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HomeMy WebLinkAboutMINUTES - 04251995 - 2.5 2 .5 THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Adopted this Order on April 25, 1995, by the following vote: AYES: Supervisors Rogers, Smith, DeSaulnier, Bishop NOES: Supervisor Torlakson ABSENT: None ABSTAIN: None ----------------------------------------------------------------- ----------------------------------------------------------------- SUBJECT: Proposed Clean Needle Exchange Program Mark Finucane, Health Services Director, presented to the Board this day his proposal to implement a clean needle exchange program in Contra Costa County as part of a comprehensive AIDS prevention and health services plan. Mr. Finucane estimated $10,500 to be expended in County funds for supplies during fiscal year 1995-1996. He advised that based on the size of the County's Program, the needle exchange program will prevent 18 to 76 HIV infections each year which will save the County approximately 5 - 20 million dollars in AIDS-related medical costs over five years. The Health Services Director reported that his staff has reviewed the efforts of other Bay Area counties which have revealed many models for a needle exchange program. He noted that the Santa Clara County Health Department has implemented a needle exchange program through the use of County staff and County funds. He expressed the belief that Contra Costa County would best be served by this model which will have continuous quality review to insure maintenance of the County's standard for a comprehensive program that will also contain educational components and linkages to drug treatment and medical care. Mr. ,Finucane emphasized that a County program will not diminish into a needle handout without an education or treatment component. Comments were presented on the pros and cons of a needle exchange program, the transmission of HIV infection through the sharing of contaminated paraphernalia used for injecting drugs, the need for outreach and educational programs to reach our youth in this County, concern that a needle exchange program will increase drug use, and the need to identify early HIV infection in drug users in order to increase early referral to medical treatment as well as reduce HIV transmission to others. The following persons spoke: Tom Aswad, Substance Abuse Advisory Board, P. O. Box 31114, Walnut Creek; Jane Bryan, Contra Costa HIV/AIDS Prevention Planning Group, 1433 Dover Avenue, San Pablo; David M. Melgoza, SoJourne Community Counseling Center, 3029 MacDonald Avenue, Richmond; Michael Arata, 589 Bobbie Drive, Danville; Deborah Dias, City of Richmond and East Bay AIDS Foundation, 2600 Barrett Avenue, Richmond; Bruce Oberlander, P. O. Box, Concord; Michael Davenport, AntiDrug Task Force, P. O. Box 391, Station A, Richmond 94808; Dennis Woulf, 1618 Zinn Drive, Richmond; Angela M. Davis, Aids Project of Contra Costa, 2280 Diamond Boulevard, Concord; Deborah Sharp, 205 39th Street, Richmond; Amalia Del Valle, Community Partnership, 597 Center Avenue, Suite 320, Martinez 94553; and Blanche H. Stevens, 12 Woodland Avenue, Richmond. All persons desiring to speak were heard. 9 Clean Needle Board Order Page 2 April 25, 1995 Board Members discussed the concerns expressed by the speakers and the need for input from the community at large. It was suggested that the report of the Health Services Director be referred to the Internal Operations Committee as well as for the Committee to be an oversight of the community discussions on this subject. Therefore, IT IF BY THE BOARD ORDERED that the report of the Health Services Director is REFERRED to the Internal Operations Committee for review and report to the Board of Supervisors on June 2711 1995. IT IS FURTHER ORDERED that staff of the Health Services Department is REQUESTED to facilitate community discussions on a proposed needle exchange program for Contra Costa County. I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT COPY OF AN ACTION TAKEN AND ENTERED ON THE MINUTES OF THE BOARD OF SUPERVISORS ON THE DATE SHOWN . ATTESTED: _April 25, 1995 Phil Batchelor,Clerk of the Board of Supervisors and County Administrator By Deputy cc: County Administrator Internal Operations Committee Health Services Director 2� TO- BOARD OF SUPERVISORS FROM: Mark Finucane, Director Contra Health Services Department cc)s}„ DATE: April 21, 1995 coi�/ SUBJECT: AIDS PREVENTION / NEEDLE EXCHANGE PROGRAM �� ��``�� SPECIFIC REQUEST(S) OR RECOMMENDATIONS) & BACKGROUND AND JUSTIFICATION RECOMMENDED ACTION The Contra Costa County Board of Supervisors authorize the Health Services Department to implement a clean needle exchange program in Contra Costa County as part of a comprehensive AIDS prevention and health services plan. FISCAL IMPACT This action will cost the Health Services Department an estimated $10,500 in County funds for supplies during fiscal year 1995-96. It is estimated that our needle exchange program will prevent 18 to 76 HIV infections each year which will save the county approximately 5-20 million dollars in AIDS-related medical costs over five years. These figures are both dependent on the size of our program. REASONS FOR RECOMMENDATION People who inject illegal drugs are at significant risk of HIV infection through sharing of contaminated paraphernalia used for injecting drugs. According to the University of California San Francisco, Urban Health Study, Contra Costa County has the second highest rate of HIV infection among injecting drug users surveyed on the West Coast. In 1992, more than one in four (27%) injecting drug users (IDUs) in West Contra Costa County was HIV infected, up from one in five (19%) in 1991. Approximately one in three (31%) African American drug injectors in West County was infected with HIV. As of March 31, 1995, persons who have injected drugs account for 385 (or 25%) of the county's 1,546 reported AIDS cases. This is the second largest group of AIDS cases and the fastest growing risk group. Additionally, injecting drug users who become infected with HIV can infect their sexual partners and babies with this deadly virus. Contra Costa's Health Services Department began working with substance users, in 1987, early in the epidemic, to reduce risky behaviors. Since that time our outreach program has been providing prevention information and risk reduction materials, including condoms and bleach kits, to drug users on the streets as well as providing education and testing to inmates in the detention facilities, substance abuse treatment programs and public housing developments. We have increased both the level of HIV information and reduced the risk, through the provision of education and bleach disinfection kits for syringes. However, we are aware that bleaching contaminated syringes reduces but does not eliminate all risk of HIV transmission from shared needles. CONTINUED ON ATTACHMENT: _ YES SIGNATURE: RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER SIGNATURE(S): `\ACTION OF BOARD ON APPROVED AS RECOMMENDED OTHER The Board took no action on this proposal. See separate Board Order. VOTE OF SUPERVISORS 1 _BY CERTIFY THAT THIS IS A TRUE _ UNANIMOUS (ABSENT ) CORRECT COPY OF AN ACTION TAKEN AYES; NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. CC: ATTES --- PHIL TCHELOR, CLERK OF THE BOARD OF SUPERVI S AND COUNTY ADMINISTRATOR M38 -83 BY ,DEPUTY i PLAN OF ACTION Recognizing the uniqueness of our community, Contra Costa Health Services Department has moved slowly to the decision to propose a clean needle exchange program. Although all other Bay Area counties now have needle exchange programs, we have elected to try many other prevention strategies to stem the rising infection rate. Despite our best efforts, the number of infections continues to rise with rates especially high among African American injection drug users. We now realize that we must add this prevention tool, a needle exchange program, to our armory to fight this major epidemic. Of course we will continue our efforts to educate individuals and communities, in collaboration with community-based organizations, testing the people at highest risk (including clients at substance abuse treatment programs and STD clinics) and providing bleach kits and condoms. We will also move forward to strengthen our ties with the interfaith communities and enlist their support in our efforts. However we must appeal to you for your support in this vital and life-saving program. We have reviewed the efforts of the other Bay Area counties and there are many models for a needle exchange program. Santa Clara County Health Department has implemented a needle exchange program through the use of county staff and county funds. All other counties have chosen other models using community organizations, contractors, grant funds and donations. We have included a summary of all Bay Area programs for your review. In our county Health Services has traditionally tailored health programs for our very specific needs and special populations, such as the Geriatrics Program, the North Richmond Center for Health and our model and very unique health maintenance organization, the Contra Costa Health Plan. Our proposal is to utilize county funds and county employees to implement and continue operations of our needle exchange program. We feel that our county would best be served by this model which will have continuous quality review and to ensure maintenance of our standard fora comprehensive program which always contains educational components and linkages to drug treatment and medical care. And that over time the program will not diminish into a needle handout, without an education or treatment component. The program we are proposing is a clean needle exchange and education program that would exchange one dirty needle for one clean needle ("needle" refers to a syringe with an attached needle). It would offer drug users, their sexual partners and babies an opportunity to stay healthy until seeking treatment. Additionally this program will be one component of our comprehensive health promotion system which includes prevention education as well as a bridge to needed health and social services, including drug treatment. In studies reviewed by the Centers for Disease Control and Prevention and those conducted in New York, needle exchange and education programs were found to be beneficial in that needle exchange can reduce new HIV infections among injecting drug users by as much as 35 - 50% in program participant, through reduced needle sharing. These studies also provide evidence that needle exchange can reduce the potential hazard of contaminated syringes discarded in the community. Despite concerns regarding the potential of needle exchange programs to increase drug use, findings in a study of a San Francisco program suggest that needle exchange and education may increase the likelihood that clients will enter treatment programs and represents a valuable adjunct to a total HIV prevention effort. There is no evidence that needle exchange and education programs increase the amount of individual drug use by program clients or increase overall community levels of drug use. The advisory boards to the Health Services Department from Substance Abuse, Public and Environmental Health, and the HIV Prevention Planning Group have voted unanimously to recommend that the Board of Supervisors declare a state of emergency and implement a clean needle exchange program in Contra Costa County. By implementing a comprehensive plan for AIDS prevention and health services, including needle exchange, we can: • Reduce the transmission of HIV infection in Contra Costa County. • Reduce needle sharing in the drug-using community and therefore reduce the transmission of HIV among injecting drug users and to their sexual partners and children. • Increase contact with people who use injection drugs and promote entrance into drug treatment programs as well as provide education and testing. • Identify early HIV infection in injection drug users to increase early referral to medical treatment and entrance into drug treatment programs to reduce transmission to others and promote maintenance of health in the infected. The Health Services Department continues to oppose drug use and support substance abuse treatment as the best option for current drug users. We will continue to do this while increasing our efforts in every way possible to stop disease. However, this needle exchange program represents an essential part of the solution to the epidemic we are now experiencing. The Health Services Department plan consists of three components: implementation of the needle exchange program; ongoing evaluation of the program; and development of a panel of scientific experts to advise and review this program. • The Health Services department believes that we are the best agency to implement such a program as we have comprehensive HIV prevention activities and outreach staff with years of experience who are well known and trusted in the community and act as peer role models by providing a positive example of sobriety and recovery. We are also part of a continuum of health care and can provide the linkages to substance abuse treatment and medical care. • Health Services staff are currently working with the UCSF Urban Health Study and UCSF has and will continue to assist in evaluation of the program through baseline testing for HIV infection rates and testing of needles brought in by the program. • With the recognition that this is a controversial program and that guiding the program through the initial period will be difficult, the Health Services Department plans to develop a scientific review panel of experts in substance abuse, HIV prevention, infectious disease and health programs administration. This panel will advise the Board of Supervisors and the Health Services Department on the efficacy of the program design, the implementation and ongoing evaluation of the program components. This panel will consist of representatives with experience not only in the Bay Area but throughout California and in other major population areas with high infection rates. We realize that we are asking the Board to make a difficult decision. Together the Health Services Department and the Board have faced many of these controversial problems in the past, including the street distribution of condoms and bleach kits and provision of release kits for jail inmates and the Health Services Department has appreciated the support of the Board of Supervisors. Because of the nature of the AIDS epidemic, this will probably not be the last time we come to you with controversial strategies to prevent the spread of this deadly disease. We know that now is the time to implement this aggressive program to reduce new HIV infections and disease in Contra Costa County and we ask for your support of this plan. Date: REQUEST To SPEAK FORM (Two [2] Minute Limit) Complete this form and place it in the box near the speakers' rostrum before addressing the Board. Name: Phone: Address: City: I am speaking for: ❑ Myself OR [Organization: NAME OF ORGANIZATION CHECK ONE: ❑ I wish to speak on Agenda Item # My comments will be: ❑ General U' For ❑ Against ❑ I wish to speak on the subject of: ❑ I do not wish to speak but leave these comments for the Board to consider: Date: REQUEST To SPEAK FOAM (Two [2] Minute Limit) Complete this form and place it in the box near the speakers' rostrum before addressing the Board. Name: Phone: Address: v - City: El �C! 