San Francisco residents are complaining about a record number of used and discarded syringes littering the streets, as a growing heroin epidemic grips Northern California.

The city distributes nearly 5 million needles each year through various programs aimed at reducing HIV and other health risks for drug users who might otherwise share needles.

The city distributes an estimated 400,000 syringes each month through various programs aimed at reducing HIV and other health risks for drug users. About 246,000 syringes are discarded through the city's 13 syringe access and disposal sites. But thousands of the others end up on streets, in parks and other public areas... -AP

While syringes discarded in public areas have become a nationwide problem amid a growing opium crisis, the problem in population-dense San Francisco (about 50 square miles) is much more noticeable given the city's growing homeless population. Last year there were 9,500 requests by residents for needle pick-ups by the city. So far this year, there have been 3,700 requests.

Despite the needles strewn around the city, San Francisco officials have no plans to change their needle program.

“Research shows that reducing access to clean syringes increases disease and does not improve the problem of needle litter,” said Barbara Garcia, director of the Department of Public Health.

In response to the problem, Mayor Mark Farrell has hired 10 workers to go around the city picking up needles.

Meanwhile to the north, the coastal town of Eureka has been hit hard by the heroin epidemic which has spread throughout California's rural north.

While the state as a whole has one of the lowest overall opioid-related death rates in the country, a sharp rise in heroin use across the rural north in recent years has raised alarms. In Humboldt County, the opioid death rate is five times higher than the state average, rivaling the rates of states like Maine and Vermont that have received far more national attention. -NY Times

Eureka, with its sizeable homeless population, lack of affordable housing and a "changing, weakened economy that relies heavily on tourism" has been hit particularly hard.

Intravenous drug use has been a persistent menace across rural California for decades, but longtime drug users who once sought methamphetamine — which is also often injected — are increasingly looking to score heroin or opioid pills instead. An astonishingly high rate of opioid prescription in Humboldt County has bred addiction, officials said, and the craving is increasingly sated by a growing market for heroin. -NYT

“I’ve lost so many people to this,” said 46-year-old Stacy Cobine, a chronically homeless woman who has struggled with drug abuse.

While Meth is still the drug of choice in Humboldt, Chief Deputy Coroner at the County Sheriff's Department, Ernie Stewart, says he is certain that the county's heroin-related overdoses are "way underreported," and that meth and heroin abuse is affecting every type of person locally - not just the homeless.

And with such heavy use of opioids comes the trash...

With the sharp increases in use and overdoses, syringe litter has become a significant flash point for the town’s middle-class residents, particularly because tourism is so important for Eureka and the surrounding region. The town’s homeless have borne the brunt of the blame and frustration. Many Eurekans described various shocking experiences, including witnessing injections on public streets. They worry that discarded syringes could threaten children and tourists playing in the area’s parks. -NYT

Like San Francisco, Humboldt distributes clean needles to drug users through the Humboldt Area Center for Harm Reduction. Many residents blame the organization, founded in 2014 to combat the spread of hepatitis C, for the proliferation of needle litter. The exchange has given out close to one million clean syringes since 2017, while founder Brandie Wilson says her group gets around 94% of the used needles back.

“Our Hep C and mental health and drug use and homeless and opioid use issues, all of those are so intertwined with being rural, and with a culture of silence,” she said. “No matter where I looked, there was no help. There was no help.”

Another factor which many point to is the break-up of a major homeless encampment by Humboldt officials.

The needle litter problem intensified two years ago when the town removed a homeless encampment along the Palco Marsh where somewhere between 250 and 400 homeless people had been sleeping. City officials and health service workers had encouraged the town’s large homeless population for years to go there. The tent city, which was colloquially called Devil’s Playground, provided a place to sleep and to linger during the day, but it also saw severely unsanitary health conditions and, at times, violence. In 2016, the town decided to clear the camp to install a bike path along the water, and did not allow a new camp anywhere else. -NYT

And while Humboldt County does what it can, many are pointing a finger at the state of California for not taking enough action.

“The state is failing miserably, and you can quote me on that,” said Mr. Stewart, the deputy coroner. “The state is failing miserably across the board. They are not putting enough funding and resources toward rehabilitation.”

Mike McGuire, who represents several Northern California counties including Humboldt in the State Senate, said that government leaders needed to be more proactive about expanding resources in rural parts of the state. He said rural Californians are “desperate” for more assistance.

“Humboldt County is just a few hours up Highway 101,” he said, “but as an individual travels further north on the highway, it’s like you take a step back in time. We need to step up to the plate and provide rural counties with the tools they need to combat this crisis.”

“We’re just trying to figure out how to keep people alive while we wait for more treatment up here,” said Wilson.

