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Gov. Jerry Brown signs bills expanding drug user access to syringes The measures are intended to combat the spread of hepatitis C and HIV.
  Opinion: California needs a logical, uniform needle-exchange program - (09/29/11)

"The average cost to treat someone with hepatitis C exceeds $100,000; for HIV the cost exceeds $600,000. According to CDPH, approximately 19% of cumulative AIDS cases were caused by syringe sharing. Treating these cases alone cost the State over $80 million, not to mention the costs to treat hepatitis cases caused by contaminated needles. And since the Obama administration has recently approved federal funds for SEPs, AB 604 does not cost state or local coffers, yet has the potential to save millions in healthcare costs every year."

By Diana Marcum, Los Angeles Times Oct 11 2011

Gov. Jerry Brown on Monday signed two bills that will expand access to sterile syringes for drug users in an effort to combat the spread of hepatitis C and HIV.

The first bill, written by Sen. Leland Yee (D-San Francisco), allows people to buy syringes at pharmacies without a prescription. California was one of the few states where this was illegal, other than in a few pilot program areas.


The second bill, introduced by Assemblywoman Nancy Skinner (D-Berkeley), allows the state to authorize needle exchange programs in areas deemed high risk for the spread of disease.

As the bill made its way to the governor's desk, the issue was playing out in real time in Fresno, which has one of the highest rates of IV drug use in the country.

In September, the Fresno County Board of Supervisors voted to back away from a plan to legalize a longtime needle exchange even though county health officials warned that new infections of HIV and hepatitis C were climbing.

Dr. Marc Lasher, who runs a free medical clinic in conjunction with the Fresno needle exchange, vowed to continue the program despite the county's ban.

"We're legal again!" Lasher said Monday. "This allows us to do what's right health-wise for our patients and our community, and we'll never have to ask permission ever again from the Board of Supervisors."

The League of California Cities and some police organizations opposed the measure, saying it takes away local control.

In his signing message, Brown said he was directing health officials to implement the law in a "constrained way, working closely not only with local health officers and police chiefs but with neighborhood associations as well."


Needle exchange proudly flouts the law

A Fresno program that treats addicts continues to operate after county supervisors back away from a plan to legalize the operation.


Dr. Marc Lasher operates the Fresno needle exchange from a converted school bus. Up to 10,000 needles are exchanged each week. (Michael Robinson Chavez, Los Angeles Times)

By Diana Marcum, Los Angeles Times

September 19, 2011, 8:53 p.m.

Reporting from Fresno

In an isolated Fresno cul-de-sac on a recent Saturday afternoon, Dr. Marc Lasher and a small band of volunteers were collecting dirty needles, doling out clean ones and providing medical care for addicts from a yellow school bus.

But they were breaking the law.

Fresno County supervisors, to the dismay of most public health experts, recently backed away from a plan to legalize the 15-year-old underground needle exchange program - reversing a truce they had struck with health officials and activists three years earlier.

Photos: Underground needle exchange

But that didn't stop Lasher. "You could say we appeal to a higher power than the supes," Lasher said. "We appeal to the law of humanity - how we treat our fellow man."

Activists have even been arrested for trying to provide clean needles in Modesto; Lasher's group is the one of the few to have succeeded in flouting the law to provide a consistent service.

His group may soon be regulated by higher state law, however.

Two bills now on Gov. Jerry Brown's desk could supersede Fresno's prohibition on needle exchange. One would let doctors, pharmacists and workers at approved programs provide a limited number of syringes without a prescription. The other would direct the state Department of Public Health to sanction needle exchange when they believe there is a public health risk.

For now, Lasher's volunteers, including a trucker with a bum knee who keeps the old bus running and a second-year medical student, rumble up to the same spot every week to unpack sterile syringes and set up blue tarps to shield the lines of people from the sun.

They wear bright yellow T-shirts riffing off the Michelangelo painting of God reaching out to Adam. In this version, Adam holds a dirty syringe and God offers a biohazard waste container.

Lasher, a 61-year-old man in Converse sneakers who wears his curly silver hair long, laughed at questions about his background.

"C'mon, isn't it obvious?" he asked in a Brooklyn accent. "Jewish. Middle class. New York."

