Occasional crystal meth smoker Richard Russell ambles up to a church storage garage in a Seattle alley and a recovering drug addict hands him two brand new meth pipes, no questions asked.
One of about two dozen methamphetamine users who received free bubble-ended pipes on a recent afternoon, Russell is a participant in a pioneering but illegal program launched in March that aims to indirectly curb infectious diseases.
"Dude's got something to smoke but he doesn't have a pipe, what's he going to do?" Russell said later as he munched on a sandwich. "Panhandle, steal. Inject."
The theory behind the handout program is that giving meth pipes to drug users may steer some away from needles, which are far riskier than smoking, especially if the user is sharing with another person infected with HIV or hepatitis C.
There is little scientific evidence to support that claim, but The People's Harm Reduction Alliance, a privately funded needle-swap group run by drug users, said it has distributed more than 1,000 pipes in Seattle in a matter of weeks and could expand to other cities in Washington state and Oregon.
Its program also draws addicts from society's fringes into its compassionate fold, with links to treatment and housing services, Executive Director Shilo Murphy said.
Even though needle exchanges have faced continued opposition in many parts of the United States since the first legal one opened in Tacoma, Washington in 1988, the programs have been credited with reducing HIV infections and saving lives.
But opponents say giving away meth pipes discourages quitting while wasting resources on an untested scheme that will not solve a city-wide health problem. They note that among methamphetamine-using gay men, HIV is transmitted primarily through unprotected sex, not syringe- or pipe-sharing.
There are no studies to show meth users will resort to injections if pipes are unavailable, or that handing out pipes prevents needle use, said Matthew Golden, a Seattle and King County Disease Control Officer and a University of Washington professor of medicine.
It is also hard to quantify how much the campaign might prevent death or infection, if at all, even if it does give meth users safer options than a needle or smoking out of a jerry-rigged light bulb, Golden said.
"It is plausible the intervention could be effective," Golden said. "It's simply an unstudied idea."
But the Alliance, which says it is the nation's largest needle-exchange program by syringes dispersed, has pushed legal boundaries for years with user-conceived experiments unacceptable to its taxpayer-funded counterparts, Murphy said.
It faced public outcry five years ago with a similarly illegal campaign to hand out crack pipes with extension tubes to prevent the hot glass from blistering addicts' lips, on the theory that disease could spread between pipe-sharers through open wounds, Murphy said. A similar program began in San Francisco last year.
The Alliance launched its meth pipe program after learning from its own survey that 80 percent of area meth users would be less likely to inject drugs if given access to pipes.
On a recent afternoon in an alley near the leafy University of Washington campus, dozens of drug users ambled up to a makeshift table to dump fistfuls of dirty syringes into biohazard bins and retrieve fresh boxes of needles, as well as meth pipes.
Addicts, among them a transient man with a military-style backpack and two glassy-eyed college-age youths, also helped themselves to supplies like cookers, pushers and latex ties, as well as condoms and health pamphlets.
"We don't see this as controversial. We see this as what's needed in our community," Murphy said.
Giving out meth or crack pipes is illegal under state law, but the Seattle Police Department said it has taken no action to actively monitor or shutter the program.
Anti-drug groups say needle exchanges make hard drug use appear acceptable and bring crime to communities, among other concerns.
Phillip Wilson, 56, said the pipe programs were harming the community, adding that he planned to re-sell the glassware he got on the street for about $10.
"Come on man, giving that shit away to people who are trying to quit? I just can't understand it," he said.