HEALTH OFFICER URGES NEEDLE EXCHANGE

Fresno CO. Supervisors Face Controversial Issue Surrounding Drug Users

Fresno County's health officer has declared a health crisis among
intravenous drug users infected with hepatitis C and the AIDS virus,
setting the stage for supervisors to face off over the authorization
of a legal needle-exchange program.

In a 17-page report presented to supervisors Tuesday, Dr. Edward
Moreno said 81% of illegal drug users in Fresno County are infected
with hepatitis C, compared to 1.8% for the general population.

Illegal drug users experience more health problems and require
expensive treatment, two other criteria that Moreno said contribute
to the public health crisis.

In response to the crisis, Moreno recommended "that harm reduction
programs in Fresno County continue to provide education, testing,
counseling, medical referrals, drug treatment and clean needle access
to injection drug users."

In the past, supervisors have refused to approve a legal needle
exchange, and Tuesday they again stopped short of endorsing such a program.

Instead, supervisors on a 4-1 vote accepted the doctor's report and
asked to have the issue of creating a needle-exchange program placed
on next week's agenda for discussion and possible action.

Supervisor Susan Anderson said it was the board's responsibility to
move the issue forward.

"It should have been moved forward a long time ago," she said.

Supervisor Henry Perea objected, saying the report gave tacit
endorsement to needle exchanges. Perea has expressed reservations
about legal needle exchanges that do not require mandatory treatment
programs for drug users.

But Perea said supervisors need to decide whether to approve a needle
exchange and not continue ignoring an illegal needle exchange that
occurs each week in Fresno.

Supervisors in September ordered Moreno to report back on a grand
jury recommendation that the county establish a legal needle-exchange program.

The grand jury cited a study showing Fresno has the highest number of
users of illegal injection drugs per capita of any large,
metropolitan city nationwide.

The grand jury said a legal needle exchange would reduce the sharing
of dirty needles, a known risk for spreading hepatitis C and HIV, the
virus that causes AIDS.

State laws protect California counties or their agents from criminal
prosecution for operating a needle exchange. At the time of the grand
jury report, state laws required the county to proclaim a health
crisis so supervisors could declare a public health emergency,
allowing a legal exchange of clean syringes.

Moreno said that since the grand jury report was issued, a new law
was passed allowing counties to create a needle exchange without a
health officer declaring a health crisis.

On Tuesday, supporters of a legal needle-exchange program said
Moreno's report confirmed the grand jury findings. They urged
supervisors to move ahead.

"You have to think of a needle-exchange program not as a political
issue, but you have to think of it as a critical public health
issue," said Dr. Harold Price, a retired Fresno pathologist and
member of the 2004-05 grand jury.

Price said that at the underground needle exchange in Fresno, more
than 4,000 dirty needles are collected and exchanged for clean ones
during a one-hour period each week.

With a legal needle exchange, he said: "Can you imagine how many more
could be collected and how many more cases of HIV and hepatitis C
could be avoided?"

Gail Henry told supervisors she became addicted to heroin at age 20.
She was homeless and on the streets for two years. She heard about
the underground needle exchange and went there, she said.

Henry said she is disease-free and has been clean and sober for seven
years. This month she will earn a bachelor's degree in social work at
Fresno State.

"Thanks to my participation in needle exchange, not only am I a
productive member of society, but I'm a healthy member of society," Henry said.

Moreno's report, based on statistics from 2002 to 2005, said that of
the 665 people living with HIV in the county, 34% admit to injecting
drugs. By comparison, Merced County reported the lowest proportion
among San Joaquin Valley counties of HIV infections associated with
injection drug use, at 18.6%. Madera County reported the highest rate
of infection connected to drug use at 79.3%. On average, in the San
Joaquin Valley, 35.6% of residents with HIV infection were also using drugs.

According to a study of urban areas, Fresno has 173 injection drug
users per 10,000 residents, the highest among 96 regions. But
Moreno's report said a high injection drug rate was not unique to
Fresno. Stockton ranked third and Bakersfield was sixth in the same study.

Moreno estimates 15,169 injection drug users live in Fresno County.

Supervisor Judy Case said the question not answered is why Fresno
County has the highest rate of injection drug users.

Said Case: "You're going to have to explain to this board member why
we have the most drug addicts, what's driving that and why existing
programs aren't dealing with that."

Allen Middleton, a member of the county's drug and alcohol advisory
board, urged supervisors to establish a legal needle-exchange program.

Legal needle-exchange programs can be supported by grants. Middleton
said a visit to such a needle exchange in Monterey County found
one-third of the drug users entered formal substance abuse treatment
programs and became drug-free altogether.