips,” she said. “I was putting myself at risk for blood-borne viruses. I remember I had a bleeding lip and I was sharing.”
As she spoke, she fashioned paper clips into handles for “tiny frying pans” used for preparing drugs for injection. The pans are one of several sanitary supplies PPOP offers its clients for safer injection.
Toevs, who oversees Multnomah County’s syringe exchange program, said that while the county supports different approaches to harm reduction, it would not consider offering meth pipes without evidence it would work better than the county’s current efforts, which she thinks have the strongest impact.
“The dramatic increase in heroin use of the last few years has stretched the county and our partner syringe exchange very thin financially,” she said in an email.
She said county syringe exchange clientele have not reported using needles because pipes weren’t available.
“We know of no evidence that people who don’t have meth pipes will turn to injecting,” she said.
In Canada, major health care provider Vancouver Coastal Health launched a pilot project in 2011 to see if distributing crack pipes would be an effective means of harm reduction.
An evaluation of the pilot project showed a significant decrease in respondents who reported burns and cuts on their mouths and hands and an uptick in safer smoking habits, such as not sharing pipes and using mouth covers. Out of about 65,000 crack-user visits for safer smoking kits, which were made by about 4,200 crack users, there were at least 1,280 referrals to addictions services and more than 9,000 referrals to other social services.
Vancouver Coastal Health hands out 90,000 safer smoking kits — each including a crack stem — from about 25 different community health center locations across Canada each year, said Sara Young, harm reduction programs coordinator.
“I continue to hear from service providers that if they don’t have pipes available, people are asking for needles instead,” she said. “That’s what we hear around the meth pipes as well, that because we don’t have meth pipes available, people ask for injection supplies instead.”
She said the apparent need for meth pipe distribution is only anecdotal until her employer conducts a pilot project around meth pipes — which is under consideration.
“I know from my personal experience working with these programs,” said Raymond, of the Harm Reduction Coalition in New York, “the most powerful effect of starting a syringe exchange program is that it actually becomes the engagement strategy.”
He said the same could apply to meth pipes. If an organization offers a stigmatized and high-risk population something tangible, such as a meth pipe, it starts a conversation, and that conversation can lead to connecting drug users with services, such as health care and addiction treatment, he said.
On their table in the back of the Anarres Infoshop on North Lombard, PPOP volunteers offer an array of pamphlets and fliers containing information about resources their clients may want to access — from skin and dental care to information about blood-borne disease. What they don’t offer is information about drug treatment.
“It’s not a recovery-based program,” PPOP volunteer Megan Pettit said. “If people are interested in quitting, we point them to Outside In or the county syringe exchange.”
So far, she said, they haven’t had anyone ask about treatment.
Pettit said she’s a former meth and heroin user, and she remembers it wasn’t easy for her to find clean, new pipes when she was using five years ago.
In the space of about 45 minutes, about a dozen people came into the back of the bookshop to get syringes and other items.
“Do you need any Narcan or water?” volunteer Wren Ronan asked each guest. Narcan is a brand name for overdose-reversing drug naloxone.
One visitor revealed an open, oozing, bright pink abscess on his wrist. Gabrielle pulled out a first aid kit and bandaged him up.
“A lot of people have hard time going to the hospital,” Pettit said. “The treatment is inhumane, and you feel weak and powerless and alone. At least that was my experience.”
She said they see about five people each day with serious skin care needs. They aren’t medically trained, so they usually refer people to Bud Clark Clinic, but it’s open only four days a week, and only for a few hours two of those days.
“We need someone who can come in and do abscess care,” Junge said. It’s one of many additions the volunteers would like to make to PPOP.
Murphy plans to come down from Seattle for the meth pipe program rollout Friday, when PPOP will take pipes, along with the syringes, naloxone and hygiene items it regularly delivers via bike to drug users along its route.
The only hurdle, Junge said, is figuring out how to transport the fragile glass pipes without breaking them.
“We might have to go to the post office and buy some padded envelopes,” he said.