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When the Orange County Needle Exchange Program opened in February 2016, it sought to fight rising H.I.V. and hepatitis C infections in the county by providing clean needles to intravenous drug users. Based in Santa Ana, the program began amid a national opioid epidemic that had resulted in a surge of heroin use.

It was organized by medical students and public health experts steeped in data about effective public health interventions.

But the program, the first and only one in Orange County, soon found itself under fire by critics and concerned community members. A swell of needle litter in public libraries and parks in Santa Ana collided with a worsening homelessness epidemic in the region, and the two issues became intertwined in the minds of the public and political leaders.

Transient individuals, critics said, were using the needles to shoot up in public and then improperly discarding them. And the syringe exchange program, they said, had facilitated their drug abuse and created the needle litter.