At the Harm Reduction Coalition of Santa Cruz County’s mobile syringe clinic, a single lamp shines a bright circle over folding tables stacked with boxes of soap, toothpaste, electrolytes, syringes, condoms and Narcan — a drug that can reverse opioid overdoses. HRCSCC’s Blanca Carrillo is working with a few volunteers as clients line up a few feet away, waiting to request a paper bag of supplies.
As a former drug user, Carrillo wishes these services had been available during her time on the streets.
“I got Hep C when I was actively using,” she said. “I was grateful to get treatment, and now I don’t have Hep C anymore. But it was from sharing needles. I wish that when I was out there, that something like this would have been available, you know?”
Across the Bay Area, coroners are reporting about half as many overdose deaths from the synthetic opioid fentanyl than during the peak of the crisis in 2023. In part, public health experts attribute this success to efforts by county public health departments and nonprofits to promote harm reduction strategies, which focus on reducing the risks of drug use without demanding abstinence.
But the work of groups like HRCSCC continues to be controversial, with a series of lawsuits around the state leading to legislation that has changed the landscape of harm reduction efforts in California.
In the face of the fentanyl crisis, the mainstay of harm reduction has been the distribution in vulnerable communities of naloxone. Delivered as a nasal spray or an injection, it blocks the effects of opioid drugs and can be a life saver. Clinics and outreach workers may also provide clean syringes, condoms, and test strips to detect infection with HIV and Hepatitis B and C, so people who use intravenous drugs are less likely to spread the diseases.
While the ultimate goal remains getting people off drugs, immediate abstinence isn’t required for help to be provided. “Harm reduction, from a simple definition, is meeting someone where they’re at,” said Dr. Teresa L. Jackson, medical director for the Hazelden Betty Ford Foundation, the nation’s leading addiction treatment provider.
“If you meet someone who’s using fentanyl or engaging in high-risk IV drug usage, and engage with them and lead with kindness, they’re going to remember that,” Dr. Jackson said. “When the time comes that they’re ready to try to stop using drugs, they’ll think of you and know that you’ll help them.”
Back when he was injecting heroin, Eddy Luz was given safe syringes and alcohol wipes, something that likely prevented him from contracting HIV and Hepatitis C. Nowadays, he comes to the SCCHRC to receive wound care kits and shampoo. “Out here, being homeless, you get a lot of bumps and spider bites,” says Luz.
According to Anna Koplos-Villanueva, the coalition’s executive director, its outreach activities were responsible for half of all reversals of fentanyl overdoses across Santa Cruz County in 2023.
Yet that success came in the face of legal challenges. In 2020, a neighborhood group sued the Santa Cruz County Department of Public Health over several claims, chiefly that the Harm Reduction Coalition had failed to conduct an environmental review required under the California Environmental Quality Act, resulting in increased syringe litter. The plaintiffs, a group of seven founding members of Grant Park Neighbors, said they were concerned about the cleanliness and safety of their neighborhood.
“My daughter would go to preschool and afterschool programs … She found one needle in Grant Park while we were cleaning, but she never picked it up,” said Brad Angell, an attorney and architect and a member of Grant Park Neighbors. “That’s a very scary thing for a parent to find out.”
The lawsuit was initially denied by a trial court, but Angell and his allies successfully appealed, causing the Harm Reduction Coalition of Santa Cruz to pause its safe syringe program. The ruling was followed by a series of similar lawsuits in Chico, Eureka, and Orange County, prompting the passage in 2021 of Assembly Bill 1344, which prevents opponents from suing safe syringe programs in California on the basis of noncompliance with California Environmental Quality Act.
Programs in Santa Cruz were able to bounce back, but in other areas, they have not.
Angell remains opposed to syringe exchanges operating around Grant Park, pointing out that drug users can obtain clean syringes from the Santa Cruz County Governmental Center. “We think it’s a good idea to have a needle exchange with the county, but we do not support the Harm Reduction Coalition,” he said.
Carrillo said many of the coalition’s clients are reluctant to go to the county building to get syringes. “There’s somebody at the door — they let you in this locked door. It’s scary, you know, and they’re asking you a lot of questions,” she said. “They would rather come somewhere where you’re not going to feel shamed.”
Koplos-Villanueva said the clearing of homeless camps, bolstered by a June 2024 U.S. Supreme Court ruling, is also a threat to effective harm reduction. Encampment sweeps can result in more fatal overdoses, and discourage people from seeking treatment, according to a study published in June in the Journal of the American Medical Association.
“When there are encampment sweeps, people’s medications — whether that’s their treatment meds, whether that’s there to manage chronic health issues, their Narcan — all of those things get tossed alongside the tents and personal belongings,” she said.
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