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EXECUTIVE SUMMARY

In order to reduce drug-related harm in Los Angeles, there is a need to take specific action in a number of
key areas. Persons who are injection drug users (IDU’s) are particularly vulnerable to a number of health
risks, most especially HIV/AIDS and Hepatitis C. They are also a large portion of persons incarcerated in
California jails and prisons and due their enfranchised state face a number of barriers accessing mental
health and social services. While Needle Exchange Programs (NEP’s) provide key services for IDU’s,
there are too few of them in the Los Angeles area and their work is often highly misunderstood. There is
a need to conduct a wide-spread media and education program to enlighten the public. There is also a
need to conduct culturally appropriate education programs to reach IDU’s across a broad range of
communities. California jails and prisons need to update their protocols on Hepatitis C testing and
treatment. Mental health and social services need to review the protocol of providing only abstinence-
based services and the RFA’s related to the release of funds provided by SB767 should be immediately
distributed. In addition, there must be a greater awareness of overdose-related issues – in particular, the
general public requires education on the principle that drug users’ lives are worth saving.

HARM REDUCTION: A FRAMEWORK FOR IDU HEALTH

Harm reduction is a set of practical strategies that reduce negative consequences of drug use,
incorporating a spectrum of strategies from safer use, to managed use to abstinence. Harm reduction
strategies meet drug users "where they're at," addressing conditions of use along with the use itself.
Because harm reduction demands that interventions and policies designed to serve drug users reflect
specific individual and community needs, there is no universal definition of or formula for implementing
harm reduction.

Harm reduction accepts for better and for worse that licit and illicit drug use is part of our world and
chooses to work to minimize its harmful effects rather than simply ignore or condemn them. It
understands drug use as a complex, multi-faceted phenomenon that encompasses a continuum of
behaviors from severe abuse to total abstinence, and acknowledges that some ways of using drugs are
clearly safer than others. It also establishes quality of individual and community life and well-being--not
necessarily cessation of all drug use as the criteria for successful interventions and policies. Harm
reduction philosophy calls for the non-judgmental, non-coercive provision of services and resources to
people who use drugs and the communities in which they live in order to assist them in reducing attendant
harm and ensures that drug users and those with a history of drug use routinely have a real voice in the
creation of programs and policies designed to serve them. It is a philosophy that affirms drugs users
themselves as the primary agents of reducing the harms of their drug use, and seeks to empower users to
share information and support each other in strategies which meet their actual conditions of use. Finally, it
recognizes that the realities of poverty, class, racism, social isolation, past trauma, sex-based
discrimination and other social inequalities affect both people's vulnerability to and capacity for
effectively dealing with drug-related harm but does not attempt to minimize or ignore the real and tragic
harm associated with licit and illicit drug use.

THE NEED FOR HARM REDUCTION IN LOS ANGELES

Persons who are injection drug users (IDU’s) continue to face a high number of health risks – Hepatitis,
HIV, STD’s, Tuberculosis and death from overdose. As of 2005, injection drug use was the second leading

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Blueprint for Harm Reduction Coalition

Ilanna S Mandel, 2008
cause for HIV transmission and the leading cause of Hepatitis infection in California.1 There is also a
particularly strong link between injection drug use and women and people of color. Among
adult/adolescent women in California, injection drug use-related risk factors account for 37% of
cumulative AIDS cases. Forty-six percent of AIDS cases among African American women and 55% of
AIDS cases among Native American women are associated with injection drug use, compared to 40% of
AIDS cases among White women.

HIV/AIDS

LA is disproportionately affected by the HIV/AIDS epidemic.” Los Angeles County, with 45,241
cumulative reported AIDS cases has the second highest number of AIDS cases in the nation, exceeded
only by the City of New York. Furthermore, the City of Los Angeles accounts for 25,696, or 56%, of all
AIDS cases ever reported in the County, despite the fact that it accounts for only 40% of the County
population”2. According to a 2006 report published by AIDS Project LA, persons who are injection drug
users are the second highest group of persons contracting HIV/AIDS in LA at 7%, with a cumulative
number of 3,463 persons. There is a great need to prevent or at least reduce the prevalence the HIV/AIDS
among IDU’s.

