Sparks fly over syringes, glass pipes, reports

LAKEPORT >> Differences of opinion over the interpretation, scope and execution of a syringe exchange program (SEP) were in full display at an emotionally-charged Lake County Board of Supervisors (BOS) meeting on Nov.2. After almost two hours of discussion among board members and public participants, the BOS voted 4-1, to let the program continue with restrictions. Vice Chair and District 3 Supervisor Eddie Crandell was the lone naysayer.

SEPs, also referred to as syringe services programs (SSPs) or needle exchange programs (NEPs) by the CDC (Centers for Disease Control and Prevention), have been in existence in California since the late 1980s. According to the California Department of Public Health, “Since 1999, the California State Legislature has expanded access to sterile syringes through SEPs authorized by local government. Most of the SEPs operating in the state today have been authorized by their county boards of supervisors or city councils.” The SEP now active in Lake County was authorized by the 2008 BOS, not the state of California.

In his remarks, Board Chair Bruno Sabatier, feeling under the weather and appearing via Zoom, provided background information on the 2008-42 resolution that authorized an SEP in the county. In 2009, the BOS approved Any Positive Change (APC) to be the SEP facilitator in unincorporated areas of the county. Any Positive Change today operates out of a mobile van in front of a senior center in Lucerne and near a thrift shop in Lower Lake. It also operated at a church parking lot in the City of Clearlake for about a year until last month when ties were severed.

At issue was the contention that the authorizing resolution strictly addressed exchanging clean syringes and needles for used ones to prevent the “spread of HIV and blood-borne hepatitis infection among injection drug users.” It did not specify handing out other drug supplies, such as glassware, also known meth pipes, glass pipes or smoke pipes. The resolution also required an annual report to update the BOS and the public on the status of the program and to give community members a chance to discuss the impacts of the pro

gram. State-sanctioned SEPs or SSPs are required to submit a report every two years and a modified state Health and Safety code that went into effect in 2020 included “any other supplies” in its language.

Moratorium or ban?

Keeping calm and his disappointment in check, Sabatier expressed his concerns. He did not know glass pipes were being handed out by Any Positive Change as part of the SEP until last month when law enforcement agencies made him aware of the activity. Other board members later admitted they, too, were just as surprised when they recently learned about the glass pipe distributions. Any Positive Change started distributing glassware in February 2021.

Sabatier brought up the lack of an annual SEP report. The BOS last received a program report in 2018. “Reports are something we need,” he said. “Changes were made without coming back to BOS… It’s difficult to tell the impact of the program on the spread of HIV and other diseases. Our own Public Health is saying it’s hard to tell. We hit in 2019 the highest number of overdoses. Let’s reboot. Continuing as is means we’re OK with the break of trust.”

Sabatier then offered two proposals: Pausing or imposing a moratorium on the program until a report can be provided to the BOS, or continuing the SEP with a ban on glass pipes.

Three of the district supervisors opposed stopping the program. District 4 Supervisor Tina Scott said, “I was disappointed we didn’t get a report but I don’t believe it’s in the best interest of the county to suspend the program… Studies show baseline savings of $1,300 to $3,000 per client. Data and research shows needle exchange does not increase drug use…We are already struggling here. We have high rates of overdose and disease and need to use every tool possible to help individuals that are suffering. We also have to know that data has shown these exchange places are pathways for recovery… when clients are ready to receive treatment with an exchange program, they know somebody that they already trusted to hand them off to somebody licensed to give them treatment… We cannot stop these programs but I agree to make them (Any Positive Change) accountable.”

Scott read aloud a letter from a former Clearlake resident who was able to overcome her drug dependence with the help of Any Positive Change. The letter said, “I was lucky to get support from APC in Lake County. Rare to be treated with love and respect…”

District 5 Supervisor Jessica Pyska would rather see people using glassware. “I’ve seen way too much damage to bodies with using needles,” she said. “If you have a glass piece, there is no expiration date on it. With needles, you can’t use them after a certain time… Stopping services would hurt people who are hurting the most in our community.”

