Tanner (not his real name) sat in the stairwell connecting the first and second floors of a parking structure near the Santa Ana Civic Center on a recent, cold Saturday afternoon. His rib cage was visible through a snug, faded red T-shirt; his long, dark hair exaggerated the thirtysomething's jolty mannerisms. Snapping out of a trance, he glanced around, then grabbed something from a white paper bag between his legs.
In one quick motion, Tanner rolled up his left sleeve, wrapped a rubber tourniquet around his upper bicep, then dropped his left arm to the cement. He cleaned off the soft, inner crease connecting his forearm and bicep with an antibacterial wipe before reaching back into the bag, looking around one last time to see if anyone was near. Bending his forearm into a 90-degree angle and forming a fist with his left hand, Tanner flicked the syringe in his right hand twice, inspecting the liquefied heroin inside for air bubbles—all good.
The needle went into his arm, and the drug kicked in within seconds. Tanner swayed from side to side, his head in his hands. His arms then slowly fell to his sides while his body remained crouched. He stayed like this for nearly 30 minutes before getting up and slowly walking toward the Civic Center courtyard. In a complete daze, he sat down on the steps while about 50 people gathered in a line nearby.
Everyone noticed Tanner's state, but no one passed judgment (a woman sat next to him and silently rubbed his back as he kept swaying). They understood. They were there for the Orange County Needle Exchange Program (OCNEP), the first such experiment in county history. Started by five medical students at UC Irvine and operating every Saturday from noon to 3 p.m. in the Civic Center courtyard, the effort allows anyone who uses needles—from drug users to diabetics—to exchange dirty ones for new syringes. They also hand out tourniquets, antibacterial wipes, cotton balls, even heroin cookers. Plus, OCNEP lets its clients know where to go for treatment, refers them to rehab, and provides basic health care—no cost, no questions, no judgement.
This comes at a time when Orange County faces a heroin epidemic. According to the coroner's office, overdose fatalities spiked to 400 last year—a 6 percent increase from 2014, and 63 percent from 2006. It has affected all of OC, from South County to the homeless encampments of the Santa Ana River, and claimed everyone from the children of police officers and firefighters to third-generation addicts. And while the majority of deaths come from opioids, it's the addicts who arrive every Saturday at the Civic Center who often need the most help—and haven't gotten it until now.
The needle-exchange program is a controversial effort, but one co-founder Kyle Barbour argues is nothing less than social justice. "The people who eventually became clients of the needle exchange told us how bad things were and that they needed a service," says Barbour. "There are a number of services homeless people need, like health care and testing at the most basic level, but because of society's oppression and stigma against them, they have no way to access these services."
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Derek and Peter (not their real names), two admitted chronic drug users, haven't missed a week since the OC needle exchange started last February. Both say they contracted HIV and hepatitis C from dirty needles. "I've been full-blown positive for 30 years, and I've been terrified of giving the virus to other people," says Peter, who's on a first-name basis with most of OCNEP's volunteers. "We've become so spoiled that if we don't have new syringes, we'll go without using."
A smile forms across Derek's face. "We might go without, or we'll snort it or smoke it," he cracks, provoking a belly laugh from Peter. "I have stage-four hepatitis C. I've been terminal for the past five years, but I used to go forever off [one needle]. Now I don't use the same one twice, and neither of us loans out or uses anyone else's needles. There's just no way."
"Orange County has the fourth-highest number of HIV-positive patients in California—a number that's doubled in less than 10 years—and has nearly 1,000 cases of hepatitis C," says Barbour. "Providing clean equipment to injection-drug users can drastically reduce the risk of contracting these diseases because the need to share or use a needle more than once is essentially eliminated."
A report conducted by New York City government officials showed that between 2001 and 2013, the rate of new HIV infections plummeted from 5,684 to 2,832 after needle exchanges were implemented there. Barbour also cites a survey conducted in 2011 by the National Center for Biotechnology Information that compared neighborhoods in Miami (a city with no needle exchanges) to San Francisco, which has multiple such programs; Miami racked up a total of 371 used needles on the ground, while San Francisco landed at 44.
