Response to the Orange County Board of Supervisors

June 5, 2018

The Orange County Needle Exchange Program would like to take the opportunity to address the recent Press Release submitted by Supervisor Andrew Do.

  1. First and foremost, Supervisor Do's comment: "The program, which plans to operate in a different city each day of the week, will give away 20 syringes for every dirty needle" is misleading and factually incorrect. Using the distribution policy described by Supervisor Do, if a person were to turn in 10 needles, they would receive 200 needles in return. OCNEP does NOT use this distribution model. OCNEP uses an "N+20" model. This means that for every needle a person turns in, they receive that amount plus 20, up to 200 needles maximum. Therefore, if a person visits the exchange and does not have needles to turn in, they receive 20 needles. If a person brings in 10 needles, they receive 30. If they bring in 300 needles or more, they'll only receive 200. A person without any needles would need to share, and that is what the program and our distribution model is trying to prevent. OCNEP's "N+20" model is based on research, which demonstrates that providing a sufficient amount of needles can significantly lower the chances of individuals reusing or sharing syringes, which can prevent the spread of bloodborne diseases.

  2. The large number of syringes found while cleaning the riverbed is most likely due to the lack of safe disposal available at the time of the riverbed eviction. At the Civic Center location, OCNEP volunteers continuously offered free and safe disposal of used syringes, as well as sharps containers, to our clients and the residents of the Civic Center throughout the two years that it operated. OCNEP volunteers were developing a plan to serve the riverbed directly before OCNEP was shut down and the riverbed encampment closed. It is important to note that OCNEP volunteers were routinely collecting over 30,000 syringes a week. Given that OCNEP volunteers were not able to operate in the weeks before the riverbed eviction, the residents of the riverbed would not have had access to syringe disposal at the time they were moved, leaving behind the used syringes. If OCNEP was operating at the time of the riverbed eviction, these 14,000 used syringes could have been disposed of properly.

  3. Syringe exchange programs do not just "give away more needles." The purpose of exchange programs is to safely dispose of used syringes while providing sterile syringes and equipment to prevent infectious disease transmission. The most effective syringe exchanges are "needs-based," where participants can receive as many needles as they ask for, regardless of how many they turn in. The California Department of Public Health (CDPH) recommends that syringe exchanges operate using "needs-based" distribution policies. However, due to the political climate in Orange County, OCNEP compromised and chose to operate on an "N+20" model. When there were issues regarding needle litter in Santa Ana, OCNEP capped the number of syringes that clients could receive at 200, in opposition with CDPH recommendations. We have continually compromised, finding the middle ground between the recommended "needs-based" and a one-for-one distribution policy. After the cap was implemented in October, 2017, OCNEP routinely collected more needles than it distributed.

  4. OCNEP is not attempting to subvert the city of Santa Ana by requesting authorization to become a mobile syringe exchange program. We have applied to be a mobile exchange in order to meet the need for clean syringes in Orange County, and to address the concerns regarding the needle litter. As requested by Santa Ana, we will be open more days so that people can dispose of needles safely throughout the week. We will also have a hotline and an email address where people can specifically report littered needles, allowing us to build a map of needle litter hotspots, with which we will conduct informed, strategic needle disposal sweeps. We will advocate for permanent disposal containers in those locations identified as hot spots. Our long-term goal has always been to operate throughout the county; we are not subverting Santa Ana but rather are trying to expand our program to make it more effective so that we can serve our community.

  5. "The City of Santa Ana's decision must be respected," said Chairman Do, "Santa Ana residents have every right to be safe from dirty needles in their neighborhoods." We agree with Chairman Do, Santa Ana residents do have every right to be safe from dirty needles in their neighborhoods, which is why we plan to be open more days, advocate for more permanent syringe disposal bins throughout the county, and conduct needle pick ups. Closing down our needle exchange will not get rid of all of the syringes in the county or end drug use in Orange County. This action will, however, threaten the lives of residents who suffer from addiction to intravenous drugs and have no access to clean syringes. Every day individuals transition from taking oral opioids to intravenous versions of the drug (e.g. heroin). Lastly, Santa Ana leaders communicated to OCNEP that they chose to close down the needle exchange program due to its location at the Civic Center. OCNEP reached out to the City of Santa Ana to discuss a new location. Ultimately, OCNEP chose to seek mobile certification in order to meet the vast need for the program throughout the county. Allowing OCNEP to operate more frequently and in more locations will reduce the amount of needle litter while simultaneously allowing OCNEP volunteers to continue our vital public health service.

  6. Supervisor Do quoted Costa Mesa officials who expressed concern that the mobile exchange will function as a "magnet for drug users." Beyond the mounting public health research that shows that needle exchanges do not increase drug use, drug use is already widespread across all Orange County cities, neighborhoods, and populations (as indicated by the high rates of overdose and bloodborne disease.) Rather than functioning as a "magnet" for drug use, our mobile unit will go to areas where the need already exists. When we were operating, we were a pathway to recovery for drug users. When our clients were ready to receive treatment, we connected them with licensed treatment options that meet their unique needs, thereby improving their chances of achieving and maintaining sobriety on their terms. When clients exit treatment, they have a support network in place to help them maintain that sobriety. We've had the pleasure of watching clients make the choice to get clean and continue on to lead happy, healthy, drug-free lives. Future clients should have this same opportunity.

  7. Lastly, given the current state of the nationwide opioid epidemic it is vital that we utilize appropriate language. It is stigmatizing and dehumanizing to refer to individuals suffering from addiction as "addicts." A recent study published in JAMA reported that in 2016, one in 65 deaths in the US involved opioids and that among younger adults "that number skyrocketed to one in five." Substance use and addiction is widespread across demographics and communities. As a publicly elected official, Supervisor Do is responsible for promoting the wellbeing of every resident in Orange County, regardless of the chronic conditions they suffer from.


The Orange County Needle Exchange Program Steering Committee