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Name: Phone: X(P '0751) Address: S S a I City: f�,A,-- -A I am speaking for: Eil Myself OR ❑ Organization: NAME OF ORGANIZATION CHECK ONE: ❑ I wish to speak on Agenda Item # 'a 1 My comments will be: ❑ General ❑ For ❑ Against ❑ I wish to speak on the subject of: dI do not wish to speak but leave these comments for the Board to consider: DATE: REQUEST TO SPEAK FORM (THREE (3) MINUTE umrr) Complete this form and place it in the box near the speakers' rostrum before addressing the BogardAyle, NAME. ////9i��/ /�`� � r PHONE: Si la- 7l ADDRESS: -76 / 4 U14U iii err r CITY: L_ X/4 ,F ae e(c I am speaking formyselfy/ OR organization: (NAME OF ORGANIZATION) Check one: I wish to speak on Agenda Item # My comments will be: general for against I wish to speak on the subject of I do not wish to speak but leave these comments for the Board to consider. /fce �d . 7 . SPEAKERS 1. Deposit the "Request to Speak" form (on the reverse side) in the box next to the speakers' microphone before your item is to be considered. 2. You will be called to make your presentation. Please speak into the microphone. 3..Begin by stating your name and address; whether you are speaking for yourself or as a representative of an organization. 4. Give the Clerk a copy of your presentation or support documentation. if available. b. Please limit your presentation to three minutes. Avoid repeating comments made by previous speakers. (The Chair may limit length of presentations so all persons may be heard.) /4! v , Date: REQUEST 'TO SPEAK FORM (Two [2] Minute Limit) Complete this form ''�h�and place it in the box near the speakers' rostrum before addressing the Board. Name: ��_�C4 ,a Phone: fl 0r Address: 14 S C=4, �" City: I am speaking for: Lam"Myself OR ❑ Organization: NAME OF ORGANIZATION CHECK ONE: //�� El wish to speak on Agenda Item # 2-- My comments will be: ❑ General ❑ For ❑ Against ❑ I wish to speak on the subject of: 1 ❑ 4 o not wish to speak but leave these comments for the Board to consider: DATE: REQUEST To SPEAK FORm (THREE (3) Mw= L rr) Complete this form and place it in the box near the speakers' rostrum before addressing the Board. NAME: <Pl/l/O/Z/4 U PHONE: ADDRESS: 131 l 1�I7 = l iti�� �� Crnr: le�"L SD32 / I am speaking formyself OR organization: Check one: NAME OF ORGANIZATION) I wish to speak on Agenda Item # 2 S My comments will be: general for against I wish to speak on the subject of I do not wish to speak but leave these comments for the Board to consider. 'TP/,f COOkla" uL�-C g Ve201,t CC �'x�Cl,-9N6e '� C �F�t�c�� 7��E P2 °4 DATE: REQUESTTO SPEAK FORM (THREE (3) MINUTE LWT) Complete this form and place it in the box near the speakers' rostrum before addressing the Board. NAME: PHONE: ADDRESS: City /0 I am speaking formyself X OR organization: (NAME; OF ORGANIZATION) Check one: I wish to speak on Agenda Item # My comments will be: general for against I wish to speak on the subject of I do not wish to speak but leave these comments for the Board to consider. Date: ".�'? ..9:� REQUEST TO SPEAK FORM (Two [2] Minute Limit) Complete this form and place it in theboxnear the speakers' rostrum before addressing the Board. 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NAME: JOAN COkONF-L ]PHONE: (fCO-)4-73 '9'7-f$ ADDRESS: Z 1(0 �► ! 1 Nr 1-J� CrIY: P f IT69t1f & I am speaking formyself OR organization: Pl'�� , Gt-t PrC, Check one: (NAME OF ORGAW17-NTION) I wish to speak on Agenda Item # 2 5 My comments will be: general for,,2L against I wish to speak on the subject of V/ I do not wish to speak but leave these comments for the Board to consider. - IM IN 'FAVD9 D)= 1WL 1=k1e,LT1 ti C L�i4/�l NA L E7c C filr 14 [en1nRA rr!vM i7wjm4 etc o41tIVy►l ow c e)1= PR�JI=nl t►�4C, X11 C (f1�2EAb 0 I=- 14 Iy j N Our, coMN]T / DATE: 21 — a S REQUEST To SPEAK FORM (THREE (3) MIN= umrr) Complete this form and place it in the box near the speakers' rostrum before addressing the Board. NAME: �iJ�O� PHONE: ADDRESS: rl�•� -�Pv��C'3 �('� CITY: �Rt GY'e�r` 10 I am speaking formyself OR organization: NAME OF ORGAWI7�1T101) Check one: I wish to speak on Agenda Item # -2' S My comments will be: general for ,2�_ against I wish to speak on the subject of . 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My comments will be: general for „A— against I wish to speak on the subject of I do not wish to speak but leave these comments for the Board to consider. 17 ���/- Date: REQUEST TO SPEAK FORM (Two [2] Minute Limit) Complete-tki� r and ace it in •he b 4"the speakers' rostrum before addressing the Board. JName A- eVe�r Phone. Address: �� � City: I am speaking for: ❑ Myself OR ❑ Organization: G NAME OF ORGANIZATION CHECK ONE: LJ I wish to speak on Agenda Item # My comments will be: ❑ General or ❑ Against ❑ I wish to speak on the subject of: ❑ I do not wish to speak but leave these comments for the Koard to consider: Date: ` 2 S 9s REQUEST TO SPEAK FOAM 0/.2- (Two [2] Minute Limit) Complete this form and place it in the box near the speakers' rostrum before addressing the Board. Name: Phone: SIB &-�359 Address: 5 9 7 3--;110 City: 4V&77/L'�9-- `r I am speaking for: ❑ Myself OR Organization: (n6J-')/YO/7.1'7-V NAME O ORGANIZATION CHECK ONE: wish to speak on Agenda Item # My comments will be: X General ❑ For ❑ Against I wish to speak on the subject of: 1-VAWI S 04) F.5 9 944 . ❑ I do not wish to speak but leave these comments for the Board to consider: DATE: REQUEST TO SPEAK FORM (THREE (3) MINUTE umrr) l Complete this form and place it in the box near the speakers' rostrum before addressing the Board.Board. NAME: T)Q-r�C2 Lo,,, O, PHONE: CSI 0) 3 C ADDRESS: _o�O S ��M S�. CrrY: I am speaking formyself OR organization: NAME OF ORGAN17iT10\) Check one: I wish to speak on Agenda Item # c o My comments will be: general for against I wish to speak on the subject of Q-eAAc. I do not wish to speak but leave these comments for the Board to cons i er. 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Contra /�,, Holly Scheider,MPH (Costa Education/Prevention Coordinator County AIDS Program (510)313-6776 `E (510)313-6798 FAX Department of Health Services •w-s :• Public Health Division _. 597 Center Avenue,Suite 200 Martinez,CA 94553-4669 i�1 NEEDLE EXCHANGE PROGRAMS Status Report of Bay Area Counties March 25, 1995 CALIFORNIA SUMMARY: There are currently about 23 needle exchange programs (NEP) throughout the State of California which participate in the California Safety Education Network, a Marin based network which requires programs to operate a one for one exchange. BAY AREA SUMMARY: All Bay Area counties have a needle exchange program in operation except Contra Costa. San Mateo and Santa Cruz have community run NEPs. Alameda, Marin, Santa Clara, San Francisco and Sonoma Counties as well as the cities of Berkeley and Oakland have all declared local States of Emergencies to support the local NEP. Many of these counties and cities are also providing funds to support the NEP and/or related activities like street outreach (see below for details). The Santa Clara County Health Department is running their NEP with county staff exchanging needles and providing materials, including syringes. CITIES & COUNTIES WHICH HAVE DECLARED STATES OF EMERGENCY San Francisco Marin County Oakland Alameda County Berkeley Santa Clara County City of Los Angeles Sonoma County BAY AREA CITIES & COUNTIES WHICH ARE FUNDING NEEDLE EXCHANGE PROGRAMS & RELATED ACTIVITIES All allocations are for FY 94-95 unless otherwise indicated. San Francisco = $235,000 for 3 years to Prevention Point needle exchange program Berkeley = $10,000 to NEED in 1993/94 fiscal year with additional funds for 94/95 FY. Alameda County = $21,120 to the Alameda County Exchange and $145,000 to CAL-PEP Marin County = $10,000 seed money to Needle Exchange Program of Marin Santa Clara County = $20,293 for their Health Department AIDS Program to conduct a NEP 8 Contra Costa County HIVIAIDS Epidemiology Report September 1994 The Local Epidemic Among Injection Drug Users (IDUs) Percent of Heterosexual Injection Drug Users Among New Contra Costa AIDS Cases, 1982-1994 24.7% Since the first years of 21.7% the AIDS epidemic in ,, 7 Contra Costa County, increasing numbers of AIDS cases have been 14.4% 14.1% IDUs and larger .... proportions of the people diagnosed with AIDS in Contra Costa have been injection drug users. 2.4% 27 46 (The number of cases _/ / is shown inside the bars) 1982-86 1987-88 1989-90 1991-92' 1993-94 HIV prevalence among injection drug users entering treatment in Contra Costa County tested blindly, by year and race/ethnicty * (xx/xxx= tested positive/total tested) (09194) 1989 1990 1 1991 1 1992 J 1993 1994 1989-94 White *111179 17/629 15/468 20/573 16/643 3/437 i,:4212929:.>:<: 6.1% 2.7% 3.2% 3.5% 2.5% 0.7% 2>8%...::a: 2 /70 83)Zi57 81/217 66)222 48%Z09 291114 African 333)1099 `; American 37X% 3031 1% 37 301 29;7% Z3 0%i S4% 3%a Hispanic 1134 5182 6/80 7/96 2/117 2181 23490 2.9% 6.1% 7.5% 7.3% 1.7% 2.5% 4 7% Other 014 2142 2140 2/56 1157 0/28 7j227 0% 4.8% 5.0% 3.6% 1.8% 0 3.3%.....:. Missing 0/1 014 115 018 0/1 112 2121 Total 3$j288 107/1 Q24 ;105/810 951955 67//027 35/622 447 (4766 650 9.4% . IDUs tested at methadone treatment clinics. Clients readmitted during the same calendar year were excluded. Many tests during the five year period were performed on clients who has tested the previous year. Contra Costa County HIV/AIDS Epidemiology Report 9 HIV Prevalence Among Injection Drug Users in Contra Costa County = Out of Treatment Surveys The University of California San Francisco Institute of Health Policy Studies, Urban = Health Study, has conducted street surveys among injection drug users of several San Francisco Bay Area communities, including Richmond. Surveys in the city of Richmond started in 1991. The following are the HIV prevalence rates found in these communities: 1991 (1) Site Number HIV + HIV prevalence Tested rate San Francisco-West 255 31 12.2% San Francisco-Central 441 79 17.9% San Francisco-South 366 41 11.2% Oakland-Northeast 223 11 4.9% - Oakland-West 240 43 17.9% Richmond 222 43 1992 (2) Site Number HIV + HIV prevalence _ Tested rate.: Oakland-Northeast 321 22 6.9% Oakland-West 341 58 17.0% - Rchmond 304 82 27'0% For more information see the references or contact Dr.John Watters, Urban Health Study, (41 S)476-3400. - 1. Drug Injectors and HIV-1 Infection in the San Francisco Bay Area. Watters, John K., Cheng,Y.T., Bluthenthal,R, at alt.International Conference on AIDS,Amsterdam, The Netherlands,July 19-24, 1992. 2.HIV-1 Infection and Drug Injectors in Oakland/Richmond, California.Bluthenthal,Ricky;Estilo,Michelle and Watters, John. International Conference on AIDS, Berlin, Germany, June 7-11, 1993. September 1994 s c N O. • N K Sup- surfaces at forum about A needle exchanges . By CHUCK SQUATRIGLIA . Exchange workers counsel ad- Staff writer dicts, make referrals to treatment _ RICHMOND — Hank Stinson centers, often provide condoms to has seen four people die from AIDS prevent sexual transmission of.the after infecting themselves with dirty disease and test the addicts for sex- needles. He's willing to break the ually transmitted diseases and tu- law to stop the carnage. berculosis, said John DeWitt, a "Give me a handful of.needles," counselor at a Richmond metha- ' he said. "I'll go out there and give done clinic. 'em away myselV' Opponents say needle exchange y Stinson was.among two dozen Programs increase the use of intra- people at Nevin Community Center venous drugs and send the wrong on Wednesday night at a public fo- message about.drug use. Gov. Pete ' rum to discuss needle exchange Wilson cited those reasons in Sep- programs, which are.illegal under temberwhen ;he vetoed, for the state law. third time-in as.many years, a bill ..