LEADERS SPLIT ON NEEDLE ACCESS

County Health Experts Say Clean Syringes Would Curb Disease; Critics Fear
More Drug Abuse.

For the first time in a decade, the Sacramento County Board of Supervisors
will consider making it easier for drug abusers to get clean needles.

A new state law allows a pharmacy to sell up to 10 needles at once to
adults without a prescription, but only if the practice is approved by the
local government where the pharmacy is located.

Right now, Sacramento County residents need a prescription to legally
purchase needles for uses other than injecting insulin or adrenaline. That
means drug abusers regularly have trouble finding clean syringes, so they
often turn to the black market.

If the board approves the measure at an Aug. 10 hearing, all pharmacies in
the county could sell needles without a doctor's signature, so long as they
register with the county and follow a few rules.

The issue has divided two large sections of county government. On one side,
law enforcement officials say easy access to needles could encourage drug
use and cause dirty needles to litter the street.

On the other, county health officials say improving access to clean needles
would slow the spread of such diseases as HIV and hepatitis C.

"We know that injection drug users tend to share syringes and also tend to
reuse them because they are hard to come by right now - certainly in
California they are," said Dr. Glennah Trochet, the county's public health
officer.

Most other urban counties in the state already have agreed to let
pharmacies sell needles without a prescription, said Kelly Brooks,
legislative representative for the California State Association of Counties.

Though it's unclear what Sacramento's Board of Supervisors will do, the
measure has the support of at least two supervisors.

"When they've had at least that interaction where they're getting needles
(from pharmacies) and they are understanding that it is dangerous to use
needles that aren't clean, I think that is a better approach," Supervisor
Illa Collin said.

Supervisor Roger Dickinson, given a choice, said he'd prefer programs that
allow drug users to trade dirty needles for clean ones. "But if we can't
get to needle exchange, I think this is at least a step in the right
direction," he said.

Several law enforcement leaders disagree. Earlier this year, Sheriff Lou
Blanas, District Attorney Jan Scully and Chief Probation Officer Verne
Speirs sent a letter to health officials - copied to supervisors - saying
the new law "provides no benefit to the community or to law enforcement."

"If you talk to people who have had a degree of success in substance abuse
treatment - like Alcoholics Anonymous - they will tell you the absolute
worst thing you can do for a person with an addiction is anything that
enables their further destructive behavior," Undersheriff John McGinness
said in an interview.

Health officials counter that needle-exchange programs - a slightly
different concept from what the supervisors will consider - have not been
shown to cause an increase in drug use.

Why, asked Jim Hunt, director of the county's Department of Health and
Human services, would someone suddenly decide to start or keep using drugs
just because they can get a needle?

"The presence or absence of legal needles is not going to make that
decision for the individual," Hunt said.

McGinness countered with a rhetorical question of his own.

"If hypodermic needles are more easy to come by, is it a foreseeable
consequence that people might be more inclined to fall victim to that kind
of lifestyle?" McGinness asked. "I think it is at least a reasonable question."

It's not just about drug abuse. Health officials want needles to be more
readily available because too many local residents are contracting diseases.

Almost all of the 1,000 or so injectable-drug users helped at Bi-Valley
Medical Clinic, which offers methadone treatment at three Sacramento County
locations, have hepatitis C, said John McCarthy, the clinic's executive and
medical director, citing a recent survey conducted on clinic patients.

Liver failure, a common outcome of hepatitis C, is the leading cause of
death among his patients, he said.

"Their desperation drives them to use dirty needles," he said.

The evidence is clear, health officials say, that easy access to needles
quickly lessens infection rates for HIV and hepatitis C.

Not allowing pharmacies to sell needles without a prescription boosts the
public cost of health care for indigent drug users, health officials add.

"For HIV alone, you are looking at about $20,000 a year, potentially, for
each new infection. Hepatitis C, you may be looking at treatment of $50,000
to $100,000 dollars," said Dr. Bary Siegel of Sutter Medical Group, who has
treated patients with HIV in Sacramento for more than 20 years.

McGinness isn't convinced. He said sharing needles is a social activity, a
way of bonding, among many drug users. They will keep doing it even if
needles are more readily available.

Law enforcement officials are concerned that new sales of needles will lead
to more dirty needles lying on the ground - a big public safety concern.

"I'm afraid they are going to become like cigarette butts that will litter
parks and highways after being used by members of a very high-risk group,"
McGinness said.

Health officials note pharmacies would be required to tell customers how to
dispose of needles and sell or provide means to safely get rid of them.

The issue of access to needles has a long history in Sacramento County. In
1994, county supervisors narrowly approved a needle exchange program for
drug addicts. The proposal was stopped three months later by a Superior
Court judge, who said it would violate state law.

Later, a state law allowed local jurisdictions to conduct needle exchange
programs, but only if they declared a state of emergency. Some
jurisdictions took advantage, but Sacramento was not one of them.

Elsewhere in the state, counties that have approved provisions of the new
law are waiting to see how it works. The provisions of the law are in
effect until Dec. 31, 2010, when the state will evaluate the measure.

In Contra Costa County, a little more than one out of every five pharmacies
has registered with the county.

"There are individuals who are using the pharmacies to purchase clean
syringes," said Christine Leivermann, head of Contra Costa's AIDS
program."It's a little early to say anything beyond that."