Vancouver houses the only “safe injection site” in North America, where drug addicts can shoot up with clean needles. Thanks in large measure to the clinic’s free needles and antiretroviral medication that lessens infectiousness, Vancouver’s HIV infection rate among drug injectors has decreased in the past decade. Now the city is embarking on a pilot program to give out clean and unused crack pipes, which addicts often share, and usually construct themselves out of whatever they can find. The stated aim of the crack pipe program, like the injection clinic, is to reduce the sharing of pipes and mouthpieces, and lessen the odds spreading infectious diseases like Hepatitis C and HIV, the latter of which cannot be spread by saliva, but can be by blood from lips or gums, or by drug dealers who accept sex as payment. Reducing infectious disease by cutting back on shared pipes is not a controversial position in Canada, per se. What’s politically tendentious is the program’s $50,000 price tag (with the potential to cost five times that much), as well as the question of whether giving out free drug paraphernalia to all comers is good way to reduce drug use. In 2007, the city of Ottawa voted to eliminate its crack-pipe program for its suspected role in fostering addiction. So do crack-pipe exchanges result in more people smoking crack cocaine?

The short answer is yes. But, oddly, that could actually be a good thing. A 2007 study in the International Journal of Drug Policy tracked a group of Ottawa drug addicts during the first year of the pipe exchange’s implementation. The study found that 12 months after the program began, 60 percent of users were smoking at the same level they had before, and 25 percent were smoking more. “There’s lots more crack around,” one participant testified. But one of the reasons users smoked more is they injected less. One month before the study, 96 percent of subjects were injecting drugs. A year later, only 78 percent were, and 40 percent were injecting less. Besides lowered rates of shared pipes, this is perhaps the study’s most encouraging finding—after all, drug injection is the third most common way of contracting HIV, after sex between males and high-risk heterosexuals. But one 2010 study also found that drug users in New York City and Baltimore, whether they injected or not, had strikingly similar HIV infection rates. The most important aspect of the forthcoming Vancouver program, then, may not necessarily be the clean pipes, but the balm to reduce lip bleeding, the free condoms, and the access to medical staff, who can encourage HIV testing and medication.