A bill currently making its way through the California Legislature would let eight counties, including Fresno, open “safer” places for people to take illegal drugs – without any legal repercussions – under the supervision of a health professional, who would also monitor the addict for signs of overdose.
The new facilities would let a heroin user, for example, bring his drugs into a facility where he would be given a clean syringe and needle. He would be able to shoot up in a sterile environment and under the supervision of a doctor, nurse or properly trained professional, who could also render aid if he began to overdose.
The proposed legislation has irked local leaders who believe it to be deeply flawed, and they chafe at the inclusion of Fresno County in the proposed pilot program. The bill was opposed by western Fresno County’s assemblyman, Democrat Joaquin Arambula, who is also the only physician currently in the state Assembly. Local doctors active in the ongoing effort to curb addiction and related infectious diseases also have their doubts.
If approved, the law would allow Alameda, Fresno, Humboldt, Los Angeles, Mendocino, San Francisco, San Joaquin and Santa Cruz counties and their cities to approve any qualified entity wishing to start a safer drug use program. The local governments also can choose not to allow any such clinics in their jurisdictions. The pilot program ends on Jan. 1, 2022.
Opioid ODs targeted
Assemblywoman Susan Eggman, D-Stockton, introduced AB 186 as a way to combat opioid overdose in California. It was approved by the Assembly on June 1 and is currently undergoing revisions in the state Senate. If the Senate approves it, Gov. Jerry Brown would have final say on whether it becomes law.
In the bill, Eggman notes that California hospitals treat one opioid overdose every 45 minutes. A similar safer drug use program in Vancouver, British Columbia has seen some success over the years, including lowering the rate of overdose deaths.
“Programs like this have been proven to save lives, connect individuals with vital services like detoxification, treatment, medical care, and housing, and reduce public nuisance and safety concerns, such as improperly disposed syringes,” Eggman said.
California hospitals treat one opioid overdose every 45 minutes.
But not everyone agrees with that assessment.
Dr. Marc Lasher has offered medical care and sterile supplies to thousands of drug users for 20 years through the Fresno Needle Exchange. He fought the Fresno County Board of Supervisors for more than a decade before the governing body recognized his organization, which is part of a broader movement of “harm reduction” that spreads across the world.
Lasher believes safe injection clinics can be effective in large cities with concentrated areas that have been ravaged by drug use for years. Los Angeles and San Francisco may have use for these, but Fresno would not.
“Our area is very different,” said Lasher, who hands out about 18,000 clean needles weekly at the once-a-week exchange near Roeding Park. “We don’t have that high concentration in a downtown area. Our drug use is more spread out.”
No politician in conservative Fresno County would ever risk their career in favor of such a facility, Lasher said, nor is any health professional that he knows of willing to run one.
The Fresno Needle Exchange “hasn’t even made a phone call to support this bill,” Lasher said.
In its two decades, the needle exchange has given out nearly 1 million clean needles to drug users. Lasher notes that this is not only a service to the addicts but to the community as a whole, as it has helped curb the spread of HIV, hepatitis and other intravenous diseases, as well as cut down on the number of used needles being unsafely discarded on city streets.
“Sanitation has saved so many more people over the centuries than fancy surgeries have,” he said.
Hepatitis C rates drop
According to the Fresno County Department of Public Health, Hepatitis C rates have dropped from 146.84 cases per 100,000 residents in 2011 to 104.19 in 2016. The rate of HIV infection has dropped slightly in the last three years, from 11.52 cases per 100,000 residents to 10.
Lasher believes there is still a heavy stigma surrounding the treatment of drug users in Fresno and beyond.
“We need to be there for folks the way we’re there for people with hypertension, diabetes and other chronic diseases caused by lifestyles,” he said.
Sanitation has saved so many more people over the centuries than fancy surgeries have.
Dr. Marc Lasher, proponent of needle exchange programs
Fresno County Health Officer Dr. Ken Bird praised Lasher’s work as a reason for the drop in infectious disease. He said the safe injection sites proposed in AB 186 are a more advanced technique in harm reduction that has worked in other countries, but he cautioned that this particular piece of legislation is lacking in several key areas.
“AB 186 does little to address community safety concerns including standards for medical oversight, impairment of the user following the use, and a requirement that such programs be linked to a more complete treatment program,” he said.
More opioid deaths
Bird added that opioid addiction and overdose are major problems in Fresno County. In 2015, there were 13.13 hospitalizations per 100,000 residents in Fresno County for opioid overdose. The state average was 10.46. The county also had a slightly higher opioid death rate than the California average.
Clovis Mayor Bob Whalen said the bill was written by “people who are well-meaning but misguided when it comes to dealing with the drug epidemic.” He pointed to a recent column in the Vancouver Sun that reported Vancouver, which has implemented a similar policy, is on pace to have more opioid overdose deaths in 2017 then it did in 2015 and 2016 combined.
Whalen, also a Fresno County deputy district attorney, believes a stronger approach is to let Proposition 47 – which reclassified minor drug offenses into lesser crimes – play its way out. He was not in favor of Proposition 47, but he noted that Fresno County’s drug court has had some success in getting addicts to opt into rehabilitation programs.
Fresno County Sheriff Margaret Mims strongly opposes the bill. She said anyone running or using these facilities would be in violation of federal law, and she’s concerned that the jurisdictions they would operate in might lose federal grants.
Mims said Fresno County has asked Eggman to remove it from the pilot program, but she refused. Eggman’s office confirmed this, saying counties where opioid hospitalizations were highest were selected, and any city or county not wanting to participate may simply not implement it.
The bill would exempt all employees, owners, volunteers and clients from prosecution for drug-related offenses committed at the facility.
The bill specifies that any approved facility must only admit adults who have previously obtained whatever drug they wish to use. It must provide a hygienic space and sterile supplies (needles, syringes, and so on). It must be supervised by a health care professional who can render first aid if needed, monitor the user for signs of overdose and, if needed, take steps to prevent overdose.
The user would be offered optional educational and rehabilitation services before being allowed to leave. The clinics would also educate users on infectious diseases such as HIV or viral hepatitis, as well as offer referrals for drug treatment programs and naloxone, a drug commonly used to treat opioid overdose.
Any entity running a program must also provide an annual report to its approving government body. The bill would exempt all employees, owners, volunteers and clients from prosecution for drug-related offenses committed at the facility.
The city or county opting into the program would be responsible for finding a way to pay for it.
When told about that, Fresno County Board of Supervisors Chairman Brian Pacheco laughed.
“That’s just the icing on the cake, isn’t it?” he said. “They take this great state mandate that we didn’t ask for, shove it down our throats, then say ‘you have to pay for it.’ ”
He continued: “Even if this bill makes it into law, I am confident the board of supervisors will not implement it. No taxpayer money will be spent on this.”