El Dorado County drafted an urgency ordinance that would take a big step toward eliminating syringe exchange programs on its turf. 

This would include Sierra Harm Reduction Coalition, which has operated in the county since 2019 under the authorization of California’s Department of Public Health. DPH reauthorized Sierra Harm’s operations, an action county supervisors, Sheriff Jeff Leikauf and District Attorney Vern Pierson publicly disapproved. 

The action by the Board of Supervisors during its Tuesday, Dec. 5, meeting follows Placer County’s approved prohibition on operation and establishment of such programs. El Dorado County’s ordinance went into a first reading and will go into a final reading next Tuesday, Dec. 12, before a vote can be made to approve the ordinance.

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The ordinance echoes county leaders’ concerns — a rise in drug overdoses, improper used needle collection and public health risk with little evidence such programs are slowing the spread of blood-borne diseases, including HIV and hepatitis, county officials have said.

“The Board of Supervisors recognizes that the establishment and operation of a syringe exchange program will increase improperly disposed needles which pose a serious risk to the public health, safety and welfare, given the potential for personal bodily injury, property damage and contaminated waterways,” the draft reads. “It is the purpose and intent of this section to prohibit the establishment, operation, use and/or participation in a syringe exchange program within the unincorporated areas of the county to protect the public health, safety and general welfare of its residents.” 

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The ordinance establishes enforcement protocol, including a notice of violations and fines, misdemeanor charges for every offense. 

The ordinance also claims its right to produce such prohibitions under various California regulations, including Article XI of the state’s constitution and its Government Code Section 25845. 

County leaders rebuke syringe exchange

Syringe exchange programs such as Sierra Harm Reduction Coalition exchange unclean drug paraphernalia for clean paraphernalia in an effort to stop the spread of AIDS, HIV and other blood-borne diseases and to reduce other negative consequences associated with drug use. The overarching goal is to build recovery, judgement-free environments for those wishing to end drug use and seek treatment. 

However, county leaders say the coalition is doing more harm than good in the county. They felt their voices were not heard regarding syringe-exchange programs while stating their case to CDPH Harm Reduction Unit Chief Alessandra Ross May 18. The county subsequently received a letter from CDPH Sept. 1 stating SHRC was reauthorized to continue its operation.

“This is one more example of what I felt from all our work that we put in to state our argument that they were just checking the boxes on us,” Leikauf said. 

Leikauf shared the statistic during the board item addressing the urgency ordinance that 130 El Dorado County residents have lost their lives due to drug overdose in the last three years, including an increase of fentanyl overdoses from 2020 to 2022.

Leikauf noted drug users were three to five times more likely to die from a drug overdose than blood-borne diseases. 

CDPH data shows eight people were diagnosed with an HIV infection in 2021, while six were diagnosed in 2020; there were 145 reported cases of hepatitis C in the county in 2021, a decrease from 181 in 2019 and 152 in 2020.

An email from CDPH states 15% of people living with HIV in El Dorado County reported injection drug use as a risk for transmission. The statewide average is 12%, according to information from CDPH.

Leikauf said while blood-borne diseases can be treated with medication, “There is no medication to save the lives of the ones who died from drug overdoses.” 

Another issue county leaders took on is a reported increase in the presence of used drug paraphernalia, including dirty needles, around public spaces on the West Slope, including the Placerville library, which they say is creating a public health concern and nuisance. 

“I have to ask, is this what we want?” the sheriff asked. “Is it what we want when our parents with young children visit the library daily?” 

A letter from the county to CDPH indicates SHRC will distribute more than 150,000 needles and recover 125,000 with a potential 25,000 being unaccounted for.

“These programs may work in other parts of California and the United States, although I have my doubts,” Leikauf said. “What I do know is that El Dorado County does not want or need these types of programs. We need to exercise local control and decision making.” 

The board obtained four yes votes to enact the ordinance, including votes from Board Chair Wendy Thomas and District 4 Supervisor Lori Parlin, who brought the discussion to the forefront of county affairs.

“We have evidence of them not doing education and just handing out paraphernalia, and that is not what they are supposed to be doing,” Parlin told the board. “So that first meeting I thought we were heard, and that’s why when we got the letter from CDPH … it felt like a big gut punch.” 

Thomas in turn stated efforts made by the county to reduce drug use have been undermined by syringe-exchange programs. 

“We have gone through great lengths with our sheriff’s Homeless Outreach Team, the city of Placerville, through local nonprofits, Marshall Hospital and their substance abuse program … our community partners are very engaged in helping those who are addicted to drugs find their way out of that to be safe,” Thomas said. “We are actively engaged in ensuring the safety of that population, but it is our sacred responsibility to ensure the safety of our broader population.” 