« The West County Community that' would have legalized the Substance Abuse Program spon- Programs. n sored the forum in an effort to edu- Statistics support the propo- cate citizens about the controversial nents. Studies'.by the American programs. Foundation for AIDS'Research and California is one of several states the National Academy. of Sciences that require a prescription to obtain show'that needle exchange pro- y hypodermic needles, and it,is illegal grams decrease:the incidence of to possess them without one. .AIDS among injection drug users by Despite this, needle exchange as much as 50 percent and do not o programs operate — often clandes- lead to increased drug use. tinely—in 23 cities and counties in The federal Centers for Disease California, but not in Richmond. Control and Prevention report that Nowhere in California is the the lifetime cost for care of one need for such a program greater, AIDS patient is $102,000. The proponents said. Bronx-Harlem Needle Exchange Roughly 30 percent of Contra spends exchanges about 300,000 Costa County's 620 AIDS patients needles a year at a cost of about a dollar each. are intravenous drug users.The per- centage is about the same in Rich- County supervisors support the mond, where one in three injection idea of such programs but will allow drug users have AIDS. The city has them only if they are legal,said Hol- the second-highest rate of AIDS ly Scheider,coordinator of HIV edu- cation for the county's AIDS " among IV drug users in the state, program said Ted White, an HIV prevention However, many of those at the::. specialist with the county's AIDS forum seemed willing to circumvent program. the law. Although only Stinson said "This is the epicenter of the epi- so verbally, most shook their heads demic on'the West Coast," White in agreement when-he spoke. said. "We know it is safer to use a "We can't wait for someone else clean needle with-every injection, to solve our problems," he said. but the needles are not available. "We got to do what we got to do. There is no way for an addict to get No one's doing anything about it. clean needles in this area." All that talk of the Legislature and Proponents say needle exchange going through the procedure is programs decrease the incidence of good, but we can't wait around for AIDS. them to say it's OK." LOCATIONS OF BAY AREA CLEAN NEEDLE/SYRINGE EXCHANGE PROGRAMS: Berkeley Needle Exchange Emergency Distribution (NEED) no phone Thurs: 6:00 to 8:00 p.m. Hearst at San Pablo Avenue Marin Needle Exchange Program of Marin (415) 499-6865 (call for locations) Oakland Alameda County Exchange (ACE) (510) 287-8993 Sat: 10:00 to noon Goss between Pine and Cedar Tues: 7:00 to 9:00 p.m. East 10th and Derby (East Oakland) San Francisco Prevention Point Needle Exchange Program (415) 861-6710 Runs 11 exchanges a week Call for times and locations San Jose Risk Reduction Task Force (408) 236-2126 Tues/Thurs: 6:00 to 7:00 p.m. San Pedro, 1/2 block north of Julian (by appointment only) San Mateo County San Andreas Syringe Exchange (415) 369-0330 Tues: 11:00 a.m. to 12:30 p.m. Redwood City Train Station (bus turnout) Tues: 2:00 to 3:00 p.m. Value Max parking lot, East Palo Alto (by appointment only) Santa Cruz Santa Cruz Needle Exchange (408) 427-4557 Runs five or six exchanges a week Call for times and locations (by appointment only) There are also needle and syringe exchange programs in Sonoma County, Mendocino County, Yolo County, Sacramento County, and new programs planned for Chico and Stockton. If you live in one of these areas, call one of the needle/syringe exchange programs listed above for information, they usually know about each other. NEST COUNTY TIMES November 1, 1994 N.Y. sshows , needle exchange cuts AIDS nsk By DANIEL 4 HANEY needles. However, other studies of AP science writer addicts in New. York suggest that about 5 percent a year become in- Handing out clean needles to' fected. drug users appears to cut their risk Because there is no direct com- of AIDS in half, a new study parison, "the amount of certainty . concludes. we have is difficult to pinpoint. More than 40 U.S. cities have However, it is reasonable to con- needle exchange programs,but evi- clude that we do see a reduction dence that they actually reduce the from these data in the incidence of risk of AIDS infection has been HIV infection that may be as high as slim. 50 percent," commented Dr. David Until now,most of the data came Vlahov of Johns Hopkins Univer- from studies in Europe,where AIDS sity. among drug addicts is generally far The New York program uses less common than in the United storefronts and mobile units in States, especially the Northeast. neighborhoods with a heavy drug The latest study was based on a trade.Addicts are given color-coded needle exchange program in New syringes,which they must turn in to York City, where about half the receive new ones. city's 200,000 needle drug abusers Those participating in the study are already infected with HIV, the were frequent drug users,averaging AIDS virus. three injections a day. In the month The effort, sponsored by the before the needle exchange, they American Foundation for AIDS Re- rented or bought used syringes an search, has provided clean injection average of 16 times. After the pro- supplies to 22,000 users., Addicts gram,this fell to four times. can catch the virus if they share Much of the evidence supporting needles. needle exchanges until now has Dr. Don C. Des Jarlais of New been indirect: Supporters have ar- York's Beth Israel Medical Center gued that removing contaminated presented data on the program's re- needles from circulation makes bio- sults Monday at a meeting in Wash- logical sense;and studies have ington of the American Public shown that participants are less Health Association. likely to share needles. "The best estimate of the effect Researchers said the New York of the program for the people who study is the first to measure'the new come in is that it probably reduces infection rate among participants of the new infection rate by about a needle exchange program in a city half," he said. where many addicts already carry The findings were based on 350 the virus. users whose saliva was tested for Dr. Peter Lurie of the University HIV when they enrolled in the pro- of California at San Francisco said gram and when they returned to one strength of the new study is pick up clean needles. Des Jarlais that"this is based on real testing of calculated that their annual risk of real individuals." infection was 2 percent. . Across the `United States, about For ethical reasons,the research- 1.5 million people inject illegal ers did not enroll a comparison .drugs. This habit is responsible for group that was deprived of clean about 30 percent of all AIDS cases. USCM AIDS/HIV PROGRAM AIDS a INFORMATION ?� #. EXCHANGE October 1994 Volume 1 l, Number 3 The United States Conference of Mayors • 1620 Eye Street, NW Washington, DC 20006 • 12021 293-7330 Needle Exchange is Cost-Effective ♦ The total lifetime cost of treating a single adult AIDS patient is $102,000. ♦ The cost in the first year of life of treating a single child born with AIDS is $210,000. ♦ Baltimore's pilot needle exchange program will serve approximately 1,000 addicts at a total cost of $160,000 (all from City general funds). Therefore, if only two adult cases of AIDS are prevented, the pilot program will save the State money (since the vast majority of AIDS care ends up being covered by Medical Assistance or is passed on as uncompensated care). ♦ In New Haven, a needle exchange program has been operating since 1990 and-has resulted in a 35% decrease in the risk of HIV transmission among participants. With a 4% seroconversion rate per year among injection drug users in Baltimore, such a result with Baltimore's proposed initial pilot would result in savings of approximately $1 million per year. ♦ If just a third of Baltimore's uninfected injection drug users are eventually enrolled in a needle exchange program (far lower than the 60% of injection drug users enrolled in New Haven), approximately 125-150 new HIV infections would be averted per year, saving approximately $12.5 to $15 million in public health care expenditures. ♦ The money saved by this program would be put to good use in providing additional substance abuse treatment slots to help more addicts become drug`free. Taken from US Conference of Mayors AIDS Information Exchange, Vol 11, (3); Page 4 THE PUBLIC HEALTH IMPACT OF NEEDLE EXCHANGE PROGRAMS IN THE UNITED STATES AND ABROAD SUMMARY, CONCLUSIONS AND RECOMMENDATIONS SCHOOL OF PUBLIC HEALTH, UNIVERSITY OF CALIFORNIAN BERKELEY INSTITUTE FOR HEALTH POLICY STUDIES, UNIVERSITY OF CALIFORNIA, SAN FRANCISCO PREPARED FOR THE CENTERS FOR DISEASE CONTROL AND PREVENTION September 1993 Project Personnel PROJECT PERSONNEL Principal Investigators: Peter Lurie, MD, MPH* Institute for Health Policy Studies University of California, San Francisco Arthur L. Reingold, MD School of Public Health University of California, Berkeley Co-investigators: Benjamin Bowser, PhD Donna Chen, MPH Jill Foley, BA Joseph Guydish, PhD, MPH James G. Kahn, MD, MPH Sandra Lane, PhD, MPH, RN James Sorensen, PhD Project Assistants: Pamela DeCado, BA Nicholas Harris, BA Project Officer: T. Stephen Jones, MD Office of the Deputy Director for HIV Centers for Disease Control and Prevention Funded through a cooperative agreement with the Association of Schools of Public Health (ASPH Agreement No. M1589) *Philip R.Lee,MD was the Principal Investigator through July 2, 1993 Page i Executive Summary EXECUTIVE SUMMARY CONCLUSIONS How and Why did Needle Exchange Programs Develop? Needle exchange programs have continued to increase in number in the US and by September 1, 1993 at least 37 active programs existed. The evolution of needle exchange programs in the US has been characterized by growing efforts to accommodate the concerns of local communities, increasing likelihood of being legal, growing institutionalization, and increasing federal funding of research, although a ban on f federal funding for program services remains in effect. How do Needle Exchange Programs Operate? About one-half of US needle exchange programs are legal,but funding is often unstable and most programs rely on volunteer services to operate. All but six US needle exchange programs require one-for-one exchanges and rules governing the exchange of syringes are generally well enforced. In addition to having distributed over 5.4 million syringes, US needle exchange programs provide a variety of services ranging from condom and bleach distribution to drug treatment referrals. Do Needle Exchange Programs Act as Bridges to Public Health Services? Some needle exchange programs have made significant numbers of referrals to drug abuse treatment and other public health services,but referrals are limited by the paucity of drug treatment slots. Integrating needle exchange programs into the existing public health system is a likely future direction for these programs. How Much Does it Cost to Operate Needle Exchange Programs? The median annual budget of US and Canadian needle exchange programs visited is relatively low at$169,000, with government-run programs tending to be more expensive. Some needle exchange programs are more expensive because they also provide substantial non-exchange services such as drug treatment referrals. The annual cost of funding an average needle exchange program would support about 60 methadone maintenance slots for one year. Page iii Executive Summary Who Are the IDUs Who Use Needle Exchange Programs? Although needle exchange program clients vary from location to location, the programs generally reach a group of injecting drug users with long histories of drug injection who remain at significant risk for human immunodeficiency virus (HIV) infection. Needle exchange program clients in the US have had less exposure to drug abuse treatment than IDUs not using the programs. What Proportion of All Injecting Drug Users in a Community Uses the Needle Exchange Program? Studies of adequately-funded needle exchange programs suggest that the programs do have the potential to serve significant proportions of the local injecting drug user population. While some needle exchange programs appear to have reached large proportions of local drug injectors at least once, others are reaching only a small fraction of them. Consequently,other methods of increasing sterile needle availability must be explored. What Are the Community Responses to Needle Exchange Programs? Unlike in many foreign countries,including Canada,proposals to establish needle exchange programs in the US have often encountered strong opposition from a variety of different communities. Consultation with affected communities can address many of the concerns raised. Do Needle Exchange Programs.Result in Changes in Community Levels of Drug Use ? Although quantitative data are difficult to obtain,those available provide no evidence that needle exchange programs increase the amount of drug use by needle exchange program clients or change overall community levels of non-injection and injection drug use. This conclusion is supported by interviews with needle exchange program clients and by injecting drug users not using the programs, who did not believe that increased needle availability would increase drug use. Do Needle Exchange Programs Affect the Number of Discarded Syringes? Needle exchange programs in the US have not been shown to increase the total number of discarded syringes and can be expected to result in fewer discarded syringes. Page iv Executive Summary Do Needle Exchange Programs Affect Rates of HIV Drug and/or Sex Risk Behaviors? The majority of studies of needle exchange program clients demonstrate decreased rates of HIV drug risk behavior,but not decreased rates of HIV sex risk behavior. What is the Role of Studies of Syringes in Injection Drug Use Research? The limitations of using the testing of syringes as a measure of injecting drug users'behavior or behavior change can be minimized by following syringe characteristics over time, or by comparing characteristics of syringes returned by needle exchange program clients with those obtained from non-clients of the program. Do Needle Exchange Programs Affect Rates of Diseases Related to Injection Drug Use Other than HIV? Studies of the effect of needle exchange programs on injection- related infectious diseases other than HIV provide limited evidence that needle exchange programs are associated with reductions in subcutaneous abscesses and hepatitis B among injecting drug users. Do Needle Exchange Programs Affect HIV Infection Rates? Studies of the effect of needle exchange programs on HIV infection rates do not and, in part due to the need for large sample sizes and the multiple impediments to randomization, probably cannot provide clear evidence that needle exchange programs decrease HIV infection rates. However, needle exchange programs do not appear to be associated with increased rates of HIV infection. Are Needle Exchange Programs Cost-effective in Preventing HIV Infection? Multiple mathematical models of needle exchange program impact support the findings of the New Haven model. These models suggest that needle exchange programs can prevent significant numbers of infections among clients of the programs, their drug and sex partners, and their offspring. In almost all cases, the cost per HIV infection averted is far below the$119,000 lifetime cost of treating an HIV-infected person. Page v Executive Summary RECOMMENDATIONS Recommendations for the federal government • The federal government should repeal the ban on the use of federal funds for needle exchange services and substantial federal funds should be committed both to providing needle exchange services and to expanding research into these programs. Recommendations for state governments • State governments in the eleven states that have prescription laws should repeal these laws.