A one-year, privately-funded pilot program to provide clean needles to San Diego intravenous drug users won narrow approval in a City Council committee vote on October 10, but with a key city council member wavering, approval by the full council remains an open question.
The council's Public Safety and Neighborhood Committee voted 3-2 to okay the program, which was recommended by the city's Clean Syringe Exchange Program Task Force to slow the spread of Hepatitis C, HIV/AIDS, and other blood-borne diseases. The council appointed the task force, whose members included doctors, other health workers, and city officials, including a police captain, appointed the task force last year.
The task force report, issued in June, found that between 1998 and 1999 there was a 50% increase in the number of reported Hepatitis C cases countywide and in the city of San Diego, and that injection drug use probably accounted for 60% of all new cases. With HIV/AIDS, the report found that San Diego had the third highest rate of incidence in the state (behind only San Francisco and Los Angeles), and that injection drug use accounted for 25% of new cases.
"Conclusive, science-based evidence demonstrates that comprehensive harm reduction programs which include clean syringe exchange are effective in reducing the transmission of infectious viral agents without increasing the prevalence of substance abuse or crime," concluded the task force. "Therefore, the Clean Syringe Exchange Task Force recommends that the San Diego City Council declare a state of local emergency and authorize the implementation of a privately-funded comprehensive harm reduction pilot program, which includes clean syringe exchange."
Under a law signed by Governor Gray Davis (D) in 1999, in cities or counties that declare a state of local emergency to deal with health crises, needle exchange programs may take place without fear of criminal prosecution if authorized by local authorities.
"The science is all done now in San Diego," said Ian Trowbridge, a cancer biologist recently retired from the Salk institute, who served on the task force. "Now it's just politics."
On the other side are the San Diego County Board of Supervisors, which rejected a countywide state of emergency, San Diego Police Chief David Bajarano, District Attorney Paul Pfingst, the city's largest newspaper, and at least four members of the nine-member City Council. The San Diego Union-Tribune summarized opponents' arguments in an Oct. 12 editorial snappily titled "Just Say No."
Allowing a needle exchange program "does not send the urgently needed message that intravenous drug use is a deadly habit," opined the Union-Tribune. Instead, it is based on "the controversial movement known as harm reduction," which, the newspaper explains, "is based on the tragically flawed premise that the use of illegal intravenous drugs should be decriminalized and that government should simply work to make the practice less harmful to addicts." Thus, reasoned the newspaper, needle exchange programs "deliberately abet" drug use.
The City Council voted 5-3 last October to declare a state of emergency and authorize the task force study, but with new members in office after last year's elections, Councilman George Stevens, an African-American opponent of needle exchanges, used parliamentary maneuvers to kill the state of emergency. Now, according to Trowbridge, the council is split 4-4, with Councilman Byron Wear (R-2nd District) the swing vote. "Byron Wear voted for this thing three times, but now he's wavering," Trowbridge told DRCNet.
Wear press spokesman Peter Bryan confirmed as much. "I'll have to get back to you on whether he has decided," Bryan told DRCNet. "He has concerns. There is a perception on the public's part that this is condoning drug use," said Bryan. "Another concern expressed was that this was less an exchange than just handing out needles."
Adrina Kwiatkowski of the Monger Company, the government and public relations consultants for Alliance Healthcare, the needle exchange program funder, is confident that Wear will come through. "Byron was out front on this issue, and I don't see him changing his position," he told DRCNet. "In the last year, we have only solidified the reasons he should support this."
According to Kwiatkowski, the proposal should pass the council. "You can continue letting disease spread and do nothing, or you can try to do something," he said. "The needle exchange program is the best we've got right now. People are beginning to realize that."
Under the proposed pilot project, clean needles would be distributed by a mobile van running a route in the neighborhoods bounded by El Cajon Boulevard, University Avenue, Park Avenue and Euclid Avenue. The van would also go to the east side of downtown and on to Barrio Logan. These neighborhoods were selected because of their high rates of drug arrests or sexually transmitted diseases.
A City Council vote is looming. "The mayor is on record saying he will move promptly if it comes out of committee," said Trowbridge. "That means probably within six weeks."
In the meantime, the unapproved and technically illegal San Diego Clean Needle Exchange continues to go about its business.