The Orange County Needle Exchange Program: A Public Health Victory in Unconventional Form

By:  Maryam Karimi

In April 2017, there were 7 million people in the United States who used injectable drugs.[1] Meanwhile, as of April 2017, there were only about 265 Syringe Services programs (SSPs) in the United States.[2] Yes, you read that right, 265 needle exchanges for an estimated 7 million users.

According to the Centers for Disease Control and Prevention, persons who use intravenous drugs may reduce the chances of getting and contracting blood borne infections and HIV with the use of sterile needles and syringes with each injection.[3] SSPs and Needle Exchange programs (NEPs) are among many types of programs that provide members of the public sterile needles and syringes at no cost in order to reduce the transmission of disease.[4]

A study from 1988 based on one of the first Needle Exchange programs in the United States, conducted in Washington, found that use of a needle exchange program was correlated to a 60% reduction in risk of transmission of Hepatitis B or C.[5] Additionally, in another study done in New York state, where 1,600 intravenous drug users did not partake in syringe exchange, they were found to be three times as likely to contract H.I.V.[6]

According to the California Department of Public Health, Orange County is “one of the most vulnerable in the state to the rapid spread of disease and infection through injection drug use…OC saw a 201-percent increase in cases of chronic Hepatitis C from 2011 to 2015…the rate of newly-diagnosed HIV cases increased by 24 percent from 2012 to 2016.”[7]

In short, needle exchanges save lives and reduce the spread of disease and infection; a public health positive, albeit in an unconventional form.

Moreover, syringe and needle exchange programs have also been proven to save taxpayer money.[8] According to a 2014 cost effectiveness analysis, for every dollar invested in syringe exchange programs, six dollars is saved because of the high cost associated with providing medical care and treatment for HIV.[9]

Meanwhile, this past August, attorneys for the cities of Costa Mesa, Anaheim, and Orange sought a preliminary injunction to stop the needle exchange from operating,[10] The Costa Mesa City Council adopted an urgency ordinance that would prohibit any needle exchanges within the city boundaries.[11]

On October 1, San Diego Judge Joel Wohlfeil ordered an evidentiary hearing next month to determine whether or not the hotly contested Orange County needle-exchange program may continue to operate.[12]

As outlined by the Orange County Needle Exchange Program (OCNEP), a non-profit volunteer organization, the proposed site will provide members of the public with as many syringes as they dispose of, and up to 20 additional needles up to a total per person limit of 200.[13]

Advocates of the OCNEP argue that providing clean needles to those who already have the intention of using intravenous drugs will help reduce the spread of HIV and Hepatitis C because alternatively, needles are shared or these individuals would use non-sterile needles.[14]

Opponents of needle exchange programs cite public safety concerns related to needle litter in their arguments against the operation of these sites.[15] Orange County opponents specifically claim that there will be an increase in needle litter because of the high numbers of needles found in the Santa Ana riverbed.[16] However, this argument is flawed because operationally, OCNEP will retain higher quantities of dirty needles in exchange for sterile needles, according to Mahan Naeim, OCNEP board member, “Between October 2017 and January 2018 we distributed roughly 26 thousand needles, and in that same period we collected roughly 29 thousand.”[17] Also, the OCNEP specifically instructs for syringe users to dispose of their non-sterile needles at their site.[18]

As to the OCNEP, the Orange County Board of Supervisors further claim that proper permits were not obtained and that the non-profit did not register properly as a medical waste producer.[19] Additionally, that the California Department of Health, which gave OCNEP power to conduct operations, is in violation of the both California Environmental Quality Act and the California Waste Management Act.[20] City officials and County Supervisors in Orange County cite crime statistics evidencing a rise in violent crime in support of their arguments against the operation of the OCNEP and express that regardless of the intentions behind the OCNEP, it should not be allowed to violate CA law.[21]

In October, Judge Joel Wohlfeil stated that purpose of the hearing next month will be to determine staffing proposed for the site as well as how the operation will safely recover and dispose of medical waste and syringes. [22] As of now, the fate of the OCNEP and many of those who rely on the program rests in the outcome of the November 13 hearing.[23]
























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