Pubdate: Sun, 16 Nov 2003 Source: Tribune, The (CA) Copyright: 2003 The Tribune Contact: http://www.sanluisobispo.com/mld/sanluisobispotribune/ Details: http://www.mapinc.org/media/391 Author: Julie Lynem Bookmark: http://www.mapinc.org/find?137 (Needle Exchange) Bookmark: http://www.mapinc.org/find?143 (Hepatitis) VOLUME RISING IN NEEDLE EXCHANGE DEBATE Health Officials Say It's Time To Talk Seriously About Creating A Program Here Twice a week, carloads of San Luis Obispo County residents head south to Santa Maria to get what they need. These aren't big-box shoppers looking for a bargain. Most are drug addicts in search of clean needles. They come to the cramped office of Pacific Pride Foundation on West Church Street to exchange used syringes at the only place to get sterile equipment for injecting their drug of choice - heroin, cocaine, methamphetamines. "We see an unusually high number of people coming down here from San Luis Obispo County who take advantage of it," said Buck Derrington, a community health outreach worker at Pacific Pride, a nonprofit agency that provides services to HIV, AIDS, lesbian, gay, bisexual and transgender communities. "They're carpooling. That tells you there's a need." San Luis Obispo County does not have a syringe-exchange program. The idea of offering clean syringes to drug users, however, has circulated quietly among some San Luis Obispo community members and county public health officials. The reuse of potentially blood-contaminated syringes can lead to the spread of AIDS and hepatitis C. Health authorities nationwide have long touted syringe-exchange programs as an effective way to get contaminated needles off the streets and prevent the spread of those diseases and other blood-borne pathogens. In California, 19 percent of all AIDS cases are linked to the sharing of used syringes. The state Office of AIDS estimates that some 1,500 cases of HIV transmission and 3,000 cases of hepatitis C infection result each year from the sharing of dirty needles. But for years, government and law enforcement officials have questioned the validity of such exchange programs, saying they encourage and facilitate drug use. Those in the local public health community expect similar resistance from San Luis Obispo County government and law enforcement authorities. "When I've talked to some law enforcement in the area, they've asked me, 'If we have a program, what kind of message are we sending to our children?'" said Tom Hutchings, a benefits counselor at the AIDS Support Network and member of San Luis Obispo's Human Relations Commission. "I tell them, 'How do we explain to our children that we knew of a public health problem, ways to alleviate it, and we didn't do anything about it?'" Supervisor approval needed After several years of talking about the idea of syringe exchange, Hutchings said public health officials are ready to step up the dialogue. Officials with the HIV Consortium, Economic Opportunity Commission, San Luis Obispo Hepatitis C Project, county Drug and Alcohol Service and other agencies plan to meet soon to discuss ways to educate community and county government leaders about syringe exchange. The ultimate goal is to get Board of Supervisors support for syringe-exchange programs, which exist in some California communities, including Santa Barbara, San Diego, Los Angeles and several Bay Area counties. "We're behind the curve," Hutchings said. "We have our rural character, and so we don't identify ourselves as being a big drug population center. You imagine Los Angeles, Hells Kitchen (in New York City), San Francisco. But it happens here, and we have a wonderful opportunity to address an issue now before it's too late." For syringe exchange to become legal in San Luis Obispo County, the public health officer would have to declare a health emergency, and the Board of Supervisors would have to approve that state of emergency every two weeks. A state law passed in 1999 gave local governments, nonprofit organizations contracting with cities and counties, and their employees the right to operate syringe-exchange programs without criminal prosecution. The unauthorized possession and distribution of syringes is illegal statewide. No federal law prohibits syringe exchange, but Congress has banned the use of federal funds for syringe-exchange program services since 1988, according to a 2003 California case study by Human Rights Watch, a nonprofit international human rights organization. Some supervisors said they would need more information before taking a stand on the syringe-exchange issue. "This is no different in some respects to providing condoms," said Supervisor Katcho Achadjian. "Some would look at that and say, 'Are we promoting sex or safety?' Some will look at needles and ask, 'Are we promoting drugs or preventing disease?' "It would be good to hear from the professionals about where it has been used and promoted," Achadjian added. "Hopefully, studies will educate us enough to come to a decision." Supervisor Shirley Bianchi said she would be in favor of it. "Needle exchange does not promote illegal drug use," she said. "If somebody is going to do that, they're going to do that." Declaring an emergency Hutchings first introduced the idea of syringe exchange to the San Luis Obispo Human Relations Commission in 2001. At the time, the commission supported