A clean exchange

The mid-size RV parked just off University Avenue in North Park is so nondescript, looks so much like, well, an RV, that a father walking by with his two small children takes them right past the vehicle’s front door, stopping so his little girl can pet a friendly copper-colored mutt who, with his leash tied to nearby chain-link fence, sits waiting for his owner. The dog’s owner, a skinny guy in a clean, too-big plaid flannel shirt, is inside the RV, just behind its closed door, exchanging used syringes for clean ones.

When someone comments that Dad and his kids probably had no idea they just strolled past a mobile needle-exchange program, Robert Lewis, director of HIV services for Family Health Centers of San Diego, the community medical organization that runs the city’s clean-syringe exchange program (CSEP), calmly replies, “Nope.”

This month, the San Diego City Council will review and vote on whether or not to approve CSEP’s first annual report since the program was restarted in mid-2006. One year prior, political opposition managed to shut down the program, which, at that point, had been operating for four years.

At its last meeting of 2007, the committee that oversees CSEP reviewed the annual report, which, among other things, looked at crime stats in the vincinity of the two locations where the RV parks once a week for three hours. During that time, clients who enroll in the program can exchange dirty needles for clean ones, pick up other so-called “harm-reduction” items and get referrals for services ranging from housing to drug treatment. Dr. Jim Dunford, the committee’s chair and director of emergency medical services for the city was pleased with the crime data that showed no increases in incidents, but he didn’t want to draw any conclusions.

“Can you ascribe [a decrease in crime] to syringe exchange?” he asked. “Can you take credit for it? No and no.”
Around the site in East Village, where on Thursdays a mobile RV unit staffed with three employees from Family Health Centers parks from 6 to 9 p.m., crime dropped by 11 percent overall and 25 percent during the hours when the RV was there. At the program’s North Park site, the numbers were initially as good until a committee member pointed out that the San Diego Police Department had run the wrong address. An updated analysis showed a slight increase in crime within 500 yards of where the RV parks on Fridays from 10 a.m. to 1 p.m.—66 incidents, up from 60 last year—but Sgt. Mike Parga, the committee’s police liaison, said there’s no indication the program’s at fault. “I’d hear about it,” he said. “If something bad was happening around there, we’d be all over it.” When asked if he could point to any problems caused by the city’s needle-exchange program, Parga’s response was a simple “No.”

During fiscal year 2007, roughly 3,600 people used the city’s needle-exchange program.

Despite the positive annual report, in a series of e-mails, Martin Chevalier, a North Park resident and vocal needle-exchange opponent since the program’s inception, repeatedly and angrily asked whether this reporter would want a needle-exchange RV to park in front of her house—this reporter wouldn’t mind, though the RV doesn’t park in residential areas.

The reasons for having a municipal needle-exchange program are pretty straightforward, but the politics surrounding the programs can get messy. Politically, needle-exchange can be a litmus-test issue for moderate elected officials, with opponents arguing loudly that giving addicts clean needles enables drug use.

That argument doesn’t fly when it comes to public-health concerns, said Family Health Center’s Lewis, who said an addict won’t opt against shooting up just because there are no clean needles available. “If people don’t have a clean syringe, they will continue to use and share dirty ones,” Lewis said.

And, as Dunford explained, needle-exchange programs offer “an educatable moment” for people who wouldn’t otherwise interface with drug-treatment providers—each time an addict shows up to exchange needles at one of San Diego’s two mobile sites, he must sit down for a short case-management session with a Family Health Centers staff member. “We don’t wait for them to ask for a referral; if you’re ready for detox or treatment, we can help get you in… within the same day,” Lewis said. Lewis doesn’t have a count of how many people have completed treatment—26 percent of program clients have entered treatment, but confidentiality rules preclude dissemination of information about who’s completed it. But Anthony, who’s worked the RV since the program began, said he’s seen “so many success stories. They come by all the time to tell us how they’re doing,” he said.

Supporters point to numerous studies that have shown that giving addicts clean needles helps curtail the spread of incurable blood-borne diseases like HIV and hepatitis C. And, drug users aren’t the only ones who frequent San Diego’s needle-exchange RVs. For diabetics and others who depend on injected medication, it’s the only place to safely dispose of sharps. Last year, the program took in 20,000 more needles than it disbursed (127,136 to 106,368). The “dirty little secret,” one multiple-sclerosis patient explained to CityBeat, is that hospitals, doctor’s offices and pharmacies won’t take dirty needles. Family Health Centers, through its grant from Alliance Healthcare, contracts with a hazardous-waste disposal company that picks up used syringes and incinerates them. One woman who was waiting at the North Park RV to exchange needles for a friend said that before the friend had a place to switch out needles, he would bend the tips and throw them in the trash. Sgt. Parga said that since the program’s been going, there’s been no increase in used syringes littering parks, streets or sidewalks.

Still, the enabling-drug-use argument was the foundation for San Diego Union-Tribune editorials vehemently opposing a local clean-needle exchange program, and it was the reason that 10 years ago, the county Board of Supervisors—the region’s ostensible public-health policymakers—felt so strongly that needle-exchange sent the wrong message that the board passed a resolution to keep all programs out of San Diego County (under state law, individual cities, however, can decide whether or not they want a program). Supervisors asked the San Diego City Council to vote down a citywide needle-exchange program, but in 2001, the city declared a public-health state of emergency due to the spread of HIV and hepatitis C among injection-drug users.

The declaration allowed the city to start a needle-exchange pilot program, funded by the Alliance Healthcare Foundation and operated by Family Health Centers. With a City Council majority supporting the program, it lasted until 2005, when the City Council lost that majority thanks to the resignations of Michael Zucchet and Ralph Inzunza, who both favored the program. Former Mayor Dick Murphy never supported needle exchange, but his successor, Jerry Sanders, a Republican like Murphy and a former police chief, vowed to get the program re-started when he took office in December 2005. A spokesperson for the mayor said recently that Sanders’ support of needle-exchange hasn’t waned.

Though the program has the support of the mayor and a majority of City Council members, and though it’s causing the police no grief, and though the state Department of Pubic Health’s Office of AIDS recently allocated funding for the city to expand its program—something that requires approval from the City Council and the mayor and for which there are no immediate plans—opponents, namely Chevalier and North Park property owner Donna Dow, remain imposing forces, regularly attending CSEP committee meetings.

Lewis requested that the RV staff’s last names not be included in this story because Chevalier can be such an aggressive opponent, and others involved in the issue said as much. Amid allegations about political favors and profit-seeking (Family Health Centers operates the program on an annual $147,000 budget, Lewis said), Chevalier wants to know why the program can’t be located in a medical clinic. He doesn’t buy the news that the program has little impact on the community, either.

“It’s one day a week for three hours,” said Adrian Kwiatkowski, a lobbyist who represents Alliance Healthcare on the needle-exchange program. “People come to get their service, and when the motor home’s not there, they don’t come back…. The other thing is that people who access syringe-exchange programs, they don’t access healthcare right now, so you take the program out to them rather than expecting them to come to you.

“Mobile is less impact on the community,” Kwiatkowski added, “if there is any impact, even.”