* • States should repeal the paraphernalia laws as they apply to syringes.** Recommendations for local governments and communities • Local governments should enter into discussions with local community groups to develop a comprehensive approach to preventing HIV in injecting drug users, their sex partners, and their offspring. This approach should include needle exchange programs and the expansion of drug treatment services. • Local communities should seek to further increase sterile syringe availability by encouraging the sale,distribution, or exchange of syringes by pharmacists. Recommendations for researchers • Descriptions of the "kinetics" and determinants of needle use patterns: injecting drug users' sources of needles, methods of disposal of needles, frequency of needle re-use, and needle-sharing patterns. How do these change when a needle exchange program or other changes in needle availability are implemented? • Evaluations of"natural experiments" in which needle availability laws change or pharmacists expand the over-the-counter sales of syringes. *Prescription laws preclude the purchase of a syringe without a prescription,limiting sterile syringe availability and creating a risk of arrest for needle exchange program staff and clients. **Paraphernalia laws exist in 46 states and require pharmacists to determine whether the purchaser intends to use the syringe for"legitimate medical purposes."Conviction under a paraphernalia law is a felony or a misdemeanor. Page vi • y Executive Summary • Surveys of pharmacists to determine their willingness to participate in pharmacy-based syringe sale, distribution, or exchange and to identify the barriers to their participation. • Assessments of the effects of design features of needle exchange programs (e.g., administering bodies, site characteristics, opening hours, and program rules) upon process measures of needle exchange program outcome (e.g., needles distributed, drug treatment referrals, discarding of needles). • Ethnographic and other qualitative research to assess the factors involved in drug use initiation and in transitions between various routes of drug use. • Case-control studies of the relationship between use of the needle exchange program and acute hepatitis B,particularly in cities with active surveillance for the infection. • Large, multicenter case-control studies within existing cohorts of injecting drug users to assess whether use of the needle exchange program is associated with hepatitis B or HN seroconversion. • Mathematical modeling using program data and behavior change evaluations to determine which aspects of program design determine effectiveness and cost-effectiveness. Page vii -S C01Vj Needle Exchange: Evolving Issues * s t is a basic concept of public health In Spring 1994,the National Institute that in order to reduce the spread on Drug Abuse, the Centers for Dis- $ �*" of disease the simplest solution is to ease Control and Prevention,and the remove the means of transmission.A Center for Substance Abuse Treatment ' popular example with malaria and issued a joint notice indicating thatlop P 1 g mosquitos.To prevent the spread of decontamination of injection equip- malaria, eliminate through eradica- ment with bleach is not entirely effec- tion programs the mosquitos that rive and that "persons who inject • spread the disease.This concept has drugs...should be urged to obtain ster- not, however,been widely accepted ile,never-used needles and syringes." when applied to the spread of HIV The major questions for policy makers through infected injection equipment and the public health professionals is (needles, syringes, cookers, cotton) how to make sterile needles and sy- used by those injecting illegal drugs. ringes available to IDUs. The logical public health approach would be to reduce the use of infected Where Does Needle injection equipment eitherby making Exchange Fit in the clean equipment more available through needle (syringe) exchange Battle Against AIDS? programs,retail sales,or other mea- sures or through promoting the cessa- Needle exchange has been described • tion of drug use altogether.Unfortu- in many ways. It has been called a nately,the shortage of drug treatment necessary public health measure, a and the prevailing attitudes in society bridge to drug treatment,an invitation and among some policymakers con- to drug use,and genocide.Obviously, cerning the use of illegal drugs have there is no dear consensus on how ' turned what is considered by many to people view needle exchange. This be a public-health issue into an ex broad range of viewpoints has made it tended public debate. difficult for communities readily to adopt needle exchange as an HIV pre- While many may get bogged down in vention measure. Needle-exchange the debate about how society should programs(NEPs)are designed to pro- deal with illegal drug use,the need to vide sterile injection equipment to drug act immediately to stem the spread of users. Programs operate from fixed HIV among injection drug users sites(store fronts,health-department • (IDUs) is clearly evident. Currently, facilities,community-based clinics)or 34 percent of the nation's AIDS cases conduct exchange through street out- are among IDUs. Additionally, the reach. sex partners and unborn children of ' IDUs are at risk of HIV infection.Most Two years ago there were fewer than HIV prevention efforts targeting IDUs 20NEPs operating in the United States. emphasize cleaning syringes with Of these programs,less than half were ' bleach and water and not sharing sy- authorized,or operating legally,with ` ringes.While some drug users have the support of the health departments adopted these measures, the lack of in their communities. Forty-six states access to sterile syringes continues to and the District of Columbia have ex- be a major factor in the spread of HIV isting paraphernalia laws prohibiting among IDUs. the possession or distribution of sy- Issue 3 • July 1444 —continued on page 2— The United States Conference of Mayors • 1620 Eye Street, NW • Washington, DC 20006 • (2021293-7330 i —continued from page I— ringes except for legitimate medical Is Needle Ex- The studies conducted indicate that purposes.Iniunestates and the Dis- change Effective? needle-exchange programs do not trict of Columbia a prescription is increase drug use, do not increase necessary in order to obtain syringes. the number of discarded syringes in The distinction between authorized Over the past two years,needle ex- a community,are effective in reduc- and unauthorized programs is that change programs have been exten- ing the spread of HIV,and serve as syringe distribution is legal orwaiv- sively studied.Reports on the effi- a bridge to drug treatment and ser- ers have been obtained by programs cacy and impact of needle exchange vices for clients of the needle ex- thatare authorized(operate legally). have been carried out by the Insti- change.Despite these findings,there With unauthorized programs, sy- tute for Health Policy Studies at the are still fewer than fifty authorized ringe possession is illegal and waiv- University of California,San Fran- and unauthorized needle-exchange ershave notbeen obtained,and both cisco (funded by the U.S. Centers programs in operation today.This i P l Cand Prevention Disease Control those running the exchange and cli- for HIV Capsule Report will discuss ents are subject to arrest if they are and released inSeptember 1993)and both ongoing-and newly-emerging caught possessing syringes. Con- the U.S.General Accounting Office policy-related and operational is- gress has passed several laws that (March 1993). Existing programs sues in the debate about needle ex- prohibit or restrict the use of federal also evaluate their efforts. change at the local level. funds for needle-exchange services. Ongoing Issues Despite studies that have answered some of the initial questions about needle exchange—Will NEPs increase drug use and encourage non users to use drugs?Will NEPs increase the number of discarded syringes in the community? Are NEPs effective in reducing the spread of HIV among IDUs?Do NEPs serve asabridge to drug treatment and other social services?--some of the issues,especially those relating to the ethics of drug use,continue to be debated at the local level. In local debates, questions about the legality of needle exchange, about the impact programs will have on the community and life within the community,and how to balance enforcing the law and protecting citizens with public health needs continue to surface.The following section discusses issues that have.arisen at the local level as these questions have been discussed. Legal Barriers a larger approach to drug use called aging IDUs to inject safely every "harm reduction."Harm reduction time,even in settings where this can Central to the debate about needle- is a set of strategies and tactics that be difficult such as shooting galler- exchange programs is that the di- encourage drug users to reduce the ies or on the street. ents are participating in an illegal harm done to themselves and their activity.Attitudes toward drug use communities by their licit and illicit Beyond the ethical issues concern- often oncernoften become a factor in debate at substance use. Advocates of harm • ing illicit drug use are the logistics the local level and many have diffi- reduction contend that users should of operating a program that under culty separating the need for MV be provided access to the tools with state law is illegal.In some commu- prevention measures from the idea which to become healthierand edu- nities-programs operate under- that these measures may appear to cated on how to protect their health. ground, with or without the sup- condone or facilitate drug use. Their efforts to protect themselves, port of local policymakers, health Policymakers fear that they will their families and their communi- departments and law enforcement. appear"soft on drugs"if they sup- ties should be recognized and en- Staff and clients of these programs port.programs. couraged. risk arrest for their activities. Staff members have been arrested in New Inthemindsofmanyactivists,NEPs Central to the harm reduction ap- York,Massachusetts,California and are a casualty of the"war on drugs." proach is improving access to ster- other states. Needle exchange is just one part of ile injection equipment and encour- Page 2 HIV Capsule Report The United States Conference of Mayors Issue 3 • July 1994 The legal barriers have been re- and the community informed,most nities for other organizations that moved in some communities, programs have found that commu- are perceived as more racially and/ mostly as a result of significant lob- nity opposition is minimal at most or culturally sensitive to take over bying efforts on the part of local and does not last. the operation. In some instances, officials, service providers, and these organizations have no inter- needle exchange advocates.In New Exchange staff also report that cli- est in carrying out needle exchange. York,the State Legislature adopted ents are very protective of programs This can degenerate into an atmo- a measure that allows organizations and are unlikely to do anything that sphere where everyone is required to apply for a waiver that exempts might jeopardize their access to to pick sides and may limit the ef- program staff and clients from pros- clean syringes.Programs report in- fectiveness of the program in reach- ecution for possessing syringes.In cidents of unruly or threatening cli- ing those at risk. other states, such as Connecticut ents being told to leave or,if neces- and Maryland,legislativeactionwas sary,subdued by other clients. When considering adopting needle also required before needle ex- exchange as an HIV prevention change programs could legally be While mostconsider the early stages measure, communities should go established at the local level. of initiating a needle exchange the beyond the basic questions and most contentious, new issues can build consensus on operational Other communities have taken a arise as services are expanded, or questions such as who should con- different approach in the face of not expanded, that can be disrup- duct the program, where the ser- opposition at the state level.In San tive to service provision and be- vices will be available, and future Francisco,Mayor Frank Jordan de- come adivisive forcewithin thecom- expansionof the program.Thismay clared a state of emergency that al- munity. Even after programs are prevent disagreements that may lowed the local government to sup- established, tensions can develop disrupt programs in the future. port needle exchange even though as a result of the controversial na- California has a prescription law. ture of needle exchange. Syringe Exchange The San Francisco Department-of and Law Health provides funds to Preven- In some communities,organizations tionPoint,the local needle exchange have complained when other orga- Enforcement program that for a long time oper- nizations have come into their Ber- ated illegally. Other programs in vice area and distributed syringes. Needle-exchange programs do not California continue to operate ille- While supportive of syringe ex- need widespread support to oper- gally. change in general,these organza- ate, as some of the unauthorized tions claim that it can be disruptive programs demonstrate,but thelevel Community to their services when a new pro- of community acceptance can make Concerns gram suddenly arrives distributing a difference in terms of the services syringes. Trust may not yet have programs can provide to their di- been built between the incoming ents. The attitude of law enforce- While many in a community may program and the community.This ment within the community has agree with the harm reduction as- can lead to questions of why the perhaps the greatest impact on pro- pects of needle exchange, when service providers within the com grams.With the majority of needle- faced with the location of aprogram munity had not informed them of exchange programs that operate il- ia their neighborhood they quickly the new services and were not in- legally, minimal services are pro- adopt a NIMBY (not in my back volved with the new program. videdtoclients because the"hitand yard) attitude. It is assumed that I- run"nature of the exchange leaves any program serving a large num- Debate also continues on whether