further study of the program. Hutchings had hoped commissioners would adopt a resolution to encourage the City Council to support syringe exchange and urge the county to create a program. In September, Hutchings and Dr. Greg Thomas, the county's public health officer, explained the benefits of syringe-exchange programs to commission members. At the time, commissioners wondered whether it was an issue better left in county hands and agreed to table it until they could gather more information. A few weeks later, Gov. Gray Davis vetoed SB 774, a bill that would have permitted the sale of syringes at licensed pharmacies. With no legal way for drug users to obtain clean needles in San Luis Obispo County, some members of the public health community say now is the time to form a public health coalition to educate area residents about the benefits of establishing a program. Many syringe-exchange programs also have educated local law enforcement officials in their area, and in some cases, come to an understanding about how clients will be treated. In San Francisco, the San Francisco AIDS Foundation and the San Francisco Police Department have negotiated perimeters around the foundation's syringe-exchange sites. Police agree not to go inside unless they have to answer an emergency call. In Santa Maria and Santa Barbara, law enforcement authorities are aware of the syringe-exchange programs and have not come on site to arrest clients for possessing drug paraphernalia, said Janet L. Stanley, executive director for Pacific Pride Foundation. San Luis Obispo County Sheriff Pat Hedges, who has talked with Hutchings about syringe exchange, said he's skeptical about starting a local program. "It assists individuals in illegal drug use," he said. "It purports to decrease the spread of certain types of illnesses or diseases. But I've not been made aware of anything that necessarily supports that. Providing someone with a new needle does not guarantee they would not share that needle with someone else." A 1999 report by the Johns Hopkins School of Public Health found that syringe exchange does not generate more crime, increase drug use among people who already inject illicit drugs or encourage youth to use drugs. In addition, seven reports on syringe-exchange programs - all of them government-funded - have found that the programs reduce HIV transmission without increasing drug use, according to the Human Rights Watch case study. Thomas said syringe exchange would be "an appropriate thing to do in San Luis Obispo County." The programs, he said, not only help to reduce the transmission of hepatitis C and HIV but can serve as a link for clients seeking drug treatment. "The evidence overwhelmingly shows that syringe-exchange programs do not increase injection drug use or criminal activity," Thomas said. "In syringe exchange programs in other counties in California, referral is made to drug treatment programs for those clients amenable to such referrals or open to those referrals. These programs are a way of reaching out to injection drug users and getting them into treatment." Marsha Bollinger, director of the AIDS program in the county's Public Health Department, said it would be nice to give clients a full range of options. "My point of view is that it is an effective method, and we should use all effective methods at our disposal," she said. Limiting the spread County public health officials say local drug users are at risk of contracting a serious disease. In 2002-03, 99 people tested by the county Public Health Department for hepatitis C tested positive for the disease. Seventy-eight of them said their primary risk factor was intravenous drug use. In the first quarter of 2003, 31 people have tested positive for hepatitis C. Twenty-eight said they most likely contracted the virus by injecting drugs. Hepatitis C is a virus that can survive in the bloodstream of an infected person and can be spread through contact with someone else, typically by entering the bloodstream of another person. The disease can lead to cirrhosis of the liver and liver cancer. There is no cure for hepatitis C, although it is treatable. As of June 2003, there were 250 cases of AIDS in the community, excluding inmates at the California Men's Colony. Of those people, 39 percent said their only risk factor was intravenous drug use. Derrington, an outreach worker at Santa Maria's Pacific Pride Foundation program for about five years, said it's unclear how many people cross the Santa Barbara County line for clean supplies. Outreach workers collect demographic information - age, gender, drug of choice - but do not ask people where they live. But each week, Derrington meets clients who come from as far away as San Miguel. They save up hundreds of used syringes and often store them in containers until they can make a trip south, he said. The county's Drug and Alcohol Services estimates that more than 23,000 people in the county have substance abuse problems. That includes people addicted to alcohol and other drugs. County health officials say the majority of drug users smoke marijuana or take methamphetamine. A smaller percentage use drugs such as heroin, which can be injected. "How many have to be infected or die before people realize there's a problem?" Derrington said. "There's a serious epidemic out there." - --- MAP posted-by: Beth Wehrman