The dawn of 2000 brought a glimmer of hope to Californiaís 24 syringe exchange programs and a wait-and-see attitude from several veterans of one of drug policy reformís highest-stakes battlegrounds.
As of January 1st, a new law protects syringe exchange practitioners in the state from prosecution Ė if the locality they serve declares a public-health emergency and re-declares the emergency every two weeks.
The statute is a weaker version of a bill that California Governor Gray Davis had threatened to veto last year. The original bill would have acknowledged the effectiveness of syringe exchange programs in combating the spread of hepatitis C and HIV, and would have allowed such programs to operate without a public-emergency declaration.
Davis signed the weaker bill last October. To date, the cities of Los Angeles and Berkeley, as well as Marin, Alameda, San Francisco, Contra Costa, Santa Cruz and San Mateo counties, have declared public health emergencies.
"Itís tough to know the exact implications," says Alex Kral, an epidemiologist at the University of California-San Francisco who studies drug use, HIV/AIDS and needle exchange. "The law probably helps the most in places where the political environment supports needle exchange but where they havenít yet declared an emergency."
By contrast, Kral says the new law does nothing in places where public health and elected officials are hostile to needle exchange. An example is Fresno, where the San Joaquin Valley Needle Exchange has had several people arrested.
"It could be everything and it could be nothing," says Heather Edney-Meschery, executive director of the Santa Cruz Needle Exchange (SCNE). "My sense is that weíll be less vulnerable, and so far the level of harassment has gone down."
SCNE has worked for almost a decade with local government officials, police and the health department. "Weíre agents of the Health Department, and we contract with the county," Meschery reports. "Thatís how we get some of our funding. Ultimately, making these programs work requires both the right policy and enough funding." Meschery believes the new law might make the private sector more open to supporting syringe exchange.
DRCNet board member Joey Tranchina, who operates the nonprofit AIDS Prevention Action Network in Redwood City, about 25 miles south of San Francisco, believes needle exchange "should have been made legal by national fiat long ago." Tranchina has been a pioneer in needle exchange since 1990 and has had numerous run-ins with local law enforcement.
"Itís far from an ideal law," he said of the new statute. "Itís sort of the minimum you could do in terms of changing the law, but I think we have a better chance when local communities can declare an emergency. Weíre simply not coming to terms with the hepatitis C epidemic right now Ė thatís my focus."
According to the San Francisco Chronicle, health officials in San Mateo County, Tranchinaís home base, estimated in December that 13,000 residents may be infected with hepatitis C, a leading cause of chronic liver disease. That figure is 10 times the number of county residents who are infected with HIV.
Rich Gordon, a member of San Mateo Countyís Board of Supervisors, told the Menlo Park Almanac that the supervisors "believe this gives him [Tranchina] greater opportunities to secure funding for his operation. The bottom line of what Joeyís doing is saving lives."
Dr. Denis Israelski, chief of infectious diseases and AIDS medicine at the countyís Health Center, told the Almanac that not providing clean needles to injection drug users "has been a terrible failure of public health policy. Itís cheap, itís easy, itís effective. It doesnít lead to increased needle use."