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A California court ended this week the only needle exchange program in Orange County, a decision that illustrates the challenges these programs face despite significant evidence of their benefits.
In issuing a preliminary injunction, Judge Joel Wohlfeil terminated the Orange County Exchange Program (OCNEP).
The program planned to operate mobile needle exchange centers in four towns in the county, with state approval, after the city of Santa Ana decided to close the permanent site after nearly two years. But the Orange County government, as well as the cities of Anaheim, Costa Mesa and Orange (where the program would work, with Santa Ana) opposed the mobile exchanges and took legal action earlier this year. year.
The argument of Orange County, like that of Santa Ana, is centered on a trope often used against needle exchanges: the threat of needle litter – the idea that trade allow people to get a lot of syringes that are then badly placed in public places, thereby exposing the public to the risk of being inadvertently stuck by a needle.
The court agreed that the needle litter problem had actually preceded the needle exchange, but indicated that the needle exchange had exacerbated the problem. This is an important reason for the court's preliminary injunction.
County and court approaches highlight the persistent problem of needle exchanges: although research has been conducted for decades and many studies have demonstrated the benefits of needle exchanges, programs are often bogged down by resistance from the public and particularly by the local population, often fueled by stigma and stigma. misconceptions about addiction. This has led to the closure of several needle exchanges, from West Virginia to Indiana to California, even as America is plunged into its most lethal drug overdose crisis of the epidemic. opioids.
In one declaration, OCNEP condemned the county's actions and the court's decision, arguing that it would put lives at risk:
[B]By preventing OCNEP from providing needed services in Orange County, the County chooses to ignore the lives and health of people who are opioid addicted, homeless or under-served. During this unprecedented epidemic of opioids, the counties of the country are collaborating with their local needle exchange centers to combat this problem. Rather than follow their lead, Orange County officials have chosen to close their only needle exchange.
The county, for its part, has maintained its complaints about needle waste and the threats that they represent. The Orange County Supervisor, Andrew Do, told the Orange County Register: "Because people have not chosen to take those risks by walking down the street in the morning or by opening a book in the public library. "
For now, the county has won a big legal victory.
The needle exchanges have a lot of evidence behind them
Many researches show that needle exchanges help to fight the spread of infectious diseases such as hepatitis C and HIV, reduce the number of needles thrown in public spaces and connect more people to treatment, without increasing drug use. . It is a comprehensive body of research, supported by independent academic researchers, the World Health Organization and the Centers for Disease Control and Prevention.
Beyond the direct benefits, advocates of needle exchanges argue that programs can also give a much needed sense of hope to underserved populations.
Alex Smith, a resident of California, told me that this reflected her own experience of a needle exchange in Ventura County. In 2012, Smith had a bad bacterial infection, MRSA, resulting from the reuse of needles, with wounds covering his face and his body. She decided that she could no longer use the syringes that she used and that she needed clean equipment. So she went to her local CVS.
"They've taken a look at CVS and sent me back. I felt so humiliated, disgusted. I did not know what to do, "said Smith. "I heard that there was a mobile needle exchange in town. So I went to that. … I arrived and there was a girl. The first thing she did was to smile at me and ask me how I was going. I do not know why it had such an impact on me. But it was the first time that someone had treated me with dignity and humanity for a very long time.
Smith began treatment in a few weeks and said she had not used drugs since, recently, five years of convalescence. She is now working in a company that helps people with intellectual disabilities. She has also just graduated from graduate school and will now go on to graduate school – a step forward, she hopes, to help lead the company for which she now works. "I would not have been able to do that if I did not become sober," Smith said.
She added, "It's so much more than needles. Being treated with dignity and humanity, his power is insurmountable. It can make a lot of light in the darkest moments. "
Needle exchanges are not the only solution to the opioid epidemic and related public health problems. But experts say that needle exchanges are part of a broader set of solutions, including reducing excessive prescription of opioid analgesics, expanding access to drug treatment and implementing other methods of harm reduction, such as the increased distribution of naloxone, antidote for opioid overdoses.
The Orange County program was mired by litter issues
Despite the evidence, needle exchanges have long faced resistance from the public.
As a result, the United States continues to lag significantly behind other developed countries in needle exchange. Josh Katz reported in The New York Times: "According to the North American Syringe Exchange network, 333 such programs are active nationwide, up from 204 in 2013. In Australia, countries with less than a tenth of people, there are more than 3,000. "
Part of the resistance is rooted in the stigma attached to addiction. After decades in the United States treating drug abuse as a criminal justice problem rather than a public health problem, a large part of the public and many decision-makers still view drug addiction as a problem requiring a punitive response and consider drug addicts as part of the problem instead of people who need help. (A common answer to almost every opioid story that I write, for example, is that people who die from an overdose are part of "Darwin's theory in action".)
There are also more practical concerns, such as the issue of needle waste raised by Orange County officials.
When Santa Ana decided to end the activities of the OCNEP in the local civic center, he reported photos of needles found in the vicinity of the exchange, needles found in books from the public library to found syringes in the streets. Municipal officials did not provide any supporting data, but they told me that the OCNEP had aggravated the burial of needle waste and that the waste problem had been resolved after the closure of the program.
When the OCNEP announced that it would turn to mobile exchanges as a result, officials from Orange County and the four cities where the program would be implemented objected, arguing that the Needle waste problems would explode throughout the county.
The OCNEP noted that needle litter had preceded its existence – a point on which Wohlfeil J. at least subscribed. They also claimed to have taken action, including limiting the number of syringes that people can get and performing cleaning scans, to try to minimize the risk of needle formation.
In fact, the OCNEP claimed that the opposition of local government officials to the program made cleaning work difficult, stressing in a statement that its steps "would have been much more effective if we had a collaborating public health partner in the sector. ". county."
In Santa Ana, for example, the OCNEP operated at the Civic Center only two hours a week, on Saturdays from 1 pm to 3 pm local time. This meant that clients could get to the program to get syringes for the next week – without having to exchange a syringe for every needle purchased, as studies indicate that it is less effective at preventing the spread of disease. infectious. . But customers do not have the exchange needed to get rid of their needles for the rest of the week, which forces them to find another way to eliminate them most of the time.
If the OCNEP benefits from increased public support and so it can run normally five or seven days a week, there may be less waste. As Ricky Bluthenthal, professor of preventive medicine at the University of Southern California, said, "In an ideal world, a needle exchange program would be open 40 hours a week.
There is evidence that needle exchanges can even reduce the amount of needles if they are readily available. A 2012 study published in Drug addiction and alcohol dependence compared a city with syringe exchanges, San Francisco, to a city without exchanges, Miami. During visual inspections, they found 44 syringes per 1,000 census blocks in San Francisco, compared to 371 syringes per 1,000 census blocks in Miami.
Based on a survey of injecting drug users, the researchers also concluded that those in Miami were 34 times more likely to have disposable syringes in public than San Francisco.
However, Orange County officials have so far resisted official support for any type of needle exchange program. And, this week, the only exchange in the county has been closed.
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