A political battle in Northern California has ended in the partial closure of a local syringe service program (SSP). Humboldt Area Center for Harm Reduction (HACHR), based in Eureka, must now stop distributing sterile syringes in the city—though it can continue providing other harm reduction services and supplies like naloxone.
How did things get to this point? The tension between the SSP and the city dates back a couple of years. When HACHR was authorized by the California health department in October 2018, the city government and police opposed it, claiming (in a common line for SSP opponents), that the program “[shows] a tendency to ignore community concerns around needle and syringe litter.”
In August this year, Eureka police alleged that undercover officers observed drug use and drug trafficking on the program’s premises, and further alleged that program staff were involved. HACHR denied the allegations—countering that it has a zero-tolerance policy for drug use on its premises, and that it works with local residents and businesses to clean up syringe litter.
The city government then wrote to the state health department, demanding that it revoke the program’s authorization. The state responded with a half-measure—essentially authorizing HACHR to continue operating its services throughout Humboldt County, but giving Eureka authority over the program within its city limits.
Initially, it seemed the city and the SSP would reach a compromise through additional requirements that HACHR put a fence around its building, have an on-site “monitor,” and distribute syringes only by mobile vehicle. But on December 11, those hopes were dashed—the City Council voted 3-2 to ban any syringe distribution in the city indefinitely. The ban took effect on December 16.
“I think people have a hard time witnessing people experiencing homelessness and chaotic drug use. I think they would rather not see it.”
“It’s been a process of gaining the community’s acceptance of our offering harm reduction services, which happens in many rural communities,” HACHR Program Director Lasara Firefox Allen told Filter.
When it comes to Eureka’s decision, they said, “I think people have a hard time witnessing people experiencing homelessness and chaotic drug use. I think they would rather not see it—it reminds us how close we are to that precipice.”
Allen rejected the allegation that the HACHR has been fueling a rise in syringe litter in the neighborhood, explaining that the program takes in far more syringes (from both clients and cleanup efforts) than it gives out. It also had a dedicated staff member assigned to help with neighborhood syringe cleanup. In general, SSPs reduce the presence of discarded needles in their neighborhoods, as the CDC notes.
Allen also said that while the program has to date given out one syringe for each one it takes in from each client, as was stipulated by the city, that is not nearly enough to meet people’s needs. Health experts advise that providers give out as many syringes as each person wants, to reduce the risk of needle-sharing. Now that HACHR’s SSP has been forced to leave Eureka, it will no longer operate on that one-for-one basis.
What will be the consequences of ending the program within the city? Unfortunately, as past examples have shown, restricting syringe access will drive up disease among people who use drugs and others—all during the COVID-19 pandemic.
As of 2018, Humboldt County had the highest rate of hepatitis C in California, with about one in 18 residents being infected. That was triple the rate of infection for the whole state. Humboldt is also experiencing a rise in new HIV cases that started in 2018, the same year that syphilis infections spiked by over 170 percent. Such blood-borne diseases can of course be spread by sharing needles, among other routes.
Humboldt County is also suffering higher overdose death rates compared to California’s average, as shown by data going back nearly 15 years. In more recent years, opioid-involved deaths have decreased while methamphetamine-involved deaths have increased. And Indigenous residents are disproportionately impacted, dying at twice the rate of white people.
“We’re gonna keep showing up for our population.”
Eureka’s decision does not shut down HACHR, which will continue to operate its storefront building in the city. The facility will continue to connect patients to opioid use disorder [OUD] medication programs, give out naloxone, teach overdose prevention and provide other supplies like clothing, hot food, and wound care kits. But when it comes to syringes, staff will now have to drive a vehicle loaded with supplies to a public parking site outside of city limits; anyone who needs syringes will have to meet them there.
This is, of course, not ideal. “We have created comprehensive harm reduction for people under one roof,” Allen said. “If you have all services available in one location, people are likelier to make better choices over time. If someone comes in regularly for syringes and meets other people who consume by smoking or snorting, they may stop injecting.” They added that HACHR has so far linked 50 patients to OUD medication programs, over 90 percent of whom have stayed in treatment.
Allen is clear about the dangers this decision to take away health services for people already at risk of health problems and homelessness presents to the city and surrounding area, with its particular vulnerability to blood-borne diseases. They also highlighted the work HACHR has done to protect vulnerable clients by supplying them with personal protective equipment during the pandemic.
“We have a vast amount of support and the science on our side,” Allen said. They noted that in the fateful Council meeting, 40 residents spoke up in support of the program—and only 15 against. “We’re gonna keep showing up for our population. And every other citizen needs to show up and advocate for harm reduction for our most marginalized residents.”
Photograph by Todd Huffman via Wikimedia Commons/Creative Commons 2.0