"We live in a society that's extremely hierarchical, in which some people have access to power and wealth and influence and other people don't," Barbour says. "It's wrong to have these massive inequalities. . . . Everyone should be treated with respect and dignity. Since I have a fair amount of relative privilege, I feel like it's my duty to use it to try to even out the lack of balance in society and work on creating a pathway toward a better society."
He and his fellow UCI medical students got the idea for OCNEP in 2015 after asking the Civic Center Roundtable—a group that advocates for the rights of homeless people in the area—what health services were needed. The Roundtable told them about death or serious paralytic illness caused by botulism, a nerve toxin produced by bacterium, as a result of sharing needles. After learning about the issue, Barbour and others scoured the Civic Center for two days to get an idea of how many dirty syringes littered the area. They found nearly 200.
"I was raised in an environment where the poor, people who live on the streets, the homeless or whomever are still a valuable part of our society and important," says Miriam McQuade, Barbour's girlfriend and an OCNEP co-founder. "My parents were physicians and raised me with the mindset that people are inherently good and their situations are situations, which doesn't make them bad."
McQuade, Barbour and co-founder Jemma Alarcon, along with two other UCI med students, launched OCNEP with a small grant from the California Department of Public Health (CDPH), deciding to operate in an outdoor courtyard to better reach their target audience. The CDPH provided needles and syringes, other harm-reduction supplies, and a waste-disposal service through the Syringe Exchange Supply Clearinghouse Program, which, Barbour explains, has totally "saved their bacon" on several occasions. "People are concerned about the fact we distribute a lot of syringes," says Barbour, "but we collect about 70 percent of the syringes back that we give out . . . which is excellent in terms of syringe-exchange standards. Also, the remaining 30 percent of syringes don't just go on the ground. They get thrown away at other needle exchanges outside of the county or get disposed of at pharmacies. So the reality is that a lot of our needles do get thrown away."
The Santa Ana Police Department (SAPD) claims otherwise. Chief Carlos Rojas says that since OCNEP has opened, syringes around the Civic Center and Santa Ana library have gone up, although he admits his conclusion is based on anecdotal evidence. "There have always been people in the area who use heroin or who are heroin addicts," explains Rojas, "but we have seen an increase in syringe waste around town, which is why we've been talking to the needle-exchange folks to see what can be done to mitigate that negative impact. Although I understand that there are health benefits to the program, it has been a challenge in terms of keeping the area needle-free."
"We found 200 needles over two days before we started," counters Barbour. "So when I hear that someone found, like, five syringes, I can't help but think we're doing something right because of what a substantial decrease it is from what we saw."
That issue is one small facet of the complicated relationship between law enforcement and OCNEP. While California's Health and Safety Code allows clients of legally authorized needle-exchange programs certified by the CDPH to possess an unlimited number of syringes for personal use, Barbour claims his clients are cited all the time for items he gives them. In some cases, he says, the paraphernalia is used by police officers as justification to search clients or their car or to detain them for other reasons.
"We've had reports of this happening from every police department in the area, from Santa Ana to Orange to Tustin—it happens all over the place, and it's a huge issue," says Barbour. "People get detained, and then we have to give them advice on how to fight it in court, when really it should get dismissed. It's really unfortunate, and it stems from the idea that it's okay to treat the homeless, poor or addicted like that."
* * * * *
At the end of the needle-exchange production line every Saturday stands Aimee Dunkle, a slender, blond woman originally from the U.K. The co-founder of the Solace Foundation—Solace being an acronym for Surviving Our Loss with Awareness, Compassion and Empathy—her main task at OCNEP is distributing naloxone, an overdose-reversal medication, and training people how to use it. OCNEP claims to have already saved upward of 450 lives, including a man Dunkle found in late November seconds before he stopped breathing, bent over on a bench with saliva dripping from his mouth.
"I told my co-worker to call 9-1-1 immediately," says Dunkle. "It was a life-or-death situation. . . . It took two shots of naloxone before he was up and walking around again. Most of our clients don't dial for emergency because they're afraid of what law enforcement will do, as many of them have warrants and other legal issues. I'm glad we were there to save him. That's why we do this."
