First, I would like to address the confusion about “best practices” for syringe access and public health recommendations. The current recommendations for syringe access are to provide as many unused syringes as possible. The reason for this is that for each injection a person should be using a new syringe, for every time. That means if a person injects 4 times a day, they need 4 needles a day, not reusing one. The health concern for this is that reusing makes the syringe dull, this can tear skin more than needed. The more pressing reason is that reusing a syringe exposes the syringe to many bacteria, that bacteria is then injected straight into blood or tissue which frequently causes or puts them at higher risk of other health problems such as MRSA (drug resistant staph), necrotizing fasciitis (flesh eating bacteria), and a host of other disease.
This is not even including sharing syringes. As I’m sure you know sharing syringes is the number one cause of Hepatitis C in our country, which estimates that over 70% of IDU’s (injection drug users) contract it. This is what fuels me. I’m not sure at what point any person should be condemned to a slow death of liver failure due to their own preferences. Some drugs are legal and some are not. People are prescribed serious opiates by doctors and those that can not get them use heroin, which in its pure form is actually safer and better for your health than fentanyl, morphene, and oxycontin.
To not have access to syringes is the primary reason that people share theirs with others while using drugs. this is not just the first cause of transmission for HCV it is also the third cause of HIV transmission in our country. Another life long and deadly disease.
The current CDC recommendations are that an IDU use a new syringe for every injection. That implies they would need as many as they use personally. To have a one for one policy restricts the amount that an individual has access to at any given time. If they only have one and the exchange is not open for another two days and they inject five times a day…that’s only simple arithmetic to know they do not have enough to inject safely every time. The previous exchange at the drop in center had a one for one policy. I urge those that are against it to think about the repercussions of not giving enough syringes. On a human note, without regards to literature it just makes sense. I recall on one such occasion working at the drop in center when an individual was trying to get just one needle and I could not give it to him because he did not have one. He told me he was on his way to the metro to fish one out of the biohazards, likely to contract some disease. Why would we do this to someone just because we don’t agree with a policy? We as a community condemned him to that because we couldn’t accept a one for one plus program. This occasion and the many others that were similar broke my heart, and they push me every day to do more research, to try harder, to help those that can not help them selves.
To go back to resources and policy. There are numerous federally funded studies that prove with significance that one for one is not an effective policy. The Surgeon General endorses syringe access and the federal government has such loose language for oversight or recommendations that you could throw unused needles out of a window and that would follow federal guidelines. So when anyone says it does not follow guidelines, I’m curious which ones? There are none. http://www.cdc.gov/hiv/resources/guidelines/PDF/SSP-guidanceacc.pdf
(a copy of the most up to date federal guidelines) Syringe access has been passed on to state and local governments as a policy, way too large of a policy for a small government to regulate. When the Santa Cruz City Council first claimed SOS did not have the correct paperwork to operate a syringe access program I can address that: There is NO paperwork, there are no permits, there are very few to no regulations discerning what a syringe access program can and can not do.
Several years ago when I was more involved and helped to establish the exchange we filed an MOU with the HSA that recognized us as a viable program, to this day they support us completely, including following a one for one plus model. During this time I tried to connect with the police department to establish some agreement with them. What happened was appalling at best. I tried to have a conversation with Steve Clark who immediately cut me off and suddenly was yelling at me over the phone, thank goodness I did not try to go in there. I was and still am offended. This man clearly should not be in a public position as I experienced him loosing his temper in a matter of minutes. He then went on to say he did not and would not support our program because we did not follow federal guidelines. Obviously I tried to address the fact that there are NO federal guidelines. He used his same tactic, and barely let me talk. So, we never established anything with the police department, but boy we tried.
The only grounds that the City Council legitimately has on SOS is that they were operating without consent of the laundromat owner, we also tried to contact him when we first took over, I do not even know who he or she is.
To address discarded syringes: the primary reason people improperly discard their syringes is police harassment. It is currently legal to posses up to 30 unused syringes and any amount that are containerized. This has not changed with law enforcement practices. People are going to jail for possession of paraphernalia laws that no longer exist! For fear of arrest they are throwing them where they can (in general). As my previous anecdote states, I’m sure police practice won’t change since Dick Clark er, Steve Clark won’t even talk about needles without yelling. I for one hope never to talk to him again.
The downsides to this law:
- Sale is at the discretion of the pharmacist, if you look dirty they probably won’t sell to you
- The pharmacy has to opt in to selling this to start with
- syringes cost money, if you need money to get your fix or food more money is hard to get
- you can only get 30, what if you are exchanging for multiple people and inject frequently.
- the pharmacist does not provide other works which by sharing also lead to infection
- the pharmacist does not provide referrals to other services (shelter, food, medical services)
- the pharmacist most likely does not know health complications specific to IDUs
- in general, listening and being a non judgmental advocate as SOS volunteers are, is lost in this process
This law is definitely a step in the right direction, but it is no solution. There are still many limitations to this law.
In regards to the other, yes California legally permits Syringe Access Programs. This law allows specific counties or jurisdictions to allow Syringe Access Programs in their community when they see fit. It is still not an oversight law or regulation though, the county or area has to allow it. Santa Cruz allowed it decades ago, and I do not know the specifics of that. It is my understanding that an MOU is sufficient to allow an SAP to function.
I know this was long, but I have a lot to say about Syringe Access. It is from my experience that what is preventing these programs from functioning to their fullest across the nation is stigma of IDUs and drug use (primarily), a lack of understanding public health, and a lack of better regulation. There is a lot to overcome before we can rest at night knowing we are preventing HIV or HCV to the best of our abilities.
Robert, thank you for your interest in syringe access and the Santa Cruz program, and for being an advocate. I hope I addressed your questions, please let me know if you have any further questions. I would like to add that I write this as an individual and with no representation, perhaps only as a student at this point.
University of Nevada, Reno
MPH Graduate Assistant
A story in the L.A. Times about the Fresno Needle Exchange attracted my attention after I read this comment on your post at indybay:
Wednesday Feb 13th, 2013 6:02 PM
…first of all I support needle exchange!
That means a 1 for 1 policy.
Obviously that was the policy of the SC exchange when you were involved. But equally obvious is the fact 1 for 1 is no longer the policy. That has created unintended consequences. Until the exchange is more manageable things need to be put on hold.
Fresno’s experience was that it was not a great idea to operate in or very near homes. Being in a regional park had its problems when used needles started turning up in a children’s play area. While it was likely NOT the fault of the exchange, it was still blamed for the problem. [emphasis mine]
To its credit, the Fresno took positive steps and so prevented a shutdown. Given its illegal status at the time it would’ve been very easy to justify closing it down completely. The county supervisors were very hostile towards the concept and the city simply looked the other way. The county had prosecuted volunteers in the late 1990s when the exchange operated in the Tower District.
When the used needles turned up, the exchange moved out of the park to a nearby commercial area. That relieved the community concerns and things kept on trucking.
Hopefully the SC exchange can resolve the problems it now faces. It better. Otherwise it may go away completely. That would be likely very unfortunate.
My questions is whether you have heard this was a problem (neighborhood needle exchange resulting in the unsafe disposal of needles nearby) here, in Fresno, or elsewhere ?
I then accessed the following story about Fresno from the L.A. Times
Needle exchange proudly flouts the law
The story includes the following info:
Two bills now on Gov. Jerry Brown’s desk could supersede Fresno’s prohibition on needle exchange. One would let doctors, pharmacists and workers at approved programs provide a limited number of syringes without a prescription. The other would direct the state Department of Public Health to sanction needle exchange when they believe there is a public health risk.
Did these bills pass?