California's city-by-city, county-by-county approach to needle exchange programs (NEPs) continues to create a patchwork of NEPs across the state as officials at the city and county levels face off over their necessity and desirability.
In Ventura County, to the north of metropolitan Los Angeles, the county Board of Supervisors declared a medical emergency, clearing the way for the county to initiate an NEP like those in Santa Barbara and Los Angeles counties. NEPs have existed in San Francisco Bay area counties for years as well.
Public Health Officer Robert Levin had earlier told reporters he would ask the county Board of Supervisors to declare a medical emergency, a necessary preliminary step for NEPs. Legislation passed in Sacramento last year legalized NEPs in California for the first time, but only by declaration of local authorities.
A Ventura County survey found 811 confirmed cases of AIDS in the county since the mid-1980s, with an additional one thousand to five thousand HIV positive residents. Among men with AIDS, 19% of cases are attributable to injection drug use; among women with AIDS, that figure climbed to 45%. That same study found that since 1994, the county has had 1,467 people diagnosed with hepatitis C, which, the study said, included 50% of the county's injection drug users.
"Sometimes declaring an emergency is simply because there is something you can do about it now," Levin told the Los Angeles Times. The Board of Supervisors voted 4-1 to declare a health emergency despite skepticism from law enforcement, according to the Times.
Ventura County District Attorney Michael Bradbury, who wrote a report on the subject for the Law Enforcement Coordinating Committee, said county law enforcement agencies and prosecutors will not fight the NEP for now. But, said Bradbury, law enforcement will move to shut down a NEP if it becomes "a threat to public order or safety."
The Times quoted Supervisor John Flynn as supporting the move despite law enforcement concerns. "When the public health doctor comes to me and says we must do this, then I take his advice," said Flynn. "We've taken too many things and shoved them into the criminal justice area, when they're really health matters."
The county is moving fast. With its vote only days old, it has already announced that the program will begin in March in the towns of Ventura and Oxnard, and that the Rainbow Alliance will run the Ventura program.
Meanwhile, the situation further south, in San Diego County, has shifted in the opposite direction. As DRCNet reported last August (http://www.drcnet.org/wol/151.html#sdexchange), San Diego county officials had long resisted NEPs, but the city of San Diego was moving toward implementing such a program. In October, the city council declared a medical emergency to pave the way for a city NEP.
Now, the city's commitment to an NEP is in doubt after three newly elected council members voted against extending the medical emergency. They joined with a council veteran to split the council 4-4 on whether to extend the declaration. It needed five votes to pass.
The vote has not derailed plans for a San Diego NEP, but does suggest that it faces a much tougher fight than under the previous council. The previous council did not vote to start an NEP, but to direct the city manager to form a task force to plan how to implement such a program.
The task force continues to do its work. The Alliance Healthcare Foundation, which provides grants for health-related causes, has already agreed to spend $750,000 for a San Diego NEP.
Glum NEP supporters told the San Diego Union-Tribune they would have to educate a new batch of council members about the issue.