little time to provide counseling or ber of drug users will be disruptive outreach workers should reflect the referral services. Both clients and and that increased crime,loitering, community in which they work— staff_are primarily concerned with litter and other social ills will ac- African Americans providing ser- exchanging syringes while avoid- company the new program. vices to African Americans,Latinos ing arrest,and interaction that can providing services to Latinos, etc. build client trust,provide access to Generally,this has not been the case Many syringe exchanges are initi- additional services and provide the with existing programs.Sometimes, ated by AIDS activists of varying kind of contact that supports be- neighbors of syringe exchanges are racial/ethnic backgrounds. As ex- havior change is sacrificed. not even aware of what is taking change programs have grown,there place. If sites are carefully chosen has been pressure in some commu- —continued on page 4— HIV Capsule Report The United States Conference of Mayors Issue 3 • July 1994 Page 3 —continued from page 3— grams emphasize the importance of program's cards in order to refer maintaining open communications people to the exchange.Other pro- Being legallyable to operate,how- ro- Beinglegallyabletooperate,how- with law enforcement officials and grams report that occasional con- ever,does not guarantee perfect educating police officers on an on- tact with police when they are ex- relations with the police.Even in going basis about the goals of sy- changing syringes tends to allay communities where the mayor, ringe exchange and the role of the fears among community members police chief and health depart- program in the community's HIV whomaynotbeawareofthenature ment have expressed support for prevention efforts. of the exchange. (Programs have syringe exchange,individual of- reported community members call- ficers can"chill"exchange activi- Some programs report individual ing the police on exchange sites be- ties by intimidating staff and cli- officers being very supportive of cause they thought that outreach ents.Staff from existing legal pro- their efforts—even taking the workers were drug dealers.) New Issues: Expanding and Improving Programs As needle exchange has become more widely accepted as an HIV prevention measure and incorporated into the overall HIV prevention activities within some communities,new issues have arisen that have previously not been at the center of the debate. Serving Younger never be the primary target popula- and night clubs)is also effective Po vl atiYo hed on of needle exchange programs in reaching and providing u- p but there are IDUs who are minors cation to younger adults. who need access to sterile injection Opponents of needle exchange equipment and would probably Other programs, like Clean frequently argue that programs benefit from the other services of- Needles Now (CNN) in Los will encourage people to begin fered by exchanges. Angeles,have also found a peer using drugs—especially teenag- approach to beeffective in reach- ers and young adults.While this Many legal programs,in an effort to ingayoungerdrug-usingpopu- has always been part of the de- minimize controversy,restrict par- lation.Some clients exchange in bate at the local level it has not ticipationin theirprogramto adults. a network of friends who may usually been a central issue. As Unauthorized programs,however, beunableordonotfeelcomfort- programs have sought to expand usually do not have specific rules as able going to the exchange site. their outreach, the question of to who can exchange syringes.They CNN works to support these in- whether programs should pro- provide syringes to anyone. formal exchanges by providing vide syringes to youths under 18 a one-for-one exchange of sy- years old has arisen.The question In Santa Cruz,California,the unau- ringes with no limit on the num- of condoning drug use becomes thorized needle exchange has ber of syringes that can be ex- much grayer when minors are in- worked hard to reach younger drug changed. Participants can also volved. users.Santa Cruz is a college town. pick up unlimited supplies Methamphetamine is readily avail- . (bleach, cotton, cookers, Needle exchange programs have able and the drug of choice of many condoms, lubricant) and then not been besieged with youths younger users.The Santa Cruz ex- redistribute them to their net- seeking to obtain needles. Injec- change was able to reach younger works.. tion drug use among teenagers is users by recruiting teens and young not the most prevalent form of adults(peers)as outreach workers. Programs run by health depart- drug abuse and,according to data Younger users seem more comfort- ments or receiving funds from collected on clients,most needle- able exchanging syringes and being health departments may have exchange programs in the U.S. counseled by people their own age. more rigid regulations concern- generally serve a group of clients The Santa Cruz exchange has also ing the age of clients.Many have with long histories of injection found that holding fundraisers that policies stating that they will not drug use. Youth will probably target young adults(events in bars exchange syringes with anyone Page 4 HIV Capsule Report The United States Conference of Mayors Issue 3 • July 1994 under 18 years of age. However, Dehyery and Name and home visits allow the program clients are rarely asked their age.Ifvisits, to provide its service while main- they are,they do not have to present taining a lower profile in the corn- documentation. munity.Staff also contend that home Thegrowingcommunityacceptance visits may be safer than street out- Some organizations have sought to of needle exchange hasenabledpro- reach. Staff of one program ex- avoid potential controversies relat- grams to expand their services.The plained their clients are very pro- ing to working with younger popu- original needle-exchange"models" tective of outreach workers because lations by collaborating with other that rely on street outreach or cli- they are grateful for the service they service providers.The StreetWorks ents coming to fixed sites are not provide. Programs offering home Project of Victim Services/Travel- applicable for every community, delivery stress the importance of ers Aid, an organization in New especially suburban and rural com- building and maintaining client York City serving homeless youth munities.Some programs,such as trust in order to gain access to di- under 24 years old,is an official site Pt. Defiance AIDS Project in ents'homes. of the Lower East Side Needle Ex- Takoma, Washington, The Works Chan (an organization that does in Boulder, Colorado, and several underground programs in North- Unlimited Syringes. have a waiver from the state which allows it to conduct needle ex- ern California deliver syringes to change).As a satellite site of Lower agreed upon locations or clients' One of the major issues as many homes. Clients call the exchange communitieshaveaddressed needle East Side,StreetWorks did not have g exchange is whether the programs to apply to the state for a waiver to (come programs use pagers)to ar- g p exchange needles.Any StreetWorks range the delivery. will increase the number of dis- cardedclient can obtain syringes during syringes in the community. Home delivery appeals als to clients To avoid increasing the number of closed-door counseling sessions syringes in circulation most needle with their assigned counselor. for several reasons. Clients hs maintain a one-for-one StreetWorks does.not distinguish need to risk arrest by carrying sy-not exchanges between clients who are over u or ringes to and from the exchange exchange--clients must bring in a under n ears old. site. Home visits also eliminate used syringe to get a new sterile y many of the barriers that prevent one.Some programs have caps on Whiletheremaynotbealargepopu- people from accessing services:lack the number of exchange and other s have ay will limit. lation of youths using heroin, co- of transportation,lack of childcare, caine and other illegal injection inconvenient hours of operation, drugs,advocatesofneedleexchange and fear of"the system."Fear of the Some needle exchange advocates argue that youths do need access to system is an especially large issue argue that it is unethical to deny y for women with children who fear anyone a sterile syringe if they ask sterile injection equipment. Many out r one.One reach worker with exchange programs report that ste- that if the authorities are aware ofonfor o underground out exchang a that re- roid use among young men cre- their drug use their children maybe ated an at-risk population that is removed from their custody. cently became legal said it will be usually not considered in the de- hard to conform to new regulations bate on syringe exchange.The injec- Home visits also provide anoppor- requiring strict one-for-one ex- tion of vitamins is also practiced, �' pre-i for more intensive HIV change since occasionally clients especially in the Latino community. vention counseling. Exchanges on come withoutaused syringe.When Advocates of needle exchange con- the street take place very quickly the exchange wasoperating illegally " and clients may not initiate _ withlessregulation,outreachwork- tendthat the lust say no approach y ers at their own discretion provided has not been effective in deterring nication with outreach workers.At p youths from using drugs and that, the client's home,outreach workers syringes to clients who did not have because these children have not can discuss risk reduction at length one to exchange. heeded what they were told,it does and also assist the client with refer- rals to additional services (HIV Some also argue that limits on the not follow that they should face in- fection with HIV. Obviously, this counseling and testing,drug treat- number of syringes that can be ex- debate will continue in communi- ment,support services). changed prevent people from col- ties. lecting for others and then provid- Program staff like the approach as in g them with clean needles.(Some well. There is less of a need to do exchanges have found that men ex- streetoutreach in inclement weather change for their female partners since women tend to be reluctant to HIV Capsule Report The United Stoles Conference of Mayors Issue 3 - July 1994 Page S come to exchanges).Others contend believe that legal efforts carried out Supporters of needle exchange are that it is important for drug users to by health departments or more es- quick to point out that it is possible come to the exchange so they can tablished organizations may be less to recover from drug use(stop us- receive risk-reduction information effective because of-the problems ing) but there is no cure for HIV. and learn about additional services, drug users have in accessing these Needle-exchange programs are not such as HIV counseling and testing, organizations. Since these organi- draining a significant amount of drug treatment or medical care,that zations are part of "the system," money from drug treatment and are available through the exchange. they may appear to be less "user they can help keep people healthy friendly" because they have to ad- until they are ready and able to en- Some exchanges have found that here more closely to regulations and ter drug treatment. providing a two-for-one exchange may collect more information from up to five syringes has been well clients for evaluation purposes.Un- Conclusion received by clients. One program derground exchange usually is car- reports that this practice is espe- ried out much more informally. The debate concerning needle ex- cially popular among younger cli- change is not over.In fact,in many ents who may not know of other iOngoing Shortage communities it has not even begun sources of syringes because a their of Drug Treatment and discussions between needle limited experience with injection exchange supporters,policymakers drug use. departments have d l l h d local eate Implicit in any discussion of needle anp exchange is drug treatment.Often yet to take place. In all likelihood, Transitioning from debated is the question of whether the debate concerning needle ex- Underground Status resources devoted to needle ex- change will be the first step in a long change would be better spent on process of exploring options for fur- The transition from underground providing and promoting drug ther reducing the spread of HIV exchange to legal program has been treatment. Needle-exchange pro- among drug users. These options difficult in some communities.One grams have been found to be very include making syringes more ac- complicating factor has been a fear effective in referring clients to drug cessible to drugusers through phar- that some organizations will rush to treatment. While some programs macies or other distribution points establish anexchange programonce have arrangements that give their and by developing and making legal barriers have been eliminated clients priority access to drug treat- available non-reusable syringes. and funds are available.The exist- ment,most all programs have been ingand formerly underground pro- faced with turningdown clients who HIV has made tragic and ii-revers- grams often feel they have legiti- ask for treatment because there is ible inroads "into the drug-using mate claims since they initiated ef- no space available. population but communities now forts,have developed outreach net- have enough information about the works, risked arrest, and worked While the primary goal of needle efficacy and impact of needle ex- hard to raise money to support their exchange is to prevent the spread of change to consider it as an option in efforts.More established organiza- HlVamonginjectiondrugusers,their their HIV prevention efforts.Com- tions may claim that they have a sexual partners, and their unborn munities need to work together to better developed infrastructure,are children,many strongly support the address issues concerning needle more capable of administering a role of programs as bridges to drug exchange that may relate to local program,and are in a better posi- treatmentandother services.Accord- conditions.Thedevelopmentof pro- tion to provide clients with services ing to the report The Public Health' grams can be facilitated by open in addition to needle exchange. Impactof Needle Exchange Programs discussions involving needle ex- in the United States and Abroad,the change advocates, policymakers, Some underground exchanges are annual cost for funding an average local health departments, law en- not interested in being integrated needle-exchange program, about forcement, service providers, and into a legal program.When the New $169,000, would support about 60 potential clients.Communities must Haven Health Department initiated methadone-maintenanceslotsforone also advocate at the state and na- a needle exchange program in No- year.The estimated lifetime cost of tional level for the removal of legal vember 1990, the individuals who treating a person with HIV is barriers that will enable the adop- were operating the underground $119,000. If programs prevent two tion of effective HIV prevention program continued to distribute people from becoming infected with measures targeting injection drug syringes.Many who are involved in HIV per year, they have more than users.