Threading the Needle of Civic Compromise: Needle Exchange in Santa Cruz

Last week at the Board of Supervisors meeting I was pleasantly surprised to see what has become a rather rare site in Santa Cruz politics – a sensible and constructive compromise. Even more astonishing considering the issue being addressed, the controversial (though some would disagree with this characterization) needle exchange program. For what has been considered by many as the focal point issue of public safety in our community, if only largely symbolic, the needle exchange has spurred a huge amount of public discourse that has touched on a number of important themes. From understanding the nuances of public health policy, to determining the efficacy of harm-reduction as a strategy; from debating the morality of enabling drug users, to weighing the practical considerations of tangible impacts on neighborhoods; from having to discern a true to life picture of what is going on by analyzing competing statistics, to acknowledging the limits of government services and policy; this issue is emblematic of many of the tough choices and conversations that need to happen in order for the civic process to be effective. And though many had their doubts and had organized their respective constituencies to be prepared for the worst, level heads did indeed prevail.

For those of you who are still unfamiliar with the Needle Exchange (formerly known as the Syringe Services Program, or SSP for short), it is a public health policy and service that allows intravenous drug users to exchange used syringes for clean ones, with the primary intent of combating the spread of disease, mainly HIV/AIDS and Hepatitis. Prior to April of last year, multiple non-profits had managed various needle exchange sites, including a mobile exchange, under the guidance of state and county regulations. However, as more and more used needles began to appear in public spaces, the county Health Services Agency (HSA) took control of the program last April, managing two exchange sites and two self-serve kiosks for disposal. Since then, there have been accusations levied at specific procedures and calls to “reform” the program by groups and individuals alike.

Last Tuesday, at the April 15th Board of Supervisors Meeting, the HSA offered their first public report on the program, and a report from an advisory committee specifically charged with program oversight. Of specific concern were really two questions:

Has the needle exchange been effective, from a public health standpoint, at preventing the spread of disease through injection drug use?

Are there specific reforms that could be implemented, both with regards to the program and county health policy in general, that will reduce the direct and tangible impact of used needles on the community.

The answers to both these questions are yes. There is no doubt, both from the HSA report and countless other studies that have been conducted on needle exchange programs, that these programs do reduce the spread of disease associated with injection drug use. And yes, there are reforms in policy and practice that will more than likely (though it still remains to be seen) reduce the burden of discarded needles in public spaces.

And I was proud, as both a policy wonk and a caring member of our community, to see this nuanced discussion over public policy end in a unanimous vote by our elected leaders to assess (not yet implement) multiple recommendations for moving forward with the program. These recommendations are as follows:

Accept and File the HSA Report – A no brainer, basically accepting their statistics

Direct HSA to report on options for working with other non-profits and agencies to maximize program effectiveness while reducing cost – Again, pretty much a no brainer, but with specific directions to consider working with other organizations, which is an important step after having taken complete control last April.

Direct HSA to work with affected jurisdictions regarding the potential installation of new disposal kiosks – This is really important for two reasons, 1) It considers the installation of new kiosks in addition to the existing two, which together have collected an estimated 200,000+ needles, and 2) It specifically directs HSA to work with the potentially affected neighborhoods, to assess ways of reducing potential impacts.

Direct HSA to continue working with Public Works to see where new kiosks may be installed – Continuation of the previous recommendation, but specifies the agency partnership.

Direct HSA to look into the possibility of organized cleanups, with partner agencies and other organizations – Important because it acknowledges the problem of neighborhood impacts and makes an important incremental step towards addressing those impacts.

Direct HSA to reduce the days of operation for the Emeline facility, while pursuing a mobile exchange and home delivery model, to be carried about by a partner non-profit, but limiting beyond 1-1 exchange ratios (more needles given out than taken in) to only be conducted at the Emeline facility, with the quantity of exceptions not allowed to exceed 3% of the total number of needles exchanged per quarter – Wow, that’s a long one, so lets break it down. 1) Reduce the days of operation for the Emeline facility from 5 to 2, so it still maintains the program, but spreads out the neighborhood impact because they will 2) Pursue adoption of a mobile exchange and home delivery model. So access is preserved and the burden spread out, with stricter oversight to be conducted by 3) only allowing for medical exceptions to receive more needles to be carried out at the Emeline facility, whilst limited those exceptions to only 3% of the total needles given away. This effectively maintains a 1-1 exchange, maintains county control over possible exceptions, and caps the total number of exceptions.

Direct HSA to recommend a cap on the number of needles any one person can exchange at any one time. What that cap will be and how it will be determined still to come.

Direct HSA to assess the cost of erecting fencing around the Emeline facility – fencing could help control the flow of clients better, and provide an easier to way to monitor potential neighborhood impacts.

Direct County Counsel to draft an ordinance that would require local pharmacies that sell needles to accept used needles – The real boon of the recommendations, because according to HSA staff, they collect far and away more needles (including the kiosks) than they give out. So these needles have to be coming from somewhere! Which means that local pharmacies would have to do their part in providing more disposal locations, which will undoubtedly cut down on the number of used syringes found in public places.

So in conclusion, weighing in public testimony, empirical evidence, staff recommendations, peer-reviewed studies, feedback from organizations, theories of morality and practical considerations, the Board of Supervisors unanimously passed a series of 9 recommendations that will hopefully make a tangible impact in addressing community concerns and impacts. And maybe, just maybe, close this chapter on the public safety debate. YAY CIVICS!!!!!