Opinion: California needs a logical, uniform needle-exchange program

From global warming to evolution, politics seems to be encroaching more and more on science.  The latest example shows that California’s syringe exchange law is vulnerable to having politics block vital protections for the public’s health.

Earlier this month Fresno County’s Board of Supervisors abruptly changed course and blocked a previously approved action to allow a syringe exchange program that would save lives and protect the public from infectious diseases and used needles. A change in county supervisors caused the sensible approach taken by their predecessors to be scrapped.

The events in Fresno are emblematic of why California needs a uniform approach to syringe exchange programs, which are endorsed by all major national, state, and international health and medical associations including the US Centers for Disease Control and Prevention and the American Medical Association.

Currently, the State lacks the authority to fully respond to urgent public health concerns from HIV, hepatitis, and other blood-borne infections. The leading cause of hepatitis C infections in the state, and the second leading cause of HIV and hepatitis B, is the use of shared syringes. Syringe exchange programs (SEPs), coupled with social services, are critical for any effort to reduce the spread of HIV and hepatitis.

AB604, now on the Governor’s desk, allows the California Department of Public Health (CDPH) to grant a two-year authorization for a health and social service program to provide syringe exchange services in locations where the conditions exist for the rapid spread of HIV, viral hepatitis or other infections spread through the use of shared syringes.

Well-regulated SEPs are supported by every major health organization as a proven way to reduce infections. SEPs also reduce injuries among police officers by removing contaminated syringes from communities. One study by researchers at UCSD found that nearly 30% of active-duty police officers had received needle sticks during pat-downs, searches, or other patrol duties.

Existing law permits SEPs pursuant to a vote of local city or county government. However, many cities and counties with high rates of HIV and viral hepatitis caused by syringe sharing remain without any legal access to sterile syringes.

AB 604 requires balancing local involvement with statewide, science-based oversight. The bill does not allow CDPH to simply drop a syringe exchange program into a community. Rather, it allows local organizations – with demonstrated ties to the community, drug treatment services, and appropriate capacity – to apply to CDPH for a two-year authorization.  

If the organization’s application has merit and is from an area of highneed, CDPH must contact both the local law enforcement leadership and the health officer for consultation in advance of a 90-day public comment period.  In this way, all concerns about impacts of a program and the quality of the applicant will be considered before CDPH makes its final decision regarding authorization. After each two-year authorization, CDPH may re-authorize the syringe exchange program, but only after consultation with local law enforcement and the health officer.

 
The average cost to treat someone with hepatitis C exceeds $100,000; for HIV the cost exceeds $600,000. According to CDPH, approximately 19% of cumulative AIDS cases were caused by syringe sharing. Treating these cases alone cost the State over $80 million, not to mention the costs to treat hepatitis cases caused by contaminated needles. And since the Obama administration has recently approved federal funds for SEPs, AB 604 does not cost state or local coffers, yet has the potential to save millions in healthcare costs every year.

Syringe exchanges shouldn’t be about politics.  They are about the science of public health. That’s why AB 604 has support from the California Nurses Association, the California Medical Association, the California Society of Addiction Medicine, AIDS Project Los Angeles, California Hepatitis Alliance, county governments, and numerous health and drug treatment associations.

The experience in Fresno County exposed the State’s current policy as a failure; AB 604 represents a real, science-based reform that takes politics out of the equation.