VOLUME RISING IN NEEDLE EXCHANGE DEBATE

Health Officials Say It's Time To Talk Seriously About Creating A Program Here

Twice a week, carloads of San Luis Obispo County residents head south to
Santa Maria to get what they need.

These aren't big-box shoppers looking for a bargain. Most are drug addicts
in search of clean needles.

They come to the cramped office of Pacific Pride Foundation on West Church
Street to exchange used syringes at the only place to get sterile equipment
for injecting their drug of choice - heroin, cocaine, methamphetamines.

"We see an unusually high number of people coming down here from San Luis
Obispo County who take advantage of it," said Buck Derrington, a community
health outreach worker at Pacific Pride, a nonprofit agency that provides
services to HIV, AIDS, lesbian, gay, bisexual and transgender communities.
"They're carpooling. That tells you there's a need."

San Luis Obispo County does not have a syringe-exchange program. The idea
of offering clean syringes to drug users, however, has circulated quietly
among some San Luis Obispo community members and county public health
officials.

The reuse of potentially blood-contaminated syringes can lead to the spread
of AIDS and hepatitis C. Health authorities nationwide have long touted
syringe-exchange programs as an effective way to get contaminated needles
off the streets and prevent the spread of those diseases and other
blood-borne pathogens.

In California, 19 percent of all AIDS cases are linked to the sharing of
used syringes. The state Office of AIDS estimates that some 1,500 cases of
HIV transmission and 3,000 cases of hepatitis C infection result each year
from the sharing of dirty needles.

But for years, government and law enforcement officials have questioned the
validity of such exchange programs, saying they encourage and facilitate
drug use.

Those in the local public health community expect similar resistance from
San Luis Obispo County government and law enforcement authorities.

"When I've talked to some law enforcement in the area, they've asked me,
'If we have a program, what kind of message are we sending to our
children?'" said Tom Hutchings, a benefits counselor at the AIDS Support
Network and member of San Luis Obispo's Human Relations Commission. "I tell
them, 'How do we explain to our children that we knew of a public health
problem, ways to alleviate it, and we didn't do anything about it?'"

Supervisor approval needed After several years of talking about the idea of
syringe exchange, Hutchings said public health officials are ready to step
up the dialogue.

Officials with the HIV Consortium, Economic Opportunity Commission, San
Luis Obispo Hepatitis C Project, county Drug and Alcohol Service and other
agencies plan to meet soon to discuss ways to educate community and county
government leaders about syringe exchange.

The ultimate goal is to get Board of Supervisors support for
syringe-exchange programs, which exist in some California communities,
including Santa Barbara, San Diego, Los Angeles and several Bay Area counties.

"We're behind the curve," Hutchings said. "We have our rural character, and
so we don't identify ourselves as being a big drug population center. You
imagine Los Angeles, Hells Kitchen (in New York City), San Francisco. But
it happens here, and we have a wonderful opportunity to address an issue
now before it's too late."

For syringe exchange to become legal in San Luis Obispo County, the public
health officer would have to declare a health emergency, and the Board of
Supervisors would have to approve that state of emergency every two weeks.

A state law passed in 1999 gave local governments, nonprofit organizations
contracting with cities and counties, and their employees the right to
operate syringe-exchange programs without criminal prosecution. The
unauthorized possession and distribution of syringes is illegal statewide.

No federal law prohibits syringe exchange, but Congress has banned the use
of federal funds for syringe-exchange program services since 1988,
according to a 2003 California case study by Human Rights Watch, a
nonprofit international human rights organization.

Some supervisors said they would need more information before taking a
stand on the syringe-exchange issue.

"This is no different in some respects to providing condoms," said
Supervisor Katcho Achadjian. "Some would look at that and say, 'Are we
promoting sex or safety?' Some will look at needles and ask, 'Are we
promoting drugs or preventing disease?'

"It would be good to hear from the professionals about where it has been
used and promoted," Achadjian added. "Hopefully, studies will educate us
enough to come to a decision."

Supervisor Shirley Bianchi said she would be in favor of it.

"Needle exchange does not promote illegal drug use," she said. "If somebody
is going to do that, they're going to do that."

Declaring an emergency Hutchings first introduced the idea of syringe
exchange to the San Luis Obispo Human Relations Commission in 2001. At the
time, the commission supported further study of the program. Hutchings had
hoped commissioners would adopt a resolution to encourage the City Council
to support syringe exchange and urge the county to create a program.

