Walk along East Tusculum in Kensington and there, amid the litter in this hardscrabble neighborhood, you'll notice the used syringes - some capped, others not - on the sidewalks, in a narrow patch of grass skirting a freight rail line, and under a bridge crossing the tracks.
There's one, then a dozen, and before you know it, you stop counting - just along a two-block stretch of the street. And if the number of discarded syringe wrappers is any indicator, there would be considerably more if addicts left all their needles behind.
The situation on East Tusculum Street highlights the conflicts that can exist between residents and agencies carrying out government efforts to help drug users seek treatment or prevent them from spreading disease.
To neighborhood rabble-rouser Ellen Maenner and other residents, the syringes are the scary consequence - unintended though it may be - of hosting a needle-exchange van once a week on the street.
Though officials argue that syringe-exchange programs help control the spread of AIDS and other blood-borne diseases, she and some of her neighbors counter that it has made children - Maenner's three grandsons included - prisoners in their own homes.
"The kids used to play football in the grass," Maenner said. "They can't anymore because of the needles. And you can't see them all the time in the grass."
Time and time again, she wonders what would happen if a child fell on a syringe or a youngster jabbed himself or another child.
And time and time again, she asks why no one is doing anything about it.
On Friday, neighbors reported that a 16-year-old girl who is seven months pregnant got stuck with a needle. Where and how was not clear.
"Let [Mayor Street] come here and clean it up, maybe Ed Rendell," said Maenner, a Republican ward leader in a Democratic city and no stranger to fighting City Hall.
Prevention Point, the agency that distributes the syringes under a $354,000 annual contract with the city, said it was not to blame for the mess.
Roseanne Scotti, chair of the organization's board, said factors such as a high concentration of drug users in the area - "this is our busiest location" - and the illegal sale of syringes were factors.
But she said Prevention Point was working with the city to develop a cleanup plan and close holes in the fences lining the tracks, where users can be seen shooting up.
Roland Lamb, director of addiction services at the Philadelphia Department of Behavioral Health, confirmed that his agency was working with Prevention Point as well as with community groups to address the problem.
Scotti stressed that the main goal of her group, which offers other services besides the syringe-exchange program, was to get people into counseling and off drugs, and that it also aimed to prevent the spread of disease among determined users.
Lamb called the needle-exchange program a "bridge" to other services that have helped drug users seek treatment.
The needle-exchange program dates to 1992, when former Mayor Ed Rendell signed an executive order authorizing it in an effort to combat a public health emergency.
Since then, studies have shown that such programs are effective in reducing the spread of AIDS and hepatitis among intravenous drug users, cutting taxpayer-funded health-care costs.
Prevention Point says on its Web site that it distributes one million syringes annually at six sites and that it has a return rate of 85 percent. Scotti says the return rate is closer to 95 percent.
That leaves anywhere from 50,000 to 150,000 needles that might, or might not, be disposed of properly.
Residents in other neighborhoods where the program operates reported finding discarded needles, but nothing on the scale of the problem in Kensington.
In West Philadelphia, Naomi Middleton said used needles often turned up in the grass of McAlpin Playground at 36th and Aspen Streets.
"I saw one little kid with a needle trying to poke his cousin," she said.
Maenner, 56, used to pick up the discarded needles in her neighborhood regularly until she pricked a finger recently.
But last week, on an unscheduled tour, she could not resist when she saw a pile of more than a dozen needles near where the van usually parks.
"I can't in good conscience leave them here," she said as she gingerly picked up the syringes one by one and placed them in a discarded syringe box.
"I would rather risk having something happen to me than my grandkids or anybody's kids," she said. "They [drug users] don't care about anybody but themselves."
It is clear that Maenner, who also has waged campaigns against illegal trash dumping in Kensington, has no love lost for drug users. Her goal is to shut down the exchange program.
She questions both the effectiveness and legality of the syringe-exchange program and said she was working with a lawyer on a possible legal challenge.
A few blocks away, across the tracks, a mother of two girls, ages 9 and 11, who asked not be identified because of fear of retribution, said drug users walked into her neighborhood on Fridays from the direction where the exchange program operates and then shot up on her street.
"They even do it on my steps," she said.
The woman also blames the exchange program for providing irresponsible and sometimes desperate people with a device that can be used as a weapon or pose a health hazard after it is used.
"They don't care about themselves. What makes you think they're going to care about anybody else?" she asked.
In the rain Friday, her younger daughter pointed to the street corner.
"See, there's a needle," the girl said.
Said her mother: "This is no way to live or to raise kids."