BARRIERS

Persons who are IDU’s are often disenfranchised, socially isolated and poor. Society’s continued
negativity towards drug use creates a strong stigma on the use of drugs. The spread of HIV/AIDS among
IDU’s needs to be addressed among a large group of culturally diverse communities and individuals who
are often difficult to reach.

HEPATITIS C

Injection drug use is the highest risk factor for contracting the Hepatitis C virus. Nationally, their rates of
infection vary between 72% and 89%3. It is imperative that injection drug users understand the
connection between sharing drug paraphernalia and the risk of becoming infected with Hepatitis C. A
March 2006 report by a group known as The HCV Advocate www.hcvadvocate.org reported that persons
who are injection drug users are the persons who are most at risk for contracting HCV. However, one of
the greatest areas of risk for IDU’s is the fact that they often face incarceration rather than treatment.
“Hepatitis C (HCV) in prisons is a public health crisis tied to current drug policy’s emphasis on the mass
incarceration of drug users”4. A 2005 report5 on Hepatitis C infection in California prisons stated that “…
HCV infection is pervasive among the California prison population, including prisoners who are non-
IDUs and women with high-risk sexual behavior. These results should promote consideration of routine
HCV antibody screening and behavioral interventions among incarcerated men and women”. The report
also states that the risk of HCV infection rises with the number of years a person is incarcerated (p. 181).

1
California Department of Health Services, Office of AIDS, Fact Sheet 2005.
2
HIV and AIDS in Los Angeles: 21st Century Challenges and Approaches, A Report to the Mayor and City Council of
Los Angeles Prepared by the Mayor’s AIDS Leadership Council, December 2003.
3
See “Chronic Viral Hepatitis in the United States” at: http://www.hepnet.com/hepc/aasld00/terrault.html
4
“Hepatitis C In Prisons: Evolving Toward Decency Through Adequate Medical Care And Public Health Reform”, By
Andrew Brunsden.
5
See: “Hepatitis C Virus Infection among Prisoners in the California State Correctional System” at:
http://www.journals.uchicago.edu/CID/journal/issues/v41n2/35610/35610.web.pdf
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Blueprint for Harm Reduction Coalition

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It goes on to state that HCV is likely to be the most prevalent bloodborne infection in American prisons
and surpassing HIV/AIDS as the most significant health risk (p. 183).

BARRIERS

One of the greatest barriers to the diagnosis and treatment of Hepatitis C among injection drug users is
that people who have contracted the virus are often unaware of this fact until many years after they
become infected. Persons can go for years without displaying any symptoms. Many injection drug users
do not have health insurance and even if they know they are positive for the virus, they may not know
how to access treatment. Persons who are co-infected with HIV also have a much better chance of
receiving comprehensive services as the treatments and services for HIV/AIDS are far more advanced
and more widely available.

INCARCERATION ISSUES

Many inmates enter jail or prison and are unaware they are positive for Hepatitis C. As there is no testing
in correctional institutions, many inmates are actually spreading or contracting Hepatitis C without even
realizing it. Many inmates who are IDU’s enter prison and may not be HIV or Hepatitis C positive, but a
high percentage are when they leave. The statistics on HIV/AIDS in the nation’s prisons were last
published by the Bureau of Justice Statistics in 2002. According to this report, at the time, California had
the fifth highest rate of prison inmates who were HIV positive in the nation. At that time, 1, 181 prison
inmates were identified as HIV positive.

BARRIERS

Inmates are not allowed access to clean syringes because using drugs is illegal. This remains the case
even though it is widely recognized that inmates do somehow manage to obtain drugs. This leads to a
dangerous situation whereby inmates share syringes. It also leads to the further spread of HIV/AIDS and
Hepatitis C and further endangers the health of IDU’s6. The power to enable change is in the hands of the
Department of Corrections and the Sheriff’s Office.

