Volunteers are counting piles of used needles dumped out of plastic bags on a hot Saturday afternoon. People are lining up under a shade tent on a secluded north Fresno street to get rid of their dirty syringes. In return, they're getting an equal number of clean needles from the volunteers at the Fresno Needle Exchange Program.
The first person in line is a woman in her late forties who prefers to be called Tobi. She's a heroin user who's been coming to the exchange for 10 years. She's seen other drug users trading their old needles on the streets.
“They're selling dirty needles for a dollar,” she says. “And if needle exchange wasn't here, all kinds of people probably would have AIDS right now.”
Needle exchanges for drug users are meant to reduce the spread of HIV and other communicable diseases. These exchanges are common in other areas of the state, but Fresno's program is the only one of its kind in the Valley. And according to studies, Fresno has one of the highest rates of injection drug use in the nation.
But now Fresno's needle exchange is illegal. That's because the county Board of Supervisors withdrew its support for the program late last month. The supervisors dropped a plan that would have given the exchange a permanent location in a facility.
Supervisor Phil Larson was one of three who voted against the exchange.
“I feel it's an enabling process for someone to stay on drugs longer and not to get them off,” he says.
Dallas Blanchard believes the opposite. He's the director of the needle exchange and he says the program will continue despite the board's decision.
“I see the needle exchange as enabling people to get into treatment,” he says. “We act as a bridge to treatment. And 20 years of research has proven that it works.”
The mobile needle exchange has been around for 17 years, supported by grants and fundraisers. Volunteers don't just hand out needles to the 150 clients who drop by each Saturday. They offer referrals to drug treatment programs and social services. Medical volunteers also show up each week to provide checkups in a mobile clinic.
Dr. Marc Lasher is treating Tobi inside the mobile clinic, a green and yellow converted school bus. Tobi's injection sites are infected.
“How much heroin are you still using a day?” asks Dr. Lasher.
“It's only a nickel, maybe a dime,” Tobi replies. She adds she's also on methadone.
Dr. Lasher is the director of the Fresno Free Medical Clinic, part of the needle exchange. He says people who claim the exchange is enabling addicts don't understand the disease of addiction.
“The dragon of addiction is much stronger than what seems to be rational,” he adds. “That's not the issue. What we're trying to do is prevent the spread of infection and so that when people go through this whole process of their disease and they start getting to have a much better lifestyle, hopefully they're not suffering from killers like HIV, AIDS and hepatitis C.”
In a way, the county still partners with the needle exchange. The Fresno County Department of Public Health offers HIV and Hepatitis C tests once a month at the exchange site. Gina Adams works on communicable disease issues for the department.
“In the public health arena, needle exchanges are seen as a primary prevention method. It's harm reduction. When you know that someone is still going to engage in a high-risk behavior, any kind of education or paraphernalia we can offer to reduce risk is important.”
Two bills in the state legislature would give a boost to needle exchanges. One would allow doctors to provide syringes without a prescription. The other bill would support needle exchanges when there is a serious public health risk.
Dr. John Zweifler of UC San Francisco's Fresno campus says the medical community is generally supportive of needle exchanges. He's worked with the clinic at the needle exchange and he's grateful, in a sense, for the board of supervisors' decision.
“Really, there's been no impact whatsoever of the deauthorization,” he says. “The only positive benefit is that we are now having a discussion of what to me is a very clear and logical step that we should be taking and we should be spreading to other communities within Fresno County and throughout our state.”
In the meantime, addicts like Tobi will continue to line up for help on Saturday afternoons.
“Dr. Lasher saved my life two times,” she says. “If Dr. Lasher wasn't here, I'd be dead. I had real bad infections, diabetes infections, in my hip. I was already getting dizzy and he lanced them and saved my life. So I thank God for Dr. Lasher.”
Special funding for this program comes from the California HealthCare Foundation