For 11 years, businessman Robert E. Field has quietly made sure intravenous drug users in Lancaster had free access to sterile needles.
Field in 1998 started a needle-exchange program that today is handing out more than 7,000 needles per month to reduce the spread of HIV and other blood-borne diseases.
For all these years, Field has personally bankrolled the $50,000-a-year operation, but now he's ending his financial support in hopes the wider community is ready to embrace the concept of needle exchange. As a result, the program finds itself at a crossroads.
In the program's early years, Field hired workers to dispense needles where drugs users gathered. Now people go to Bethel AME Church on East Strawberry Street to exchange dirty needles for clean ones.
The exchange also connects drug users with social service agencies and drug treatment programs. More than 100 are referred to treatment programs each month, Field said.
Because the state's drug paraphernalia law criminalizes the possession of needles for illegal drugs, Field informed then-Mayor Charlie Smithgall and former police Chief Michael Landis before starting the exchange in November 1998.
City officials told Field they'd investigate only if someone complained.
As a result, Field shunned publicity. But he's going public now because the state Pharmacy Board in September lifted a decades-old ban on over-the-counter syringe sales.
"Deregulation ... facilitates the syringe-exchange program becoming part of a continuum of professionally managed services for addicts," said Field, who insisted on answering questions by e-mail.
Field said he is ending financial support after December because the regulatory change should free Lancaster General Hospital or other organizations to fund the effort.
There are at least two precedents for out-in-the-open exchanges in Pennsylvania. The government has allowed an exchange to operate in Philadelphia since 1992 and in Pittsburgh since 2002.
"I have requested that LGH use a tiny portion of its immense profits for this purpose, since syringe deregulation has removed any stigma from the activity," Field said.
Alice Yoder, director of community health at Lancaster General Hospital, has met for several months with Field and others in harm-reduction work and is aware of the funding challenge Field has issued.
Yoder said the hospital does not have a position on the practice of needle exchange, but physician and board committees have been asked for input.
The Rev. Edward M. Bailey, pastor of Bethel AME Church, where needles are distributed Tuesday through Saturday, said the need is great and he wants to continue hosting an exchange even if Field stops writing checks.
"Just the number of needles tells you there's a need," Bailey said. "If Robert doesn't fund this, we will still do the needle-exchange program. It may not be at the same level right away, but we'll figure something out because it's something that needs to be done."
The Urban League of Lancaster County also has expressed an interest in being part of a multiagency collaboration.
Josh Dixon, the Urban League's chief executive officer, said a needle-exchange program fits with the agency's mission of building healthy and safe communities.
"What I can say," Dixon said, "is there is a definite need in the community" for a needle-exchange effort that prevents disease and gets people off drugs.
Field, a chief executive of Lancaster-based Manor Group, which operates apartment complexes and hotels in Pennsylvania, New Jersey and West Virginia, is a long-time advocate of drug law reform and harm-reduction strategies such as needle exchange. He co-chairs a group called Common Sense for Drug Policy.
In a September 1997 letter to the editor in the Intelligencer Journal, Field first made the case for a needle exchange program in Lancaster.
Citing studies that documented huge reductions in the spread of HIV and hepatitis in cities where needle exchanges operate, he wrote, "Lancaster needs to catch up with the rest of the nation."
"All we need are a few compassionate volunteers dedicated to making this a better and safer world," Field added.
The letter prompted Lancaster attorney Daniel H. Shertzer Sr. to offer Field his support in starting a needle exchange. "I certainly don't think clean needles are an incentive to use drugs," Shertzer said in a recent interview. "It just makes sense to guard (drug users') health and other people's health."
Field began to recruit other supporters, and by November 1997 he had an advisory board that included physicians, lawyers and clergy. Among them was psychiatrist Dr. Brian Condron, who had observed Philadelphia's needle-exchange program for a day and seen how it prevented disease and got dirty needles off the street.
Among the local officials Field contacted was then-county Commissioner Ron Ford. He asked Ford, who is African-American, for potential board members from the minority community.
Ford, in a recent interview, recalled talking to Field and in particular advising him to brief law enforcement officials about what he was trying to do. Ford said he was a supporter of a needle exchange because he had visited Baltimore's program and seen the need.
"It's a depressing thing to see," Ford said, "but it's necessary."
Smithgall recalled meeting with Field and attorneys over setting up a needle exchange. Smithgall said he decided to "let the police handle it. I didn't get in the middle of it."
Landis, now chief county detective, in a recent interview said he was informed in advance of the exchange. He said his policy was to leave the exchange alone unless someone complained. Then "we would investigate any complaint as a violation of the (paraphernalia) law," he said.
"At that time," Landis said, "nothing had changed to permit the distribution of what is essentially paraphernalia."
Landis, who stepped down as police chief in 2000, said no complaints were made.
Field's first employee for the needle exchange was Rochelle Baerga, who had been an HIV educator with the Urban League and Salvation Army. She she hit the street with clean needles on Nov. 5, 1998.
John Faunce, a mental health therapist in Berks County who worked with Condron in Lancaster in 1998, volunteered to help get the exchange started. He recalled driving with Baerga and looking for addicts.
"You have to understand the reluctance of an addict to come up to a stranger," Faunce said. One strategy Baerga used was to offer McDonald's coupons as a way to start a conversation with a user.
"It didn't take long for people to catch on that it was OK to come out," Faunce said. (Baerga died in 2008.)
After Bethel AME Church became the host of the needle-exchange program, Bailey was surprised both by how many people came for needles and by who they were.
"We thought the greatest need was going to be among the people of the city and people of color," Bailey said. "But we found out it's much more expansive than that. The majority of people who come to us are non-black and non-Latino. People are coming on their lunch hour. They're coming from work. They come in decent cars. Some are business owners, professionals, construction workers, not just the so-called riff-raff."
Bailey oversees the two exchange staffers: Mary Hoskins, risk reduction supervisor, and Charlene Crosby, outreach specialist.
He said the staff gives out needles, helps people get into treatment or receive social services and offers something maybe even more important: a listening ear.
"Sometimes it's just being there for people to talk to, to sit down with them," Bailey said. A simple conversation may be what starts someone on the road to recovery.
"What we're really trying to do is get folk to begin taking charge of their illness," Bailey said.
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