❑ operating underground programs paid for themselves. Page 6 HIV Capsule Report The United States Conference of Mayors Issue 3 • July 1994 K ✓FANO Q' a �„� G• O @ N r GOO NK G n N"O✓ O O v" O•,7"@ � 7, �o`G °N G 7N@ N'Go�D°sy� K NN � � � t,J P �' � KO @ @ O 'r'ao O � N u+ @ NG•p fir• �'D o "'s eN*.t�9 U� r•, 'N�.✓..p @.'} n �t O,O N N K ry n� O•++ �„ O @✓S�Op„O n o O n .O G' !•^ P@•O t@ o ^� @ n@ N K p."O O O O O'' P ,,. �*O (n'C'cc G . N ,O «fit fl~ro N -✓'t @ N Stp VD V ',Z @ p '3•@ O-N @ @ N r-` �tf ✓.•• ." @..ty t '3-.O P. N `•' N N 'G` r' @ p� @ ' CS @ @ @ KS ° N • F"'�1 6 a O i',N CD'° �•y NN-,Y n O °'tN�'o n�`�•r'N ..�. 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".N K N O• ,•°4.�Nte+O 3 r. .N G✓,. ✓�.."� O� n@ nO o IDCS t:..0 O co 0 (kD @ roCy p� e^ N n Q N•ao ,0...d N �%S `•'`�, .'.., .S b cn O .i r p G N n 3 O.O .Ojr° Pr i• 'O N t KoG go o Rbc* op u c° GG° Cy. . p`G N N C.0 OIn @ SAN FRANCISCO CHRONICLE December 7, 1994 Public Health Malpractice ET AGAIN WE HAVE to wonder This, only a few days after the AIDS-re- what, if anything, the Clinton ad- lated death of Elizabeth Glaser who electri, ministration really stands for when fied the 1992 Democratic convention with it stubbornly refuses to release a year-old her dramatic account of how she and her government report that concludes that nee- two children were infected with .HIV dle exchange programs help to limit the through a medical transfusion. After she .spread of the AIDS virus. died Saturday, President Clinton made a There are plenty of bootleg copies of the sanctimonious call on the nation to "honor confidential report by the Centers for Dis- her memory by finishing the work to which ease Control that she gave everything she had." endorses needle ow hollow his words ring. With intra- Needle exchange pro- Hvehous drug use now the main way exchanges grams, but . the , that AIDS is transmitted in the United g Clintonites refuse States, especially in the heterosexual com- help limit to make it public munity,it is unconscionable that the admin- the dminthe spread of apparently fearing istration refuses to reveal the findings that a political confron- support the conclusions of a landmark Uni- the AIDS tation with the versity of California at San Francisco study moralists of the Re- that recommended.overturning a congres- virus publican right- sional ban on using federal funds for needle Wig• exchange programs. Chronicle staff "The evidence has now become very, writer Louis Freedberg reported that the very clear, to the point where you could administration refuses to divulge the infor- consider it-public health malpractice to mation despite repeated requests and ap- keep the ban in place," said Dr. Don Des peals under the Freedom of Information Jarlais,director of the Chemical Dependen Act. An anonymous Public Health Service cy Institute at Beth Israel Medical Center in official alibied:"Officially,the matter is still New York. Of course, it took someone out- under review." Sure. side the Beltway to tell the obvious truth.. 0 00 = 'r? °O N N U M N O d �.t rte' ,N.� C7 ��y >, ao• .:0: 00 C� 00 > O N C's U <>:6'4:i 69 Cl �o kn = rte• 00 O lz • .tl .i Q > p ,pEr _ 0 13 C,3 _ C 7 y M 3 3 ®Lu W U7 O v ao b / fns' y LL 0 i fS i. t: !W 0 V 4 v o� ol — b❑U wX. .eFd y y Q m bA 3 i Y - : : - Y � � I �W H J bD ca SZ! ct 7 : .. R o kn C� 7 U M tl CS I i--i N st... t `, O SS ON 4t -It �/ a h CIO 3 3 u y C'sW v W � 0 o23 tu t ca C4 C4. U v C'su `c eq CU ^ O w O N ::i t!1: �D ti U y O 0. on >, xXx a � N N oy ami .`J A ►�. O O 43 Q 3 h b b p p C Oct � :`i=<: O ti ff iii}dddy V '' A p cn � w (u 4. � A o o ::> o `� Z o o > - a'"i N � w w W � A C.) tn c] G7 •~ •� N �"• p /D fV O www x ¢ a � PUBLIC AND ENVIRONMENTAL a 5 HEALTH ADVISORY BOARD Members: Scott Anderson Doris Copperman Aril 14, 1995 Carlota Dunhower p Donna Gerber Art Hatchett Michele Jackson Doris Kinsley Edith Loewenstein Board of Supervisors Bessanderson McNeil 651 Pine Street Julio Mendoza Dorothy Oda Martinez, CA 94553 Mary Rocha Jean Siri hth Sooksampan Dear Board Members: Michele Thompson Rev. Curtis A.Timmons On behalf of the Public and Environmental Health Advisory Board (PEHAB), William Vega Thomas Zimmerman we are writing to express our support for the proposed declaration of a state of emergency in the County, so that clean needle exchange programs can be co Chairs: Julio Mendoza established. PEHAB has previously endorsed the concept of needle exchange Jean Siri as a public health tool for preventing the spread of AIDS, and has adopted the Ex-Officio Members: enclosed resolution in support of this declaration. Joseph Hafey George Kaplan According to the State Office of AIDS, injection drug use has emerged as one Carolyn Robinson of the most prevalent risk factors for new AIDS cases in California. In Contra Mary Anne Morgan Costa, injection drug users are the second largest group at risk for HIV Executive Assistant to the infection. Numerous studies of needle exchange programs in the United States Public&Environmental Health Advisory Board and abroad show that needle exchange is an effective HIV prevention intervention, and that it does not lead to increased drug use or criminal activity. We hope the Board of Supervisors will support this life-saving approach to responding to the AIDS epidemic. Sincerely, Julio Mendoza, D.D.S. Jean Siri Co-Chair Co-Chair cc: SAAB, Chair Wendel Brunner, M.D. Contra Costa County Health Services Department 597 Center Ave., Ste.200 Martinez, CA 94553 (510) 313-6715 FAX: (510) 313-6721 RESOLUTION SUPPORTING THE DECLARATION OF A STATE OF EMERGENCY TO ESTABLISH CLEAN NEEDLE EXCHANGE PROGRAMS WHEREAS, AIDS is a fatal disease, for which there is no known cure, which has grown to an epidemic level in Contra Costa County, the United States, and the world; WHEREAS, as of March 17, 1995 there were more than 1,531 confirmed cases of AIDS reported in Contra Costa County, including 380 AIDS cases among injection drug users (IDUs); WHEREAS, AIDS is now the leading cause of death for men between the ages of 25 and 44 in the State of California; WHEREAS, HIV and other blood-borne viruses (such as Hepatitis B) are transmitted easily from person to person through the sharing of contaminated hypodermic needles and other contaminated injection drug equipment; WHEREAS, IDUs are the second largest group at risk for HIV infection in Contra Costa County as in the nation; WHEREAS, the University of California San Francisco (UCSF) Urban Health Study has proven that Contra Costa County has the second highest rate of HIV infection among IDUs on the West Coast, with an HIV seroprevalence rate of 27% among all IDUs tested by UCSF and 30% among African American IDUs. WHEREAS, high rates of HIV infection among IDUs threaten widespread transmission of the virus to the children born to infected IDUs and to those who have sexual contact with infected IDUs or their sexual partners; WHEREAS, 32% of all cases of AIDS reported to the U.S. Centers for Disease Control and Prevention involve persons who had sexual contact with an IDU, 71% of female AIDS cases are linked directly or indirectly to injection drug use, and 70% of all children born with HIV have a mother who either was an IDU or had sexual relations with an IDU; WHEREAS, IDUs and their sexual partners are the fastest growing category of new HIV infections in Contra Costa County; WHEREAS, the impact of new HIV infections is falling particularly heavily upon communities of color in Contra Costa County and in the nation; WHEREAS, the financial cost of providing needed health care to each new person infected with HIV from time of diagnosis until death is estimated at approximately $119,000, and the personal and social costs associated with each new HIV infection are immeasurable; WHEREAS, the presence of needles and other injection drug equipment that are contaminated with HIV or other blood-borne viruses pose an extreme peril to the public health and safety and to the social and fiscal resources of Contra Costa; WHEREAS, a report issued by the Chicago Recovery Alliance Needle Exchange Program shows a significant savings of health care dollars and a lowering of seroprevalence among IDUs using Needle Exchange Programs; WHEREAS, studies prepared for the U.S. General Accounting Office, the U.S. Centers for Disease Control and Prevention, and the IX International Conference on AIDS strongly demonstrate that needle exchange programs are effective in reducing sharing of injection drug equipment and recent studies at New York's Beth Israel Medical Center demonstrate that needle exchange programs can reduce by 50% the number of new HIV infections (as well as Hepatitis B infections) of those IDUs using such programs, their drug and sexual partners, and their children; WHEREAS, needle exchange programs also have been effective in reducing the number of discarded needles and syringes found in public areas, which otherwise pose a risk of accidental transmission of HIV and other blood-borne viruses to children and adults; WHEREAS, Governor Wilson has vetoed on three separate occasions legislation to legalize needle exchange programs because of claimed adverse effects on drug abuse despite extensive studies by UCSF which prove that needle exchange programs do not promote drug use; WHEREAS, Governor Wilson has vetoed needle exchange legislation claiming he supports drug abuse prevention when, in fact, over the last several years the Wilson administration has virtually eliminated all drug and alcohol prevention dollars; WHEREAS, needle exchange programs provide referrals and access to drug treatment, medical care, HIV antibody testing, and psychosocial services; on-site counseling and education about substance use and abuse, HIV and AIDS; and training on ways to reduce risk of HIV and other disease transmission; WHEREAS, local governments have authority under California Government Code sections 8550 through 8634 to declare a state of local emergency and promulgate orders and regulations necessary to provide for the protection of life when there are conditions of extreme peril caused by an epidemic; WHEREAS, the cities of San Francisco, Oakland and Berkeley and the counties of Marin, Alameda, Santa Clara and Sonoma already have declared states of emergency regarding the transmission of HIV through contaminated needles and issued orders to permit needle exchange programs to operate within their jurisdictions; and, WHEREAS, the compelling reasons that led those local governments to declare a state of local emergency also exist in Contra Costa County. BE IT RESOLVED that the Contra Costa County Public and Environmental Health Advisory Board urges the Contra Costa County Board of Supervisors to find and declare that a state of local emergency exists regarding the transmission of HIV through contaminated needles and other contaminated drug injection equipment; and, BE IT FURTHER RESOLVED that the Contra Costa County Public and Environmental Health Advisory Board urges the Contra Costa County Board of Supervisors to take the steps possible to ensure the availability and uninterrupted operation of needle exchange programs in Contra Costa, including directing and encouraging all empowered law enforcement and prosecutorial agencies and authorities to refrain from participating in or cooperating with any investigation, detention, seizure, forfeiture, arrest or prosecution arising out of alleged violations of state drug paraphernalia laws in connection with a needle exchange program, due to the overriding needs of public health and safety at this time. ON BEHALF OF THE CONTRA COSTA COUNTY PUBLIC AND ENVIRONMENTAL HEALTH ADVISORY BOARD: DATED: `f a q BY: q-jx-� aujnn"'3'� Juli Mendoza, Chair DATED: ` BY: - Jea iri, Vice Chair Contra Costa HIV/AIDS Consortium PREVENTION PLANNING GROUP 597 Center Avenue, Suite 200 Martinez, California 94553 Telephone (510) 313-6771 Fax (510) 313-6798 April 10, 1995 RECEIVED { EAPR2995 i I CLERK BOARD OF SUPERVISORS Board of Supervisors CONTRA COSTA CO. 651 Pine Street Martinez, CA 94553 Dear Board Members: On behalf of the HIV Prevention Planning Group, we are writing to express our support for the proposed declaration of a state of emergency in the County, so that a clean needle exchange program can be established. The HIV Prevention Planning Group is a diverse group representing all regions of the County. It was developed in October 1994 to advise the AIDS Program on HIV prevention activities. We voted unanimously on this resolution and feel that a clean needle exchange and education program is one of the top HIV prevention priorities for Contra Costa County. A clean needle exchange and education program offers injection drug users an opportunity to stay healthy until they can seek treatment services. It also prevents the spread of HIV to the sexual partners and babies of injection drug users. Studies internationally demonstrate that needle exchange and education programs do not increase drug use or crime and that these programs are effective at reducing the spread of HIV. All other Bay Area counties have a Needle Exchange and Education Program. With the second highest rate of HIV infection among injection drug users on the West Coast, we urgently need to implement clean needle exchange in Contra Costa. We hope the Board of Supervisors will support this life saving approach to responding to the AIDS epidemic. Sincerely, Janet Bryan Hector Morfin Co-Chair Co-Chair RESOLUTION SUPPORTING THE DECLARATION OF A STATE OF