Legal Syringe Exchange in Sacramento - at Last!

ELEVEN YEARS AGO, National Public Radio did a special one-hour program on the underground needle exchange program in Sacramento. Noah Adams interviewed a number of local advocates for a public health approach to the problems of infectious diseases related to injection drug use.

They included Dr. Neil Flynn, UC Davis HIV specialist, Rachel Anderson, drug abuse and HIV researcher, myself, and a multi-talented social worker, researcher, drug treatment counselor, and "underground" needle exchange outreach worker named Jim Britton.

The NPR program focused primarily on the actual needle exchange process, following Jim to houses he visited where the syringes were exchanged. This part of the program was intense and more than a little disturbing. Jim risked arrest and personal safety in his very personal mission to help prevent HIV and HCV. He and I also worked as colleagues and friends for the past 12 years at Bi-Valley Medical Clinic. He died in April, 2007.

Ironically, shortly after Jim's death, I came across the audio cassette of the program that NPR sent me. I was amazed to listen to this program for the first time in 11 years and realize how relevant it remains today. The research on the effectiveness of this kind of public health approach was clear then, as it is now. The willingness of injection drug users (IDU) to change needle sharing behaviors if given accurate information and access to sterile needles was clear then, as now.

The collateral goal of using the exchange as a source of health information and treatment referrals remains unchanged. The opposition was ideological and fear based, not factual or evidence based; so eventually it began to collapse. The collapse finally occurred at the Sacramento City Council meeting of January 23, 2007.

The case for needle exchange was carried by Councilwoman Sandy Sheedy. Councilman Ray Trethaway led an earlier discussion when pharmacy sales of syringes to addicts (SB 1159) were approved on September 9, 2006. A number of members of the Medical Society, as well as UCD president and HIV specialist Dr. Claire Pomeroy, addressed the Council in support of syringe exchange as a health measure.

So, 11 years after the evidence was clear from a scientific standpoint, the political process accepted its validity.

It reminds me of the German physician Virchow's famous dictum (he fought to convince 19th century Berlin of the health hazards of raw sewage): "medicine is politics." Eventually, like Berlin, Sacramento got it right: the City Council approved a legal needle exchange in Sacramento City by a vote of 7-2. But, it provided no money for the program.

The next victory came when the California Office of AIDS awarded grants to two community-based outreach programs, Harm Reduction Services (HRS) and Safer Alternatives through Networking and Education (SANE), for infrastructure development and staff support of Sacramento's authorized exchange program. HRS is a local outreach agency bringing healthcare education, HIV and HCV testing, and treatment linkages to out of treatment drug users. SANE, through its syringe exchange program and research experiences, developed the model of using IDU social networks to develop satellite exchanges.

But there is one more step in this unduly prolonged process: the state grant specifically excluded money for purchase of needles. The buck was passed (or not passed) to the community to manage. This is where we are right now!

What's the local evidence for effectiveness of "harm reduction" policies like needle exchange and outreach education?

Dr. Flynn tells me that the prevalence of HIV now among out-of-treatment IDU is about 1 percent. In 1992 it was 11 percent among methamphetamine users and 4 percent among heroin injectors¹.

We were all fearful of the kind of epidemic that hit East coast drug users, where the prevalence of HIV reached 40-50 percent. Four programs were put in place locally back in the early 1990s to control the viral epidemics among IDU.

First was the underground exchange which came from grassroots activists, usually linked to researchers gleaning information from their work.

The other three prevention programs were supported by federal grants promoting HIV counseling and testing among IDU, sponsoring a cable channel TV program called "User Friendly TV" (former Mayor Anne Rudin, a visionary, courageously appeared on this program), and a HIV prevention poster campaign that targeted business or clinics frequented by drug users.

All these interventions are part of the success of our local HIV prevention efforts, but without the sterile needles these other important efforts may have been wasted.

As readers can imagine, raising money for syringes for drug users is not one of the universally accepted fundraising targets.

"You want to give needles to addicts so they can inject illegal drugs?"

Well, yes, but understanding the logic of this kind of intervention requires compassion, an openness to research evidence, and an awareness that needle possession laws have failed to control injection drug use and have, instead, become a significant cause of the infectious diseases endemic among IDU. This is a tall order.

It is estimated, based on numbers of needles distributed in Sacramento during the years of underground operation, that 850,000 needles will be needed per year. Needles cost about 10 cents each.

This means raising $85,000 a year for the next three years to operate the two programs. For those very special people who wish to support this important public health effort, all tax-deductible donations for the purchase of syringes should be made to Harm Reduction Services² or SANE³.

And in memory of Jim Britton, I promise we will carry on his work.

jmccarthy@bivalley.com

1. Zeldis JB, Jain S, Kuramoto K, Richards, C, Sazama K, Samuels S, Holland P, Flynn NM. "Seroepidemiology of Viral Infections Among Intravenous Drug Users in Northern California." Western Journal of Medicine 1992;156:30-5.
2. Harm Reduction Services, 3647 40th St., Sacramento, CA 95817 or hrsdir@pacbell.net
3. SANE, 8015 Freeport Blvd, Sacramento, Ca 95832 or rjvanderson@ucdavis.edu