July 11, 2005 - The Fresno Bee (CA) Grand Jury Lobbies For Needle Exchange Fresno Area Tops U.S. In Injection Drug Users, Lacks Legal Program By Barbara Anderson

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Fresno ranks No. 1 for injection drug users among metropolitan cities, but the county doesn't have a legal syringe-exchange program to reduce the use of dirty needles and help prevent the spread of the viruses that cause AIDS and hepatitis C.

The Fresno County Grand Jury says this should change.

In a report issued late last month, the grand jury recommended that the county take advantage of state laws to establish a system for drug users to exchange dirty needles for clean ones and to allow them to purchase sterile syringes at pharmacies.

The board has been reluctant in the past to create a needle-exchange program for several reasons, including concern about liability should someone be stuck by a needle distributed by the county. One supervisor, contacted about the grand jury report, said liability remains a sticking point.

"That's my only issue," said Supervisor Bob Waterston.

But this is the first time a grand jury has asked the county Board of Supervisors to establish a needle-exchange program, and proponents hope the supervisors will follow the grand jury's lead.

"It's a government body taking a good long, hard look in studying the issue outside of politics and seeing the extent of the epidemic among the people we are treating," said Dr. Marc Lasher, medical director of the Fresno Free Medical Clinic.

Lasher was unsuccessful in persuading the board to approve a legal needle-exchange program in 2002. Supervisors at the time said they would consider the idea, but they did not pursue it.

Currently, volunteers with the Fresno Needle Exchange illegally distribute needles to drug users once a week near Roeding Park. On Saturday at the underground needle-exchange, a line of drug users stood in the sun carrying plastic bags, paper sacks, boxes and purses full of used needles to exchange for bundles of clean syringes.

State Laws Allow Programs

The grand jury said the county should establish needle-exchange and needle-purchase programs using state laws created by Assembly Bill 136 and Senate Bill 1159.

AB 136, passed in 1999, protects California counties or their agents from criminal prosecution for operating a needle exchange, if the governing body declares a health emergency. SB 1159, approved in 2004, allows cities and counties to authorize pharmacies to sell 10 or fewer hypodermic needles or syringes to adults, as long as the pharmacist provides information on drug treatment and disease control and ensures safe disposal of used syringes.

Currently, there are 37 syringe exchanges in the state, but only 23 are legal. Eight counties and two cities have implemented needle-purchase programs.

In recommending needle-exchange and needle-purchase programs, the grand jury cited a recent national study reported in the Journal of Urban Health, which found "Fresno has the highest number of users of illegal injection drugs per capita of any large U.S. metropolitan area."

The report said Fresno has 173 users per 10,000 residents, compared to a 96-city median of 60 per 10,000.

The implications are that Fresno County has approximately 14,700 users at risk for HIV/AIDS or hepatitis C if dirty needles and syringes are shared, the grand jury said.

The grand jury's findings are consistent with what state officials have found.

Statewide, almost 20% of AIDS cases and HIV, the virus that causes AIDS, are related to injection drug use, said Alessandra Ross, injection drug use program specialist at the California Department of Health Services Office of AIDS.

In Fresno County, about 25% of the HIV and AIDS cases are directly attributed to injection drug use.

"You can see that Fresno has a larger proportion than statewide that are related to injection drug use," Ross said.

A 44-year-old speed addict, who was getting clean needles at the illegal exchange Saturday and did not disclose his name, said supervisors should listen to the grand jury: "If they prevented one person from getting AIDS, it would more than pay for this program."

Infection's Costs

The grand jury said treating one person infected with HIV/AIDS costs $200,000 for a lifetime, as compared to an estimated cost of $1 per distributed syringe.

And the grand jury said research shows clean needle- and syringe-exchange programs reduce the incidence and transmission of HIV among injection drug users, their sexual partners and their children. And they also reduce the incidence of hepatitis C, a blood-borne virus that causes liver disease.

In 2003, Fresno County offered free hepatitis C tests to current or past injection drug users as an incentive for them to be tested for HIV. The county found 75% tested positive for hepatitis C, said Jena Adams, Fresno County's supervising communicable-disease specialist. The county has state funding to continue the testing.

Treating a hepatitis C patient costs $15,000 to $20,000 annually, and an additional $300,000 for a liver transplant, according to the grand jury.

Jean Rodriguez, a co-founder of the illegal needle distribution in Fresno, said an average of 200 drug users come each week to receive clean syringes. Volunteers exchange between 4,000 and 5,000 needles per week.

Rodriguez began distributing clean needles almost 11 years ago. Fresno County is past due in addressing drug use and the health problems associated with it, Rodriguez said.

"My impetus for doing this is for health reasons," she said. "I get the feeling, the supervisors -- some of them -- look at it as a moral issue, and it's not a moral issue. It's a health issue."

Several men in line said they had resorted to using unsterile needles in the past.

Mike, an abscess swelling his left leg and ankle, said people have tried to buy needles from him, but he tells them to come to the needle exchange. "They need this," said Mike, who would give only his first name. "I think it saves a lot of lives and a lot of disease and infections."

The grand jury said a legal needle exchange could receive charitable contributions. And it would allow for more distribution sites, which would reach more drug users.

Needle-exchange programs encourage drug users to enter detoxification and drug treatment programs, the grand jury report said, and their legal distribution does not increase rates of drug use, drug infection or crime.

Officials React

Last week, Jeff Hollis, an assistant sheriff for Fresno County, said the Sheriff's Department was "in the process of reviewing the grand jury's report, and we haven't taken a position yet."

Supervisor Henry R. Perea said he can't support a needle-exchange program that doesn't include aggressive treatment for substance abuse.

"I would consider it if it was connected to a mandatory treatment program administered by the county of Fresno," he said.

But Rodriguez said the county would need thousands of treatment beds. "I've actually had people come and say, 'I'm ready to go into treatment.' There's nowhere for them to go. There's not enough beds."

Supervisor Susan B. Anderson, a supporter of needle-exchange programs, welcomed the grand jury report. "It's direction from the community to the board that this is important," she said. "It's a health issue."

Supervisor Phil Larson said he needs more information before making up his mind about needle-exchange. Board of Supervisors Chairwoman Judy Case was not able to be reached for a comment about the grand jury's recommendations.

The supervisors' decision about needle-exchange could hinge on what the public health officer determines from a review of the grand jury report.

Dr. Edward Moreno has been charged with evaluating the findings.

His responsibility, Moreno said, "is to present the accurate facts to the board so they can make a decision on this important issue."

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