A lawmaker in San Diego County, California is urging his colleagues to rethink a 20-year-old ban on syringe exchanges. By repealing the ordinance, he argues, they can provide lifesaving harm reduction services to some of the county’s most vulnerable residents, preventing the spread of blood-borne diseases.
Nathan Fletcher, the only Democratic member of the San Diego County Board of Supervisors, recommended on March 10 that the Board create a harm reduction program. “Syringe services programs (SSPs) is a medically approved strategy with over 30 years of academic research to demonstrate its effectiveness,” he wrote. “It is our obligation to ensure County staff have thoughtful, research-based tools and strategies at their disposal to save lives and protect public health.”
The Board voted 3-2 on March 10 to move forward by considering a syringe exchange, but it didn’t formally repeal the ban. It created a subcommittee that will study the issue and present a proposal for possible approval within 3-4 months. The Board compromised to satisfy federal guidelines that communities first make a “determination of need” before creating a syringe exchange.
Fletcher is also recommending the county create a more coordinated response to HIV and Hepatitis C infections, overdose and other health problems impacting people who use drugs. Under his proposals, the Board would hire a third-party expert to research how the county could best respond to these problems and cooperate with local agencies. And it would apply for more funding to support these programs.
The Board passed a resolution in 1997 that currently prevents the county from creating syringe exchanges. That resolution also prevents the county from even researching syringe exchanges, or working with third-party contractors who provide these services. “This 23 year-old policy is outdated and does not position our County health experts to most effectively protect the public health and safety of our residents,” Fletcher wrote.
Fletcher’s colleagues have historically seen things differently. “I think it particularly sends a wrong message to our kids,” said Board chair Dianne Jacob in 2009. “It sends a message to our kids that as county government, if we gave out clean needles for illegal drug use, that we condone illegal drug use. And we don’t. And it’s wrong.”
The same county board also sued the state of California in 2006 to try to overturn the medical marijuana program—go figure.
Of course, scientific research firmly supports Fletcher’s initiative. The Centers for Disease Control and Prevention (CDC) cites over 30 years of evidence showing that syringe exchanges are safe, cost-effective and don’t increase crime or drug use. People who use them are also five times more likely to enter drug treatment and three times more likely to stop using drugs compared with people who don’t.
Despite the county-level ban, Family Health Centers of San Diego operates the only syringe exchange in the city. Their mobile unit offers one sterile syringe for every used syringe exchanged. They have a special arrangement with the city government, to which they report. They receive no funding from the county, but survive on private donations.
“The current environment at the County prohibits County health department staff from even discussing syringe exchange, much less consider offering support or funding for such a program,” Anthony White, the health center’s community relations director, told Filter. “This policy has meant that the County has rejected millions in both federal and state funds. Additionally, funds designated for HIV and Hepatitis C prevention cannot be used for syringe services programs.”
If the county does vote to create a harm reduction program, it will help to reduce high rates of infectious disease transmission in San Diego. According to CDC data, there were over 2,400 new cases of HIV in the city between 2013-2017, while over 4,100 cases of chronic hepatitis C were reported in 2018 alone.
In December, the Eliminate Hepatitis C San Diego County Initiative found that over 31 percent of hepatitis C infections in the county are reported among people who inject drugs. Infections of syphilis, gonnorhea and chlamydia have also increased significantly since 2000.
San Diego is also suffering increasingly from overdoses. The medical examiners board found that overdoses involving fentanyl nearly doubled in the first six months of 2019. According to CDC data, San Diego County’s opioid death rate is well below the US average, but still higher than California’s average.
Creating a harm reduction program wouldn’t just meet health needs, but also give people a chance to feel more respected. “Stigmatization is a huge issue for people who inject drugs,” White said. “Clients tell us that the services we provide are the only time they feel treated with dignity and respect. That allows them to build trust with our staff and address deeper issues through mental health or substance use disorder treatment—which they may have never considered previously.”