UPDATE: 6:24 p.m., Jan. 26, 2021
The San Diego County Board of Supervisors voted 3-2 Tuesday in favor of developing a needle exchange program, nullifying a 1997 board decision.
In reversing the county's 23-year-old ban, the board directed the chief administrative officer to present a comprehensive plan, known as the County Substance Use Harm Reduction Strategy, within 90 days, focusing on harm reduction to prevent overdoses and the spread of infectious diseases.
Advocates say needle exchange programs reduce both HIV and Hepatitis C transmission.
Board Chairman Nathan Fletcher said when it comes to changing the policy, "the evidence could not be more clear, and the time is now," and Supervisor Terra Lawson-Remer said the new approach "aligns very well with evidence-based policymaking."
Supervisors Joel Anderson and Jim Desmond cast the dissenting votes.
Anderson said he wasn't against Fletcher's proposal, but wasn't comfortable "voting and then later learning that all the clinics are going to be located in my district." He said he wanted to see a plan first, adding, "Is there some middle ground? I hate to vote against this."
Desmond said that giving out needles still has the appearance of promoting drug abuse.
"I would like to see an emphasis on prevention," he added. "I see that needle exchange (would) promote health among those who are using, but I think we're kind of treating the symptom instead of the cause."
Before voting, supervisors heard from several advocates for a needle exchange program, including Tara Stamos-Buesig, executive director of the Harm Reduction Coalition of San Diego County.
Stamos-Buesig called harm reduction the off-ramp from drug abuse, and added that those in the program don't feel stigmatized, and many are sent into treatment.
"I wouldn't be here today if it wasn't for a syringe service program," Stamos-Buesig said. "If not us, then who? If not now, when?"
Dr. Christian Ramers, of Family Health Centers of San Diego, also spoke in support.
"We are dealing with poverty, mental health and infectious diseases in a group that is very hard to reach and treat," he said. "There's a whole lot more than just exchanging needles."
Ramers said that since 2002, his organization has taken in 500,000 needles and distributed Naloxen kits, which are used to prevent overdoses.
In 2018, the rate of overdose deaths was 268, almost one every day in San Diego County, Ramers said, adding it was 314 deaths the following year.
"Almost one resident died every day" in 2019, Ramers said. "We're not making any progress here."
Ramers said that not only do the World Health Organization and Centers for Disease Control and Prevention support needle exchanges, so does Alex Azar, the former Health and Human Services secretary in the Trump administration. Needle exchanges also save hundreds of millions of dollars in terms of long-term care for HIV and Hepatitis C treatment, he added.
During the public comment period, several people called in to voice support for the county's new policy.
"It's so important we catch up with the times," one caller said. "This will ultimately bring us to a healthier society."
But Poway resident Kathleen Lippitt described needle exchange programs as " a wolf in sheep's clothing."
"A needle exchange program is not a framework for the future, or, at least, a positive one," she said, adding such programs are reactive and expensive.
Last March, Fletcher proposed that the county lift its ban on needle exchange programs and develop a strategy to reduce harm for syringe users. The board instead voted 3-2, with both Desmond and former Supervisor Dianne Jacob opposed, to form a subcommittee to work on the proposal and return in a few months, but the coronavirus pandemic delayed the panel's work.
