Despite 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.”
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