He says this is his way of keeping the Sabbath. In his younger days, he worked for prisoners' rights and started an organic food co-op. He didn't start medical school until he was 42. His day job now is medical director of Aegis methadone clinic.

The line for clean needles is long. Jim Psalmon, 67, reads "The Da Vinci Code" while waiting. He served in Vietnam, where he picked up a heroin habit that he's never quite kicked.

Dallas Blanchard, the needle exchange program director, calls out "Donations? Anyone have more donations?" as people dump used syringes into a container. Up to 10,000 needles are exchanged each week.

A big man in a baseball cap - a carpenter out of work for more than two years - pours his syringes from a 2-liter plastic soda bottle.

"I have no right to talk to God. But, still, every night I pray that he won't let my children find the needles," he said.

"Dallas," Lasher whispers to Blanchard before heading to the medical clinic on the bus, "Make sure that guy gets a Sharps biohazard container."

On one of the bus' back seats, Dr. John Zweifler is lancing an abscess on a drug user's thigh.

"What the Board of Supervisors does is irrelevant," he said as he drained the angry-looking welt. Lasher "was here last Saturday, he'll be here next Saturday."

In one of the earlier go-arounds with the county, Marti Clark, 41, stood in front of the Board of Supervisors and presented herself as a reason why they should legalize the needle exchange. She told them she had been clean for years and that Lasher had kept her alive.

That was back when she would "pick a needle up off the street if she had to," she said. It was Lasher who finally got her into rehab.

Now she sat on a school bus seat and dreaded the moment she would meet his eyes.

She'd used again. Just once, she said. But her upper arm at the puncture site was swollen with a rapidly spreading skin infection. Would Lasher yell at her? Look away?

"Let's see what's going on, Marti," Lasher said matter-of-factly, taking a seat across from her. "Let's see how we can help you."

Opponents of needle exchange in Fresno defend their stance, arguing that the practice helps people harm themselves. "I think providing needles to addicts is enabling," Fresno County Supervisor Judy Case told the Fresno Bee.

Such was the prevailing wisdom 25 years ago. Before then, little medical care was provided to drug abusers who commonly kept and shared needles, passing blood-borne diseases. But after AIDS surfaced, advocates sought out addicts, providing clean needles and medical aid.

More than eight federally funded studies showed that the new approach reduced death rates and did not increase crime or drug use. It slowly became an accepted part of disease prevention, supported by mainstream health organizations such as the office of the Surgeon General, the California Department of Public Health and local doctors' associations in the Central Valley.

The supervisors' vote earlier this month ended a brief grace period for Lasher's bus. In 2008, the board had declared its approval for a plan to finally move the service indoors and legalize it.

But the new vote reversed the earlier decision, angering advocates. They point to studies that have found extremely high rates of intravenous drug abuse in the Fresno area, as well as climbing rates of needle-contracted AIDS and hepatitis C there.

In public health circles, the response to the board's reversal was "a sense of 'you've got to be kidding,'" said Meghan Ralston, a Los Angeles coordinator for the Drug Policy Alliance.

Fresno County Supervisor Phil Larson said he knew his recent vote to keep the practice illegal went against prevailing health science.

"But it wasn't opposite what my constituents think," he said. "I got thank you cards for my vote."

Now, 23-year-old volunteer Jeff Parrish, a pre-med student, finds himself looking over his shoulder wondering when sheriff's deputies are going to show up.

"I mean, I don't think they would really arrest us, but - would they?" he asked.

It's strange, he said, that something he would proudly put on his medical school application has him jumpy about law enforcement.

Yet, when a couple of city police cars drive by, no one blinks. Lasher said the program has survived over the years in part because officers have tacitly declined to enforce the prohibition.

"Those are the guys who are going to get stabbed with a dirty needle frisking someone in the park, they're not going to bother us," Lasher said.

If the county hadn't reneged on the earlier agreement, the outlaw needle exchange would have become part of a one-stop place for mental health counseling and other services. The medical clinic would have moved to a central Fresno drug rehabilitation clinic.

Truth be told, said Lasher, maybe it's better the county has kept them locked out, in the shadows and on the outskirts, near where addicts buy drugs. Maybe they don't belong inside a building.

"This kind of medicine isn't just science. It's an art," he said. "Street art."

Photos: Underground needle exchange

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