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Moving the Needle

news2Despite low community support in a recent survey, do syringe exchanges serve a greater good?

Providing intravenous drug users with clean syringes is like making condoms available for young people, says Dr. Lisa Hernandez, medical services director for the Santa Cruz County Health Services Agency (HSA).

Both are single-use items—“You don't want to share them,” she says, “you don't want to use them again.”

“We're not going to stop people from having sex, but we want people to have safer sex,” she says. “It's the same with drug addicts. They'll find a way, with or without safe needles.”

She adds that the majority of people addicted to injection drugs will find the means, whether they do it with sanitary syringes from the county, with needles from pharmacies, or by re-using needles.

On July 26, Capitola resident and nationally syndicated radio host Ethan Bearman, whose program “The Ethan Bearman Show” is based at KSCO in Santa Cruz, released the results of an online survey he conducted to gauge community opinions on the local needle exchange. Bearman describes the needle exchange controversy as a lightening rod issue for the community. Last year, many began voicing their outrage at finding syringes in public spaces, in some case on sidewalks outside their homes, and generally where they or their children could step on them. 

Over the course of 10 days, Bearman got 558 responses—517 from Santa Cruz County locals—and although he acknowledges that it’s not a large enough sample size to reliably reflect opinions among the county's approximate population of 266,000, he believes it can serve to provoke discussion.

“Ultimately,” Bearman says, “what drove me to do this survey was the disconnect

that I heard between county supervisors and HSA representatives and what I was hearing from my callers and the people in my day-to-day interactions.”

He does not believe that local officials are taking community opinions about needle exchanges into account, and hopes the survey gets their attention.

Only 32 percent of Bearman’s survey respondents were in favor of the HSA's needle exchange, which is called the Syringe Services Program, and only 20 percent supported a nongovernmental needle exchange, like the Street Outreach Supporters (SOS) exchange that was operating independently until it came under county oversight this past April.

Bearman distributed the survey through local media, on-air at KSCO, and downtown while walking around with his iPad, he says.

Hernandez, who recently spoke on a panel for the City of Santa Cruz's Public Safety Citizen Task Force, says the survey is interesting, but limited in its reflection of the entire county population. She points to HSA data that shows benefits of needle exchanges for both the community and the health of drug addicts. This information is slated for release in mid-August.

When it comes to the notion that needle exchanges enable drug addiction, she explains that the answer cannot be summed up with a simple “yes” or “no.”

“We're capitalizing on the fact that we are having an interaction with people who may not be seeking help or resources anywhere else,” she says.

This “harm reduction” approach brings intravenous drug users into the fold of healthcare rather than leaving them out on society's fringes where they have no contact with medical professionals.

While HSA does provide them with syringes, it also uses the opportunity to provide health information, on-site blood testing, and multiple clean needles so users are inclined to use them only once and not transfer diseases such as HIV and Hepatitis C, which have extended consequences for the users as well as the community.

“We're also trying to get them to change their behaviors, and this is a long road,” she says.

Beneficiaries of the needle exchange can get one new needle in exchange for one used needle, unless they have a medical condition like Hepatitis C, HIV, or a psychological disorder, in which case they can get an additional 15 syringes and leave with a maximum of 35.

Hernandez says the exchange reduces the likelihood that needles turn up in the community, especially ones that are contaminated with disease, by providing an incentive for users to bring their needles in for new ones so health workers can dispose of the syringes safely.

“I'm not saying that's a good reason to feel better about finding a needle out in the community, but the probability that it has an infectious agent is lower because people aren't sharing them,” she says. 

Bearman says that he received 280 written responses in the survey’s additional comments portion.

Suggestions for improving the needle exchange included enforcing a strict one-for-one transaction, marking needles for tracking when they turn up in the community, and a small monetary incentive—a dime or a quarter—for turning needles in to HSA. Some respondents suggested terminating the exchange altogether.