EMERGENCY TO ESTABLISH CLEAN NEEDLE EXCHANGE PROGRAMS WHEREAS, AIDS is a fatal disease, for which there is no known cure, which has grown to an epidemic level in Contra Costa County, the United States, and the world; WHEREAS, as of March 17, 1995 there were more than 1,531 confirmed cases of AIDS reported in Contra Costa County, including 380 AIDS cases among injection drug users (IDUs); WHEREAS, AIDS is now the leading cause of death for men between the ages of 25 and 44 in the State of California; WHEREAS, HIV and other blood-borne viruses (such as Hepatitis B) are transmitted easily from person to person through the sharing of contaminated hypodermic needles and other contaminated injection drug equipment; WHEREAS, IDUs are the second largest group at risk for HIV infection in Contra Costa County as in the nation; WHEREAS, the University of California San Francisco (UCSF)Urban Health Study has proven that Contra Costa County has the second highest rate of HIV infection among IDUs on the West Coast, with an HIV seroprevalence rate of 27% among all IDUs tested by UCSF and 30% among African American IDUs. WHEREAS, high rates of HIV infection among IDUs threaten widespread transmission of the virus to the children born to infected IDUs and to those who have sexual contact with infected IDUs or their sexual partners; WHEREAS, 32% of all cases of AIDS reported to the U.S. Centers for Disease Control and Prevention involve persons who had sexual contact with an IDU, 71% of female AIDS cases are linked directly or indirectly to injection drug use, and 70% of all children born with HIV have a mother who either was an IDU or had sexual relations with an IDU; WHEREAS, IDUs and their sexual partners are the fastest growing category of new HIV infections in Contra Costa County; WHEREAS, the impact of new HIV infections is falling particularly heavily upon communities of color in Contra Costa County and in the nation; WHEREAS, the financial cost of providing needed health care to each new person infected with HIV from time of diagnosis until death is estimated at approximately $119,000, and the personal and social costs associated with each new HIV infection are immeasurable; WHEREAS, the presence of needles and other injection drug equipment that are contaminated with HIV or other blood-borne viruses pose an extreme peril to the public health and safety and to the social and fiscal resources of Contra Costa; WHEREAS, a report issued by the Chicago Recovery Alliance Needle Exchange Program shows a significant savings of health care dollars and a lowering of seroprevalence among IDUs using Needle Exchange Programs; WHEREAS, studies prepared for the U.S. General Accounting Office, the U.S. Centers for Disease Control and Prevention, and the IX International Conference on AIDS strongly demonstrate that needle exchange programs are effective in reducing sharing of injection drug equipment and recent studies at New York's Beth Israel Medical Center demonstrate that needle exchange programs can reduce by 50% the number of new HIV infections (as well as Hepatitis B infections) of those IDUs using such programs, their drug and sexual partners, and their children; WHEREAS, needle exchange programs also have been effective in reducing the number of discarded needles and syringes found in public areas, which otherwise pose a risk of accidental transmission of HIV and other blood-borne viruses to children and adults; WHEREAS, Governor Wilson has vetoed on three separate occasions legislation to legalize needle exchange programs because of claimed adverse effects on drug abuse despite extensive studies by UCSF which prove that needle exchange programs do not promote drug use; WHEREAS, Governor Wilson has vetoed needle exchange legislation claiming he supports drug abuse prevention when, in fact, over the last several years the Wilson administration has virtually eliminated all drug and alcohol prevention dollars; WHEREAS, needle exchange programs provide referrals and access to drug treatment, medical care, HIV antibody testing, and psychosocial services; on-site counseling and education about substance use and abuse, HIV and AIDS; and training on ways to reduce risk of HIV and other disease transmission; WHEREAS, local governments have authority under California Government Code sections 8550 through 8634 to declare a state of local emergency and promulgate orders and regulations necessary to provide for the protection of life when there are conditions of extreme peril caused by an epidemic; WHEREAS, the cities of San Francisco, Oakland and Berkeley and the counties of Marin, Alameda, Santa Clara and Sonoma already have declared states of emergency regarding the transmission of HIV through contaminated needles and issued orders to permit needle exchange programs to operate within their jurisdictions; and, WHEREAS, the compelling reasons that led those local governments to declare a state of local emergency also exist in Contra Costa County. BE IT RESOLVED that the Contra Costa County HIV Prevention Planning Group urges the Contra Costa County Board of Supervisors to find and declare that a state of local emergency exists regarding the transmission of HIV through contaminated needles and other contaminated drug injection equipment; and, BE IT FURTHER RESOLVED that the Contra Costa County HIV Prevention Planning Group urges the Contra Costa County Board of Supervisors to take the steps possible to ensure the availability and uninterrupted operation of needle exchange programs in Contra Costa, including directing and encouraging all empowered law enforcement and prosecutorial agencies and authorities to refrain from participating in or cooperating with any investigation, detention, seizure, forfeiture, arrest or prosecution arising out of alleged violations of state drug paraphernalia laws in connection with a needle exchange program, due to the overriding needs of public health and safety at this time. ON BEHALF OF THE CONTRA COSTA COUNTY HIV PREVENTION PLANNING GROUP: DATED: 2y, BY: Hector Morfin, o-chair DATED: BY. et Bryan, Co-chair April 21 , 1995 TO BE READ TO THE BOARD OF SUPERVISORS AT THE NEXT SCHEDULED MEETING ,r-- R y � @ � !EC Contra Costa County Board of Supervisors APR 2 4 1995 McBrien Administration Building 651 Pine Street Re: CLERK BOARD OF SUPERVISORS t Martinez CA 94553 Re: Needle exchan CONTRA On March 23, 1995 I wrote to the supervisor of my district, Jeff Smith. In that letter and in a telephone call to his office I voiced my opposition to the needle exchange program proposed by the County Health officials . As a Contra Costa County tax payer and a concerned citizen I implore you as a body to vote against any such implementation of such a needle exchange. Mr. Mark Finucane ' s position to declare a state of emergency regarding AIDS is understandable, but not in accordance with State Law. If' Supervisor Mark DeSaulter and District Attorney Gary Yancey and Sheriff Warren Rupf can' t see what horrendous effects the passage of such a declaration of a state of emergency, those per- sons shouldn' t hold their respective offices. -Needle exchange will only provide tools for those who need nee- dles . At the expense of the taxpayers, the money would be better spent on encouraging those people who would receive the clean needles to leave the County or be incarcerated. I am a voting citizen. Should the Board of Supervisors approve such a needle exchange, I can promise that I will not support any candidate for public office who would cast a vote for appro- val of this NEEDLE EXCHANGE! I have to remind you collectively that you work for us, the tax- payers and voters . If you choose to ignore this letter, you've not done your job. If this letter is screened and not delivered to you, The Board, I will certainly persue other avenues. Don Moody 4087 Via Estrella Martinez , CA 94553 THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Adopted this Order on ,by the following vote: AYES: NOES: ABSENT: ABSTAIN: RESOLUTION NO. 95/ SUBJECT: RESOLUTION SUPPORTING THE DECLARATION OF A STATE OF EMERGENCY TO ESTABLISH CLEAN NEEDLE EXCHANGE PROGRAMS WHEREAS, AIDS is a fatal disease, for which' there is no known cure, which has grown to an epidemic level in Contra Costa County, the United States, and the world; WHEREAS, as of March 17, 1995 there were more than 1,531 confirmed cases of AIDS reported in Contra Costa County, including 380 AIDS cases among injection drug users (IDUs); WIMREAS, AIDS is now the leading cause of death for men between the ages of 25 and 44 in the State of California; WHEREAS, HIV and other blood-borne viruses (such as Hepatitis B) are transmitted easily from person to person through the sharing of contaminated hypodermic needles and other contaminated injection drug equipment; WHEREAS, IDUs are the second largest group at risk for HIV infection in Contra Costa County as in the nation; WHEREAS, the University of California San Francisco (UCSF) Urban Health Study has proven that Contra Costa County has the second highest rate of HIV infection among IDUs on the West Coast, with an HIV seroprevalence rate of 27% among all IDUs tested by UCSF and 30% among African American IDUs. WHEREAS, high rates of HIV infection among IDUs threaten widespread transmission of the virus to the children born to infected IDUs and to those who have sexual contact with infected IDUs or their sexual partners; WHEREAS, 32% of all cases of AIDS reported to the U.S. Centers for Disease Control and Prevention involve persons who had sexual contact with an IDU, 71% of female AIDS cases are linked directly or indirectly to injection drug use, and 70% of all children born with HIV have a mother who either was an IDU or had sexual relations with an IDU; WHEREAS, IDUs and their sexual partners are the fastest growing category of new HIV infections in Contra Costa County; Resolution Supporting the Declaration of a State of Emergency to Establish Clean Needle Exchange Programs Page 2 Resolution No. 95/ WHEREAS, the impact of new HIV infections is falling particularly heavily upon communities of color in Contra Costa County and in the nation; WHEREAS, the financial cost of providing needed health care to each new person infected with HIV from time of diagnosis until death is estimated at approximately $119,000, and the personal and social costs associated with each new HIV infection are immeasurable; WHEREAS, the presence of needles and other injection drug equipment that are contaminated with HIV or other blood-borne viruses pose an extreme peril to the public health and safety and to the social and fiscal resources of Contra Costa; WHEREAS, a report issued by the Chicago Recovery Alliance Needle Exchange Program shows a significant savings of health care dollars and a lowering of seroprevalence among IDUs using Needle Exchange Programs; WHEREAS, studies prepared for the U.S. General Accounting Office, the U.S. Centers for Disease Control and Prevention, and the IX International Conference on AIDS strongly demonstrate that needle exchange programs are effective in reducing sharing of injection drug equipment and recent studies at New York's Beth Israel Medical Center demonstrate that needle exchange programs can reduce by 50% the number of new HIV infections (as well as Hepatitis B infections) of those IDUs using such programs, their drug and sexual partners, and their children; VVMREAS, needle exchange programs also have been effective in reducing the number of discarded needles and syringes found in public areas, which otherwise pose a risk of accidental transmission of HIV and other blood-borne viruses to children and adults; WHEREAS, Governor Wilson has vetoed on three separate occasions legislation to legalize needle exchange programs because of claimed adverse effects on drug abuse despite extensive studies by UCSF which prove that needle exchange programs do not promote drug use; WHEREAS, Governor Wilson has vetoed needle exchange legislation claiming he supports drug abuse prevention when, in fact, over the last several years the Wilson administration has virtually eliminated all drug and alcohol prevention dollars; WHEREAS, needle exchange programs provide referrals and access to drug treatment, medical care, HIV antibody testing, and psychosocial services; on-site counseling and education about substance use and abuse, HIV and AIDS; and training on ways to reduce risk of HIV and other disease transmission; WHEREAS, local governments have authority under California Government Code sections 8550 through 8634 to declare a state of local emergency and promulgate orders and regulations necessary to provide for the protection of life when there are conditions of extreme peril caused by an epidemic; WHEREAS, the cities of San Francisco, Oakland and Berkeley and the counties of Marin, Alameda, Santa Clara and Sonoma already have declared states of emergency regarding the transmission of HIV through contaminated needles and issued orders to permit needle exchange programs to operate within their jurisdictions; and, WHEREAS, the compelling reasons that led those local governments to declare a state of local emergency also exist in Contra Costa County. r Resolution Supporting the Declaration of a State of Emergency to Establish Clean Needle Exchange Programs Page 3 Resolution No. 95/ BE IT RESOLVED that the Contra Costa County Substance Abuse Advisory Board urges the Contra Costa County Board of Supervisors to find and declare that a state of local emergency exists regarding the transmission of HIV through contaminated needles and other contaminated drug injection equipment; and, BE IT FURTHER RESOLVED that the Contra Costa County Substance Abuse Advisory Board urges the Contra Costa County Board of Supervisors to take the steps possible to ensure the availability and uninterrupted operation of needle exchange programs in Contra Costa, including directing and encouraging all empowered law enforcement and prosecutorial agencies and authorities to refrain from participating in or cooperating with any investigation, detention, seizure, forfeiture, arrest or prosecution arising out of alleged violations of state drug paraphernalia laws in connection with a needle exchange program, due to the overriding needs of public health and safety at this time. ON BEHALF OF THE CONTRA COSTA COUNTY SUBSTANCE ABUSE ADVISORY BOARD: DATED: 3 �p Ps` BY: David Travefs, Chair DATED: BY: . / Peter B. Burnett, Vice Chair t v h�" AH L 0 IJ95 yyf League D ContraC on Lea West � g 1015 Leneve Place, EI Cerrito, GA 94530 Jean Sin, President Barbara Vincent, Vice President "`/ Kelly Falconer, Secretary ZZ G'�� f 04/2311995 17: 00 838-9234 SANDEE PAGE 01 Mem n_ • 11�NS t D E(Z_W� rJ To: CONTRA COSTA COUNTY SUPERVISORS VIA FAX 646-1059 From- Sandee Wiecientann 1.aViolette - phone 510-$38-1961 (FAX .510-S.38-9234) 2305 Norris Canyon Road. San Ramon, CA 94593 Date: April 23. 