Drugs trending toward ‘smokable’

District 1 Supervisor Moke Simon believes needle exchange is a viable program. “I need more data on handing out glassware,” he said. “I do not favor a moratorium. I would like to see a conversation if we will distribute glassware.”

The emotional presentation and discussion elicited an equally-emotional response from the Any Positive Change founder. Annunziata van Voorene, known to the community as Annina, addressed the BOS. Standing in front of the microphone, the long-time social worker gestured and paced, and at one point, sanitized and rubbed her hands. “I was somewhat shocked about some of the things you said,” van Voorene commented. “I have been serving the issue of drug user health since August 1995…I have always worked a full-time job while giving this service to this county.”

On the issue of ASP’s recent church ban, van Voorene said her team never hid their glassware dispensing efforts from the church. Someone from the church …sat with us with every exchange,” she said. “In this time of COVID, sharing any drug using material is a bad idea…Drugs are trending to be more potent as smokable…I take exception to calling it meth pipes. It’s glassware for smokable drugs.” Admitting she did not get county permission to dispense glassware, she insisted, “I did what I thought was the right thing to do. I don’t regret the glassware.” She added, “Smoking drugs is a less riskier administration that injection.”

Van Voorene said that since 1995, ASP exchanged close to three million syringes and since they started distributing glassware, the number of syringe and needle exchange had gone down. “More are moving toward smoking, which has better health outcomes than injection,” she said. A day earlier, van Voorene posted a call to action on the Any Positive Change Facebook. Her post said: “if you value syringe exchange services in your county, please make your voice heard… Our stance is that the county or BOS never tended to Any Positive Change in any tangible manner, neither acknowledging our efforts or partnering with us. Any Positive Change acted within the guidelines of the law by obtaining and dispensing glassware from the California Clearinghouse. Drug trends are toward smoking more potent drugs and we met the needs of both drug users and the community in providing supplies to limit sharing of any drug using equipment.”

As many as 12 Zoom attendees spoke up during public comment with nine of them voicing their support for Any Positive Change and the impact of the SEP on those dealing with substance disorder.

Van Voorene pointed out that the issue at hand encompasses health, medical and cost considerations.

Attending via Zoom, Clearlake City Police Chief Andrew White offered his perspective: “All partnerships are built on trust. It’s a community issue. It’s our issue… Lot of public interest. It’s good to move forward with a group that examines it. A report is specific to public comment and a late report denies what is required to give to the public. This is not just one issue… We need to recognize all stakeholders.” He indicated the church issue was one of trust and that collaboration and public input are key.

Asked if he had other comments, Sabatier said, “It’s hard to respond when there’s a situation when trust was breached and zero regrets. That blew me away.”

In the end, a consensus was reached that collaborative work is important for the success of any program and to forego glassware distribution until a group representing all sides can come together to discuss the issue.

The BOS then passed an amended resolution that calls for the continuation of its syringe and needle exchange program, submission of an annual report, getting city permission to operate within city limits, and banning the distribution of drug-use glassware.

In a post-meeting email, Vice Chair and District 3 Supervisor Eddie Crandell, explained his “no” vote: “I’m not in objection to the SEP program. It was approved in 2008 and I understand the health justifications as to why both, syringe and glass paraphernalia, are needed to be exchanged. My issue is with the answers that were given to me from Any Positive Change, when I asked straight from section 121349.1. The questions and requirements were not available. Therefore (it) should cease to commence. I also do not agree with where the program exchanges currently occur at the Lucerne Alpine Senior Center. There are homes where seniors live and children walk to school in that area that feel threatened and intimidated by the people who Any Positive Change accommodates. There is a property in that vicinity with heavy activities that more than likely contributes synergistically to perpetual negative drug and criminal activity that also contributes to illegal dumping of cars, garbage and property theft and heavy trespassing.”