Why We Lost the Battle for Clean Needles

We have a proud history of leadership and service during many epidemics, including cholera, typhoid fever, flu pandemics, polio and HIV. We have not shied away from controversy.

So it was only natural that SSVMS would get involved earlier this year in encouraging the Boards of Supervisors in El Dorado, Sacramento and Yolo to implement important public health legislation; it authorized cities and counties to allow the sale of clean needles and syringes.

Under the legislation, participating pharmacies could sell up to 10 needles and syringes to anyone over age 18, provide drug treatment information and offer a proper sharps disposal device or service.

The sale or access to clean needles and syringes has been proven by many studies to be one of several effective strategies to prevent the spread of blood borne diseases such as hepatitis and HIV (see www.ssvms.org/SB1159).

Forty-five states allow sales of clean needles and syringes without a prescription. Twelve California counties representing almost 50 percent of the state's population have approved needle sales in their communities. Yolo County approved it months ago.

The first hearing by the Sacramento County Board of Supervisors was on August 10. Support for implementation came from the Medical Society, BloodSource, CARES, many individual hospitals, the Hospital Council, hospital chiefs of staff, medical groups, medical associations, pharmacies and all of the county's healthcare committees and commissions.

Three Supervisors - Don Nottoli, Susan Peters and Roberta MacGlashan - said they could not vote until the cities in Sacramento County were consulted.

Supervisors Roger Dickinson and Illa Collin, who were ready to vote "yes," pointed out that a delay would result in more disease and suffering. In addition, the cities have no authority to make such decisions and have no health departments or health functions of their own.

A final vote was scheduled on October 18. At that meeting Glennah Trochet, MD, Sacramento County's Public Health Officer reported the cities of Elk Grove, Galt, Folsom and Rancho Cordova were opposed to needle sales and that Citrus Heights chose to remain neutral.

Despite a second round of overwhelming support from all segments of the medical community, Supervisors Don Nottoli, Roberta MacGlashan and Susan Peters said they would not vote to support needles sales. It was a classic demonstration of how elected officials with no medical training make a medical decision and ignore the recommendations of a community's medical experts.

Why did this happen?

First, in a March 2005 letter signed by the Sheriff, the District Attorney and the Chief of Probation, the Board of Supervisors were told, "the needle law provides no benefit to the community or to law enforcement." In this community, the Sheriff wields tremendous clout on local politics for many reasons too numerous to mention here.

We tried, unsuccessfully, to convince law enforcement that other counties did not have the same concern and that needle sticks and disease would actually decline. These lay public officials ended up shaping a medical decision.

The second reason is a little more subtle. While healthcare is a huge part of Sacramento County's economy, we are not as politically active as we should be - especially when it comes to choosing and supporting candidates for local office.

So when three supervisors blow off the recommendation of their own county health officer and staff, the President of the Medical Society, the Vice Chancellor of UCDMC and Dean of the Medical School, our blood supply's medical director and specialists in drug addiction, treatment and infectious disease, what are we supposed to do?

The answer is obvious.

bsandberg@ssvms.org