Pierson spoke to supervisors on his support of the urgency ordinance, stating syringe-exchange programs, which originated in the Bay Area, were intended to only delay the inevitable of someone dying from drug overdose.

“Nonetheless, they’re really bad things that we, as a policy in the state of California, have essentially said, ‘Let’s try this’ and it hasn’t worked,” Pierson said. 

Supervisor Brooke Laine abstained from voting, citing not enough voices or evidence brought forth in the discussion, but also recognized the board’s intent on passing the urgency ordinance. 

Sierra Harm Reduction director responds

Sierra Harm Reduction Coalition Director Tom Ewing and county leaders seem to have one thing in common — both parties ultimately have the goal of preserving El Dorado County residents’ lives. 

“Who could argue that it is better to let people die than help them be healthier and stay alive?” Ewing asks in a statement emailed to the Mountain Democrat. “Our street support program focuses on safer use, medical care, behavioral care, transportation, housing and addiction treatment, or just giving a compassionate ear to what our clients have to share. Our clients are real human beings.” 

Coming to the defense of harm reduction and syringe-exchange programs, Ewing states since 2020 the coalition has helped 168 individuals navigate people to treatment and long-term recovery. He also has stated the coalition has given out 7,851 doses of Narcan, with clients reporting using it to reverse 1,057 overdoses, which he explained may be an undercount. 

“It’s a simple fact that people who use drugs will obtain the supplies they need to use them, whether there is a harm reduction organization in the area or not, just like they manage to obtain drugs in spite of the fact that they are illegal,” according to Ewing.

He notes more than 600 people year-over-year in the county were obtaining supplies from other counties and then selling supplies at “inflated prices” to others.

“Before SHRC was here, many people ended up sharing and reusing syringes, which not only caused serious harm to the people using them, but also put the community at large at risk of HIV, hepatitis C and other blood-borne infections,” Ewing states.  

He claims syringe buying, sharing and reuse has largely disappeared since the coalition began in the county.

Ewing adds that when clients are ready for recovery, the coalition refers individuals to services including Marshall Care, El Dorado Community Health Center’s STEPS program, the Shingle Springs Health and Wellness Center’s medication-assisted treatment or AEGIS Treatment Center in Placerville for those who prefer methadone. 

“We have excellent relationships with all these providers. We also refer people to specific treatment options, as well as Alcoholics Anonymous and Narcotics Anonymous, as we have our own direct experience with their versions of the 12-Step Program,” Ewing states. 

Responding to the sheriff’s observation that SHRC paraphernalia has been found at the scene of overdose cases, he argues it doesn’t necessarily matter where the supplies came from. 

“What that says to me is that those people cared about their well-being and were trying to minimize their risk when they were not ready or able to stop using drugs,” Ewing explains. 

Ewing notes that by building relationships with clients, the coalition can better help their recovery-ready mentality. 

SHRC has given out 12,121 fentanyl test strips with more than 2,500 reported positive tests, according to information from the coalition, which has been working to educate clients specifically on the dangers of fentanyl.

Sierra Harm is also trying to educate about growing use of the powerful sedative xylazine, a drug used in veterinary medicine.

“Because we build trusting relationships with our clients, we learned that the recently available drug xylazine, aka ‘tranq’, has been in our county for over a year,” Ewing continues. “There also has been one overdose death in El Dorado County where the person had xylazine in their system. We immediately started offering xylazine testing strips, ensuring that education with our clients is a very high priority, and our clients are clamoring for these tests.”

Since 2020, 263,321 syringes have been dispensed and 272,303 have been collected, according to Ewing. This year, 41,973 were dispensed and 45,457 were collected, equating to a 108.30% syringe return rate. Ewing reported 2020 and 2021 had greater than 100% return rates as well. 

“When it is over 100%, it is obvious that SHRC is not the only source of drug-using supplies,” Ewing states. “In fact, we are likely leading the pack in terms of who is cleaning up the county from litter that could easily harm children in parks, or anyone on the El Dorado Trail. We have volunteer cleanups at ‘hot spots’ regularly to ensure our entire community is benefitting from our work.” 

Despite their efforts, Ewing points out resistance to harm reduction groups and their syringe exchange programs are “rampant” not just in El Dorado County, but in nearly all of rural California as a result of stigma and secrecy of those who use drugs. Ewing adds that as a country, the U.S. has a long way to go before the general population is “ready” to come to terms with the complexities of addiction. 

“Addiction is always a highly charged emotional issue. Hatred and fear of drug users is not new in the United States, and it’s far from unique to EDC,” Ewing states. “For some who have had loved ones struggle with addiction, this topic can be very hard; I even know many people who are in recovery themselves who seem to resent the fact that we are offering people the kind of support that they themselves did not receive when they needed it most.”