NEEDLE EXCHANGE PROGRAMS

Scientific research has demonstrated that syringe exchange programs (NEPs) are
effective in reducing blood-borne disease transmission and do not increase drug use or
crime rates. In 2007, NEP’s sponsored by the City of Los Angeles removed nearly 1.4 million used,
potentially lethal syringes from the streets. The NEP’s serve app. 12,00 persons per year. The City spends
about $42 per client per year to run its syringe exchange program, but one syringe-infected AIDS patient
would require upwards of $25,200 per year in public health expenditures7.

6
“Focusing HCV care on prison populations is a public health strategy that draws not only from humanitarian arguments regarding
prisoners’ individual rights to medical treatment, but that also appeals to instrumental utilitarian reasoning that help for prison
inmates means improvement to community health generally”; Ibid.
7
See: www.lacityaids.org, “Facts About Syringe Exchange Programs In Los Angeles”
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Blueprint for Harm Reduction Coalition

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BARRIERS

There is a great deal of misunderstanding about what NEP’s do, how they function and a lack of
knowledge about the broad range of services they provide. They continue to operate almost as an
“underground” project rather than as an integral part of public health which is what they deserve to be. If
there were fewer misperceptions about them, they would likely attract more IDU’s and provide services to
an even broader number of people.

SOLUTION:

The HIV Planning and Prevention Committee has the ability to assist the NEP’s in raising their profile
and help educate the community at large about what they do and its importance to public health. They can
also work together with the NEP’s to advocate for long term funding which is essential to the expansion
of their services. The power to enact these changes is with the HIV Prevention and Planning Committee,
the LA County Board of Supervisors, the Department of Health and the Needle Exchange Programs in
LA.

ACCESS TO MENTAL HEALTH AND SOCIAL SERVICES

IDU’s typically experience numerous barriers to accessing services. Many live in extreme poverty and are
often homeless as well. They often lack the information on which services can be most helpful and how to
access them.

BARRIERS

Many services are based on the principle of abstinence as opposed to a harm reduction philosophy. In
addition, many services have not trained their staff to work with persons who are injection drug users and
thus the knowledge and experience to work with them respectfully and appropriately is missing.

SOLUTION:

Mental health and social services must review their protocols for providing treatment to persons who are
injection drug users. The primary focus here should be to remove the barrier that persons must cease all
drug use before they can enter treatment. The power to enact change is with the Department of Social
Services, Department of Alcohol and Drug Programs – Division of Treatment Services, CARE –
California Access to Recovery Effort

OVERDOSE PREVENTION

It is a fact that deaths from drug overdose are entirely preventable. People continue to die unnecessarily
from drug overdose. In March 2006, a summit on OD prevention identified that deaths in California from
an overdose are up 73% since 1990. In LA County, deaths from drug overdose are a leading cause of
premature deaths. The primary issue at this time is the need to make the applications available in order for
community based organizations to begin distributing Naloxone. This money was made available when the
Governor signed Bill SB767 but the applications are still being held up.

BARRIERS
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Blueprint for Harm Reduction Coalition

Ilanna S Mandel, 2008
The harm reduction philosophy has not yet been embraced as a ‘mainstream’ principle or philosophy and
most drug and alcohol (or substance abuse) programs continue to follow an abstinence based philosophy
and 12 step model. The notion of persons who are drug users as persons worth saving is not a concept that
has reached the public consciousness.

SOLUTION:

Community groups (OD Prevention Task Force, Harm Reduction Collaborative, Drug Policy Alliance)
must pressure the Department of Health must release the RFA’s to allow CBO’s to apply for and receive
funds from the $100,000 allocated for Naloxone distribution. The power to move this funding into the
next stage is with the Department of Health and the County Board of Supervisors. There is also a great
need to generate greater awareness among the public at large that the lives of drug users are worth
savings. The Department of Health could work with the County Board of Supervisors and the OD
Prevention Task Force to create a public awareness campaign about the importance of health services for
everyone.

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Blueprint for Harm Reduction Coalition

Ilanna S Mandel, 2008