In September, Hutchings and Dr. Greg Thomas, the county's public health
officer, explained the benefits of syringe-exchange programs to commission
members.

At the time, commissioners wondered whether it was an issue better left in
county hands and agreed to table it until they could gather more
information. A few weeks later, Gov. Gray Davis vetoed SB 774, a bill that
would have permitted the sale of syringes at licensed pharmacies.

With no legal way for drug users to obtain clean needles in San Luis Obispo
County, some members of the public health community say now is the time to
form a public health coalition to educate area residents about the benefits
of establishing a program.

Many syringe-exchange programs also have educated local law enforcement
officials in their area, and in some cases, come to an understanding about
how clients will be treated.

In San Francisco, the San Francisco AIDS Foundation and the San Francisco
Police Department have negotiated perimeters around the foundation's
syringe-exchange sites. Police agree not to go inside unless they have to
answer an emergency call.

In Santa Maria and Santa Barbara, law enforcement authorities are aware of
the syringe-exchange programs and have not come on site to arrest clients
for possessing drug paraphernalia, said Janet L. Stanley, executive
director for Pacific Pride Foundation.

San Luis Obispo County Sheriff Pat Hedges, who has talked with Hutchings
about syringe exchange, said he's skeptical about starting a local program.

"It assists individuals in illegal drug use," he said. "It purports to
decrease the spread of certain types of illnesses or diseases. But I've not
been made aware of anything that necessarily supports that. Providing
someone with a new needle does not guarantee they would not share that
needle with someone else."

A 1999 report by the Johns Hopkins School of Public Health found that
syringe exchange does not generate more crime, increase drug use among
people who already inject illicit drugs or encourage youth to use drugs.

In addition, seven reports on syringe-exchange programs - all of them
government-funded - have found that the programs reduce HIV transmission
without increasing drug use, according to the Human Rights Watch case study.

Thomas said syringe exchange would be "an appropriate thing to do in San
Luis Obispo County." The programs, he said, not only help to reduce the
transmission of hepatitis C and HIV but can serve as a link for clients
seeking drug treatment.

"The evidence overwhelmingly shows that syringe-exchange programs do not
increase injection drug use or criminal activity," Thomas said. "In syringe
exchange programs in other counties in California, referral is made to drug
treatment programs for those clients amenable to such referrals or open to
those referrals. These programs are a way of reaching out to injection drug
users and getting them into treatment."

Marsha Bollinger, director of the AIDS program in the county's Public
Health Department, said it would be nice to give clients a full range of
options.

"My point of view is that it is an effective method, and we should use all
effective methods at our disposal," she said.

Limiting the spread County public health officials say local drug users are
at risk of contracting a serious disease.

In 2002-03, 99 people tested by the county Public Health Department for
hepatitis C tested positive for the disease. Seventy-eight of them said
their primary risk factor was intravenous drug use. In the first quarter of
2003, 31 people have tested positive for hepatitis C. Twenty-eight said
they most likely contracted the virus by injecting drugs.

Hepatitis C is a virus that can survive in the bloodstream of an infected
person and can be spread through contact with someone else, typically by
entering the bloodstream of another person. The disease can lead to
cirrhosis of the liver and liver cancer. There is no cure for hepatitis C,
although it is treatable.

As of June 2003, there were 250 cases of AIDS in the community, excluding
inmates at the California Men's Colony. Of those people, 39 percent said
their only risk factor was intravenous drug use.

Derrington, an outreach worker at Santa Maria's Pacific Pride Foundation
program for about five years, said it's unclear how many people cross the
Santa Barbara County line for clean supplies. Outreach workers collect
demographic information - age, gender, drug of choice - but do not ask
people where they live.

But each week, Derrington meets clients who come from as far away as San
Miguel. They save up hundreds of used syringes and often store them in
containers until they can make a trip south, he said.

The county's Drug and Alcohol Services estimates that more than 23,000
people in the county have substance abuse problems. That includes people
addicted to alcohol and other drugs. County health officials say the
majority of drug users smoke marijuana or take methamphetamine. A smaller
percentage use drugs such as heroin, which can be injected.

"How many have to be infected or die before people realize there's a
problem?" Derrington said. "There's a serious epidemic out there."