1(Y)5 ! Subject: NO Needle Exchange I -----------------------------------------------------------t I will. not be able to attend your public comment meeting on Tuesday, April 25. I am, very op used to a needle exchange program for the following reasons: 1 . Just as I do not believe we should hand out guns for peopleto shoot themselves, I coo not want to perpetuate or encourage drug habit6 . 2 . This is not the way I want my tax dollars spent. 3. These type of programs bring people to our county for the fee goodies. If we have an emergency, why would we encourage other drug user,s to come here? 4. Drug use is ILLEGAL. Free needles would abet the criminal . f i RECEIVI' .D .APR 2 4 1995 CLERK BOARD OF SUPERVISORS COI`?TF 4 COSTA.CO� ,,.-. i f 1 r April 21 , 1995 TO BE READ TO THE BOARD OF SUPERVISORS AT THE NEXT SCHEDULED MEETING RECEIVE® 3 Contra Costa County Board of Supervisors APR 2 4 1995 McBrien Administration Building 651 Pine Street Re: Needle exchang Martinez CA 94553 CLERKBOAROOFSTACO-SOBS CONTRA COSTA CO. On March 23 , 1995 I wrote to the supervisor of my district, Jeff Smith. In that letter and in a telephone call to his office I voiced my opposition to the needle exchange program proposed by the County Health officials . As a Contra Costa County tax payer and a concerned citizen I implore you as a body to vote against any such implementation of such a needle exchange. Mr. Mark Finucane' s position to declare a state of emergency regarding AIDS is understandable, but not in accordance with State Law. If Supervisor Mark DeSaulter and District Attorney Gary Yancey and Sheriff Warren Rupf can ' t see what horrendous effects the passage of such a declaration of a state of emergency, those per- sons shouldn' t hold their respective offices . Needle exchange will only provide tools for those who need nee- dles. At the expense of the taxpayers, the money would be better spent on encouraging those people who would receive the clean needles to leave the County or be incarcerated. I am a voting citizen. Should the Board of Supervisors approve such a needle exchange, I can promise that I will not support any candidate for public office who would cast a vote for appro- val of this NEEDLE EXCHANGE! I have to remind you collectively that you work for us, the tax- payers and voters. If you choose to ignore this letter, you've not done your job. If this letter is screened and not delivered to you, The Board, I will certainly persue other avenues. Don Moody 4087 Via Estrella Martinez, CA 94553 Facts About HIV Prevention and Needle Exchange What is HIV? What is needle exchange? HIV, Human Immunodeficiency Virus, is the Needle exchange is one way to prevent the virus that causes AIDS. It is usually passed from spread of HIV, the virus that causes AIDS. one person to another through sexual contact. HIV It is a strategy to reduce the harm to drug is also transmitted by sharing needles and drug users by trading clean needles for dirty ones injection equipment, or "works." Pregnant and providing a bridge to drug treatment and mothers can also pass HIV to their babies. HIV is other health services. Needle exchange not spread by casual, everyday contact. programs allow people who inject drugs to turn in used needles, which are often What is AIDS? contaminated with HIV, for new, sterile needles. This removes dirty needles from AIDS, Acquired Immune Deficiency Syndrome, is the community. Needles are traded on a a disease carried by blood and sexual fluids that one-for-one basis so that the number of destroys the body's defenses against certain needles in a community does not increase. infections and cancers. Although medication can slow the breakdown of the immune system, there Why do needle exchange? is no cure. Needle exchange gives people a chance of Facts about HIV and drugs in Contra protecting themselves, their sex partners and Costa County babies until they can get off drugs. HIV is spreading rapidly among injection drug users ♦ More than 340 injection drug users in the in Contra Costa County because they are County have been diagnosed with AIDS sharing dirty needles. Drug users may pass and many more are infected. the virus to their sex partners and to any children born to them. Needle exchange ♦ The rate of HIV among injection drug makes it possible for people to use a clean users surveyed in 'West County is the needle every time they inject. second highest on the West Coast. Can needle exchange prevent HIV ♦ In 1992, almost one in four (27%) infections? injection drug users in West County was HIV positive, up from one in five (19%) Yes! Studies show that needle exchange can in 1991. dramatically slow the spread of HIV. Researchers in New York have shown that ♦ One in three African American injection a needle exchange program can cut in half drug users in West County is infected with the number of new infections among drug HIV. users. MORE ON BACK .... Contra Costa County Health Services Department HIV/AIDS Program 597 Center Avenue, Suite 200 ♦ Martinez, CA 94553 ♦ 510 / 313-6770 Does needle exchange encourage drug Where does needle exchange use? happen? No! Needle exchange has been studied Needle exchanges happen where drug users extensively in the United States, Canada, and already hang out, far away from schools or around the world in a great number of diverse areas where business may be disturbed. settings and communities. There is no indication that needle exchange programs increase drug Legal issues use, crime or other public health problems. In fact, studies show that in many cases drug Currently needle exchange is illegal in the injectors who exchange their needles decrease State of California, which requires a their drug use and often enter drug treatment to prescription to purchase or possess syringes. kick their habit. Many counties and cities in the Bay Area and elsewhere have passed States of How does needle exchange affect Emergency to support needle exchanges community health? happening in their area. Besides sharply decreasing the spread of HIV, needle exchange programs show drug users that health workers care about them as human beings References and wish to help them be healthier by referring them to drug treatment and other health services. ♦ "The Public Health Impact of Needle This bond encourages drug users to follow up on Exchange Programs in the U.S. and the referrals. Women can get pregnancy and Abroad," University of California San disease testing, protecting the health of their Francisco; P. Lurie, MD, et al: Sept. 1993 babies. Women and men can be offered testing and treatment for HIV, sexually transmitted ♦ Urban Health Study, UCSF; J. Watters, diseases, and tuberculosis. Also, there are fewer R. Bluthenthal, et al: June 1993 dirty needles left on streets, playgrounds and in bushes because they can be turned in for clean ♦ "Needle Exchange: Moving Beyond the ones. The health of the whole community can be Controversy," U.S. Conference of Mayors improved through needle exchange. and Local Health Officers: Sept. 1994 How much does needle exchange cost? ♦ HIV/AIDS Epidemiology Report, Contra Costa County; J. Reardon: Sept. 1994 The average lifetime cost of treating a person with HIV infection is about $119,000. Often, public ♦ Beth Israel Medical Center, D. Des funds pay a large portion of these expenses. The Jarlais, MD: "N.Y. study shows needle cost of a new, sterile needle is about 7 cents. exchange cuts AIDS risk," Contra Costa Since needle exchange programs are carried out by Times: November 1, 1994. volunteers, the overall cost is far less than that of HIV infection. December 19, 1994 For more information about HIV/AIDS contact: Contra Costa County HIV/AIDS Program at 510/313-6770 Does needle exchange encourage drug Where does needle exchange use? happen? No! Needle exchange has been studied Needle exchanges happen where drug users extensively in the United States, Canada, and already hang out, far away from schools or around the world in a great number of diverse areas where business may be disturbed. settings and communities. There is no indication that needle exchange programs increase drug Legal issues use, crime or other public health problems. In fact, studies show that in many cases drug Currently needle exchange is illegal in the injectors who exchange their needles decrease State of California, which requires a their drug use and often enter drug treatment to prescription to purchase or possess syringes. kick their habit. Many counties and cities in the Bay Area and elsewhere have passed States of How does needle exchange affect Emergency to support needle exchanges community health? happening in their area. Besides sharply decreasing the spread of HIV, needle exchange programs show drug users that health workers care about them as human beings References and wish to help them be healthier by referring them to drug treatment and other health services. ♦ "The Public Health Impact of Needle This bond encourages drug users to follow up on Exchange Programs in the U.S. and the referrals. Women can get pregnancy and Abroad," University of California San disease testing, protecting the health of their Francisco; P. Lurie, MD, et al: Sept. 1993 babies. Women and men can be offered testing and treatment for HIV, sexually transmitted ♦ Urban Health Study, UCSF; J. Watters, diseases, and tuberculosis. Also, there are fewer R. Bluthenthal, et al: June 1993 dirty needles left on streets, playgrounds and in bushes because they can be turned in for clean ♦ "Needle Exchange: Moving Beyond the ones. The health of the whole community can be Controversy," U.S. Conference of Mayors improved through needle exchange. and Local Health Officers: Sept. 1994 How much does needle exchange cost? ♦ HIV/AIDS Epidemiology Report, Contra Costa County; J. Reardon: Sept. 1994 The average lifetime cost of treating a person with HIV infection is about $119,000. Often, public ♦ Beth Israel Medical Center, D. Des funds pay a large portion of these expenses. The Jarlais, MD: "N.Y. study shows needle cost of a new, sterile needle is about 7 cents. exchange cuts AIDS risk," Contra Costa Since needle exchange programs are carried out by Times: November 1, 1994. volunteers, the overall cost is far less than that of HIV infection. December 19, 1994 For more information about HIV/AIDS contact. Contra Costa County HIV/AIDS Program at 510/313-6770 Pacts About H11V Prevention and Needle Exchange What is HIV? What is needle exchange? HIV, Human Immunodeficiency Virus, is the Needle exchange is one way to prevent the virus that causes AIDS. It is usually passed from spread of HIV, the virus that causes AIDS. one person to another through sexual contact. HIV It is a strategy to reduce the harm to drug is also transmitted by sharing needles and drug users by trading clean needles for dirty ones injection equipment, or "works." Pregnant and providing a bridge to drug treatment and mothers can also pass HIV to their babies. HIV is other health services. Needle exchange not spread by casual, everyday contact. programs allow people who inject drugs to turn in used needles, which are often What is AIDS? contaminated with HIV, for new, sterile needles. This removes dirty needles from AIDS, Acquired Immune Deficiency Syndrome, is the community. Needles are traded on a a disease carried by blood and sexual fluids that one-for-one basis so that the number of destroys the body's defenses against certain needles in a community does not increase. infections and cancers. Although medication can slow the breakdown of the immune system, there Why do needle exchange? is no cure. Needle exchange gives people a chance of Facts about HIV and drugs in Contra protecting themselves, their sex partners and Costa County babies until they can get off drugs. HIV is spreading rapidly among injection drug users ♦ More than 340 injection drug users in the in Contra Costa County because they are County have been diagnosed with AIDS sharing dirty needles. Drug users may pass and many more are infected. the virus to their sex partners and to any children born to them. Needle exchange ♦ The rate of HIV among injection drug makes it possible for people to use a clean users surveyed in West County is the needle every time they inject. second highest on the West Coast. Can needle exchange prevent HIV ♦ In 1992, almost one in four (27%) infections? injection drug users in West County was HIV positive, up from one in five (19%) Yes! Studies show that needle exchange can in 1991. dramatically slow the spread of HIV. Researchers in New York have shown that ♦ One in three African American injection a needle exchange program can cut in half drug users in West County is infected with the number of new infections among drug HIV. users. MORE ON BACK .... Contra Costa County Health Services Department HIV/AIDS Program 597 Center Avenue, Suite 200 ♦ Martinez, CA 94553 ♦ 510 / 313-6770 � a A 04/23/1995 17: 80 838-9234 SANDEE PAGE 01 Memorandum CcaNs r D ESL. w�'rt�, To: CONTRA COSTA COUNTY SUPERVISORS VIA FAX 640-1059 �C From- Sandec Wiedemann 1.aViolette - phone 510-838-1961 (FAX 510-&38-9234)r 2305 Norris C:'anvon Road. flan Ramon, CA 94-583 Date: April 23. 1(Y)5 ! Subject: NO Needle Exchange { ----------------------------------------------------------- I _.-------------------------- ------- I will not be able to attend your public comment meeting on Tue$day, April 25 . 1 am very opposed to a needle exchange program for the following reasons: 1 . Just as 1 do not believe we should hand out guns for people! to shoot themselves, I do not want to perpetuate or encourage drug habit6. 2. This is not the way I want my tax dollars spent. 3. These type of programs bring people to our county for the fee: goodies . If we have an emergency, why would we encourage other drug user4 to come here? 4 . Drug use is 11,LFGAL. Free needles would abet the criminal . ! i r I RECEIV APR 2 41995 CLERK BOARD OF SUPERVISORS; CONTRA COSTA CO. i I F E r I r