Needle exchange: Preventing HIV shouldn't be against the law [Blowback]
Glenn Backes, a public policy consultant for the Drug Policy Alliance who has specialized in HIV prevention among high-risk populations since 1987, discusses The Times' Sept. 19 article, "Needle exchange proudly flouts the law." If you also have a bone to pick regarding a recent Times article, editorial or Op-Ed and would like to participate in Blowback, here are our FAQs and submission policy.
The plight of the Fresno needle exchange program highlighted in The Times’ Sept. 19 article brings into focus why Gov. Jerry Brown needs to sign two bills mentioned in the article, and why California needs a public health standard that provides equal protection in all parts of the state.
As the Times’ piece points out, the Fresno County Board of Supervisors flip-flopped on a compromise to authorize the program. It overruled the recommendation of the county health officer, leading addiction experts and a local grand jury. The board outlawed an all-volunteer effort to stop the spread of HIV and viral hepatitis and to provide medical care, drug treatment and compassion to people in need.
You’d think there would be a law against politicians meddling in the doctor-patient relationship.
How did California get here? Other states don’t kick HIV prevention decisions down to local politicians.
In 1999, Gov. Gray Davis brokered a watered down policy to give decisions to authorize syringe exchange to local governments, empowering social conservatives and the lock-em-up lobby over public health officials. Gov. Arnold Schwarzenegger aped the Davis compromise in 2004 when he approved a pilot to allow pharmacists and physicians to provide a limited number of syringes to adults without a prescription, but only by local vote.
In conservative jurisdictions, like Fresno, San Bernardino or Orange County, health officers are overruled and science ignored. As a matter of public health, it is irrational to expect viruses to respect county lines, especially since bad disease control policy in one county threatens the health of neighboring counties.
Los Angeles County is surrounded by such areas.
As a matter of fiscal policy, it is irrational for the state to pay millions of dollars each year for healthcare for ex-drug users infected with HIV and hepatitis while it has no flexibility to authorize programs proven to prevent these diseases. Bad policy in conservative jurisdictions hurts taxpayers everywhere.
Two bills on the Governor’s desk can fix this mess. AB 604 by Assemblywoman Nancy Skinner (D-Berkeley) would allow local programs to apply to the state Department of Public Health to add syringe exchange services. If it is a good application from an area of high need, the department would consult with the local health officer, the local sheriff or police chief and provide for 90 days of public comment before making a final determination.
SB 41 by state Sen. Leland Yee (D-San Francisco) would allow physicians and pharmacists the discretion to sell 30 or fewer syringes to an adult without a prescription. This is a baseline, no-budget-needed policy that would allow adults to spend their own money to protect their health.
California is one of the last three states to require a prescription before pharmacists can provide sterile syringes. Most states never tied a pharmacists’ hands in this way, and of those that did, most amended their laws in light of evidence that government-created syringe scarcity was leading to higher rates of HIV among injection drug users, their sexual partners and their children.
Yee’s and Skinner’s bills have overwhelming support from physicians, nurses, pharmacists as well as AIDS and hepatitis advocates. The Yee bill also has the support of pharmacy chains and retailers.
Californians deserves equal protection from disease, no matter where they live. And California taxpayers deserve protection from the high cost of bad disease prevention policy. The governor should sign AB 604 and SB 41.
-- Glenn Backes
Photo: Dr. Marc Lasher operates the Fresno needle exchange from a converted school bus. Up to 10,000 needles are exchanged each week. Credit: Michael Robinson Chavez / Los Angeles Times