“I don't believe this survey justifies ending the needle exchange, but the survey should bring home the point that this is unpopular and officials should address the concerns of the citizenry,” Bearman says.

First District County Supervisor John Leopold, who has been a proponent of the needle exchange, will speak with Bearman on his radio show at noon on Thursday,  Aug. 8.

“It's important to remember that the history of the HIV epidemic is working with marginalized populations and if we let public opinion drive our public health policy, there will be lots of people who will be hurt, and communicable diseases rarely stay in its host community,” he says. “Drug users may not have popular support, but as policy makers, we have to make sure that problems that occur within that community don't spread.”

Comments (10)Add Comment
Let me try again
written by Method Man, August 21, 2013
To follow up on my criticism of the needle survey's methodology, let me explain why this survey is problematic. If you properly select a sample from a given population through random sampling techniques such that each and every member of the population has an equal chance to be included in the sample, your sample will reflect the true opinions of the population. This procedure was not followed in this survey.
So, once again, it is not the size of the sample in this survey on needle exchange that is the problem, it is how that sample was drawn.
Robert Norse
written by Ethan Bearman, August 16, 2013
Robert, The question regarding needle sticks is a valid one. I have asked it of people and there doesn't appear to be a procedure in place for reporting/gathering that information so we have only anecdotal reports over time and in various online forums. You are correct on the few health consequences, but the question is do you want HIV or Hep C from stepping on a needle that shouldn't be there in the first place?

-Ethan Bearman
Method Man Response
written by Ethan Bearman, August 16, 2013
Method Man,
As a self-reported educator using an online pseudonym, I ask, did you read the report? Because if you did, you would have read the section acknowledging the shortcomings. You would also have seen the portion discussing the canvassing done in person.

-Ethan Bearman
Stats guru to the stars
written by Method Man, August 15, 2013
The problem with Bearman's survey isn't sample size. The problem with his methodology -- using an online survey -- is that the responses he received are not representative of the population from which they were drawn. In short, his was not a random sample, and therefore the results cannot -- and should not -- be presented as an accurate gauge of the community's opinions regarding the subject. If any of my students used his methodology for a survey project in my social science research methods course, they would have received a failing grade.
Your snowball has TBSC written all over it
written by wondering, August 14, 2013
Steve Schlicht promoted your survey, the anti-needle exchange groups encouraged participation, TBSC and your own radio show base pulls heavily from TBSC and more conservative members of the community. That's no methodology it's called ensuring the outcome.
...
written by Concerned reader , August 10, 2013
KInda think Lilith is a bit baised toward the issue and Dr Hernandez. Maybe Lilith should check out Dr Hernandez's credential before making such slanderous remarks.....
Response to
written by Ethan Bearman, August 10, 2013
Interesting ad hominem logical fallacy. What part of the methodology section did you disagree? You can find the complete report here - http://blog.ethanbearman.com/u...y-results/

And as far as the ad hominem attack, I have never received a membership card to any group in Santa Cruz. On what do you base your accusation? Interacting with various groups on Facebook, guests on my radio show, or various interactions in the community? I await your response.

-Ethan Bearman
...
written by Robert Norse, August 10, 2013
Perhaps the cynical hysteria-cultivators from Take Back Santa Cruz can give us some stats on how many actual needle sticks there have been reported in the last decade (what with the big Needle Menace and all)? And of those, how many have actually had a health consequence? To my understanding it's very very few.
Ethan is a member of Take Back Santa Cruz
written by wondering, August 08, 2013
While some reporters who belong to the group seem impartial, it doesn't seem to be the case with him. That might help explain his unofficial survey results and how it's being promoted in the news and to policy makers.
...
written by lilith, August 06, 2013
Lisa Hernandez: there is a big dfference in having sex with a condom and sticking a needle full of heroin in your arm. Where did you get your medical credential, the Bryman School of Dental Assisting? As for the public officials who do what they want to anyway--get a brain.

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