'Dignity Where There Was Little to Be Found': Inside the Fight for California Needle Exchange Programs

About a decade ago, Toni Rodriguez opened up to family members for the first time about using drugs.

Rodriguez, who primarily uses the pronoun “they,” was in their 20s and living in Santa Cruz at the time, and was in a bad place and hoping for support.

But instead, Rodriguez said family members reacted with personal attacks.

“It really damaged the foundations of my relationship with almost every single family member,” Rodriguez said. “I don’t know what I was expecting, and it really is the stigma around IV drug use. There is nothing more despicable in most people’s eyes.”

Rodriguez felt unsupported and forced to move out, they said.

Rodriguez continued to use opioids over the following years. Having trouble finding clean syringes, they would reuse needles, which can cause skin infections and lead to abscesses.

Then, in 2020, while hanging around a homeless encampment, Rodriguez learned about the Harm Reduction Coalition of Santa Cruz County.

The coalition offered services without judgment or pity, Rodriguez said and delivered syringes meant to reduce the risks of infectious diseases.

“It really was game changing,” Rodriguez said. “It was dignity where there was little to be found.”

‘Recipe for disaster’

But last year, that all changed. A judge ordered the program to stop distributing needles following a lawsuit brought by members of a neighborhood group and other concerned residents. The judge ruled that the California Department of Public Health (CDPH) had not adequately consulted with law enforcement when it approved of the needle distribution.

“It’s a recipe for disaster. And it does nothing to curb drug use. It just makes it even more dangerous,” Rodriguez said of the ruling.

Santa Cruz County was home to one of the nation’s first syringe exchange programs – commonly known as a needle exchange – which was founded in the late 1980s during the AIDS crisis. However, the county is also one of several in California to see opposition to harm reduction programs in recent years.

Many needle exchanges, like the one here, are fighting to operate amid backlash spurred by fears that such programs will lead to more public drug use and an uptick in used needles and other drug paraphernalia strewn on the streets. This is also playing out in historically conservative bastions like Orange County, which remains one of the largest counties in the country without such a program.

“Can you imagine a child stepping on a needle in the sand at the playground?” Santa Ana Mayor Valerie Amezcua told KQED. “Is the answer to give [people] needles so that they can continue to live on the street and use freely? In my eyes, no.”

Last year, El Dorado County passed an ordinance to ban needle exchange programs, an action that prompted CDPH to file a lawsuit in March, arguing that the ban is preempted by state law. The judge, in that case, ordered a preliminary injunction on the ban.

Harm reduction advocates in Santa Cruz and Santa Ana are still hoping CDHP approves their applications to distribute clean needles.

And while the agency told KQED it supports these programs, some local officials and residents contend they know what’s best for their communities.

Changing views

Harm reduction advocates argue needle exchange programs save lives and are urgently needed amid the fentanyl overdose crisis. California’s opioid-related deaths spiked roughly 127% between 2019 and 2022, according to CDPH.

Needle exchange programs were born as part of an underground effort by activists and volunteers during the height of the AIDS epidemic to protect the health of people who used drugs. What started out as an act of civil disobedience gained wider acceptance over the years.

In December 2015, Congress effectively lifted the ban on federal funding for the programs. Since then, the number of counties in California with at least one needle exchange program increased markedly, and these programs now operate in about 60% of counties in the state, according to state health officials.

A CDPH spokesperson said in a statement to KQED that harm reduction programs reduce infectious disease transmission, prevent fatal overdoses, and link people to other crucial services. The agency added that research shows that these sites do not attract more drug users to certain neighborhoods and actually reduce the amount of syringe litter.

But skepticism about the programs remains strong.

Researchers at Johns Hopkins Bloomberg School of Public Health surveyed roughly 1,000 adults across the country and found that just 39% supported legalizing needle exchange programs in their communities. Those who had very negative views of people who use drugs were most more likely to be opposed to the programs.

Denise Elerick, the founder of the Harm Reduction Coalition of Santa Cruz County, said needle exchange programs should be approved based on public health evidence, not popular opinion.

“It’s not a football game,” Elerick said. “It’s the same tape, the same script that’s been repeated from Atlanta to Connecticut to everywhere, all over: ‘Those people found a syringe near my child, we have to close it down and stop it.’ That’s it in a nutshell.”

Brad Angell was among a group of residents who formed the Grant Park Neighborhood Association Advocates and sued the Santa Cruz needle exchange. A former Santa Cruz police chief and others were also plaintiffs.

He said he is not opposed to all needle exchanges but was appalled and shocked by the number of needles discarded at Grant Park, located in a residential neighborhood.

The community avoided the park because drug use and discarded needles were so common, he said.

Angell also said the program did not consult with the community.

“They act like renegades without any rules,” Angell said. “It’s shocking they were ever allowed to operate in the first place.”

Resistance in Santa Ana

In Santa Ana, where city leaders staunchly oppose such programs, another nonprofit harm reduction group has applied for state authorization to distribute clean needles.

At a city council meeting in February, then-interim city manager Tom Hatch shared images of discarded syringes.

“This needle was found inside of our city library, on one of the bookshelves, where any member of the public or young person could have come in contact with that needle and caused some harm,” Hatch said.

Amezcua, the mayor, said residents do not want a needle exchange program in their city. Santa Ana City Council members passed a resolution in April voicing unanimous opposition to the proposed program.

“Go to Irvine, go to Orange, go wherever you want, but don’t come here to Santa Ana because we don’t want it here,” Amezcua said.

Carol Newark, the executive director of the Harm Reduction Institute, the group pushing for authorization to distribute needles in Santa Ana, watched the meeting online the next day. She said felt sickened by the images displayed, and what seemed to be a lack of understanding about why the needles were there in the first place.

“I weirdly get the vibe that they’re trying to say [our group is] coming in to purposefully leave [the syringe litter] there. Like, we want to come in and destroy their city,” Newark said.

She contends her group’s latest effort to launch a needle exchange is different from the previous operation, which was run by a group called the Orange County Needle Exchange Program.

Newark’s group has laid out their plan to address residents’ concerns. If approved, they will collect syringes from participants five days a week, conduct “litter sweeps” throughout the city, and operate a hotline for residents, she said.

If the state does not approve the latest application to be authorized, Newark said she is not sure she has it in her to apply again.

“The backlash has traumatized me more than anything else I’ve experienced,” Newark said.