After considerable debate, the San Diego County Board of Supervisors voted 3-2 Tuesday to move forward with developing a syringe service program, as part of the county's harm-reduction strategies for public health.
A subcommittee, along with other county staff, will work on a proposal and present it to the board for formal approval within the next three to four months.
Supervisors nixed the idea of a syringe service program 23 years ago.
Syringe services programs encompass substance use treatment; access to and disposal of sterile syringes and injection equipment; and vaccination, testing and care and treatment for infectious diseases.
The nonprofit Family Health Centers of San Diego has its own limited syringe program, called SafePoint San Diego.
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Supervisor Nathan Fletcher said while the optics are difficult, supplying addicted drug users with clean needles is an opportunity to reduce the spread of HIV, Hepatitis C and other illnesses.
"We have to do what we know works," Fletcher said, telling his colleagues that the Centers for Disease Control and Prevention and Surgeon General Jerome Adams support syringe programs.
Supervisors Jim Desmond and Dianne Jacob cast the dissenting votes, citing philosophical objections, including having government playing a role in people shooting up illegal substances.
"That goes against everything I believe in," Jacob said, adding that supplying clean needles "address an underlying symptom -- not the problem itself."
The county should step up its treatment efforts, according to Jacob, who said she supported the 1997 needle exchange ban approved by the board.
Desmond said education is the real key to reducing the spread of HIV and Hepatitis C. Desmond added a needle-exchange program "is only one tool in the toolbox," and he doesn't know if this is the best one.
At first, Supervisor Kristin Gaspar wasn't on board, saying Fletcher's proposal caught her by surprise because she wanted to review more information and develop a "gold standard" program.
"I've loved many addicts in my life," Gaspar said, adding she was willing to abandon her preconceived notions and check out a needle-exchange program with Fletcher last year.
Gaspar proposed having a subcommittee work on a clean needle proposal, rather than a third-party consultant.
Fletcher, who admitted patience is not one of his strongest traits, said that before he was a supervisor, he spoke often about changing the county needle policy, because "people are dying every single day."
Fletcher said that after visiting the program with Gaspar, his office asked for her support, and understood she wasn't ready.
Board Chairman Greg Cox, who was also previously opposed to a needle exchange program, said that a lot has happened since 1997 in terms of science and knowledge about drug abuse.
"We all know is the best option is for folks to stop using drugs," but there needs to be another tool, said Cox, who also voted in favor of Fletcher's proposal.
During Tuesday's meeting, more than 20 people — from medical professionals to those in recovery from addiction — urged the county to adopt a needle program.
Tara Stamos Buesig, of the Harm-Reduction Coalition of San Diego County, urged the board to lift its ban, adding she "would not be here today were it not for syringe service programs."
Buesig said she brought 300 candles to represent those who died from opiate overdose throughout the county.
"These are our daughters, our sisters, our husbands, our wives," said Buesig, a substance abuse counselor. "We cannot turn a blind eye to what's happening."
Christian Ramers, an infectious disease specialist based in San Diego, said syringe service programs are cost-effective and don't increase illegal drug use.
"Do these programs decrease transmission? Absolutely yes," Ramers said.
He added that since 2002, Family Health Centers has distributed 5 million syringes and collected over 5 million syringes.
Ramers said that in 2016, federal restrictions on needle exchanges were lifted.