The Solace Foundation started after Dunkle's son, Ben, passed away at age 20 from a heroin overdose. Since then, she has become Orange County's go-to woman for naloxone. "It is one of the most important things to have if drug use is an issue that someone close to you faces," says Dunkle. "My son didn't have to die; naloxone could have saved him. But it's my job now to help other people avoid the pain that I've gone through with the loss of my son."
OCNEP has offered naloxone at all but three exchanges—and those weren't by choice. The medication isn't cheap ($4,000 per dose), and OCNEP is severely underfunded. Besides CDPH, the group gets some funding from the Orange County Health Care Agency and HIV-prevention and medical-student leadership grants, but those aren't reliable streams of income. Solace Foundation is donation-based.
"When you consider we've been doing this for 10 months, to have only three weeks without [naloxone] is pretty extraordinary given how difficult it is to get," says Dunkle. "We've just been lucky. We've had a lot of support from the harm-reduction community, which is an extraordinary group of people. We've also had some donations, but, I don't know, somehow we've just managed to keep it going.
"We're lucky," she repeats. "We've been able to save a lot of lives."
One man who OCNEP couldn't save was Garry Valdez, a resident of the Courtyard, Orange County's first permanent homeless shelter. He overdosed there on Dec. 5, 2016, according to group volunteers. As he slipped away, OCNEP client Elizabeth Wettlaufer, who resides in the Civic Center, rushed to find naloxone for him. "Someone had an auto-injector [of the drug] for us to use," she recalls, "and after I administered it to him, he did start to breathe again. But he was still non-responsive."
Dunkle had taught Wettlaufer that in situations such as Valdez's, a second dose is necessary. But just as she was going to administer another shot, Wettlaufer alleges, sheriff's deputies walked into the terminal. "They asked me what I was doing and what was in the vial and syringe. I told them it was naloxone and that Garry needed a second dose. [The deputy] looked at me with such disgust in his eyes and said, 'Let's not overload him on that stuff,' which isn't even possible. You can't overload on naloxone."
(A Sheriff's Department spokesperson says deputies did not handle the incident.)
As a result, Wettlaufer says, the second shot of naloxone was never administered to Valdez. "When the EMTs got there, they tried to resuscitate him, and blood came out," she says. "It was already too late."
The OC coroner's office has yet to release a cause of death, but Rojas claims his commander told him that OC's homeless czar, Susan Price, said the death was due to "natural causes."
(Price also did not return a call for comment.)
Wettlaufer scoffs at Price's conclusion. "I know an overdose when I see one. I may be a heroin addict, but I'm not an idiot," she says. "Perhaps [the second shot of naloxone] wouldn't have saved his life, but there's a chance it would have. We'll never know now."
"This is such a disturbing thing to hear," says Dunkle of Valdez's passing. "Due to the amount of injection-drug users in the area, every staff member who works in the shelter and law-enforcement officers need to be trained on how to administer naloxone. It's unacceptable that this isn't standard protocol."
While Valdez's death cast a pall over the past couple of Saturdays, it has given OCNEP an added resolve. During a recent session, Dunkle assisted a young man in filling out a questionnaire.
"When and where did the overdose occur?" she asked him.
"Last Thursday in a hotel room in Santa Ana," he replied, his eyes drooping sadly.
"Who was the overdose victim, and how old was she?"
"My girlfriend, Layla. She's 26. It was one of the worst overdoses I've ever seen. She would have been dead if I didn't have the naloxone you gave me."
Dunkle responded, "I'm so glad you took some home with you last week."
"Death is not an acceptable bottom [line], and we should not accept that people who use drugs should die," says Barbour. "That's why what we do will help more people than cause issues. We have the chance to help them heal."
* * * * *
Last month, shaken OCNEP volunteers packed white paper bags with clean equipment for clients. Just minutes earlier, officers patrolling the Civic Center asked them if they were handing out heroin with the syringes. "This is just another example proving the massive gap of comprehension [between] what the needle exchange actually does [and] how it works and affects the community," says Barbour, a look of disbelief on his face. "There needs to be training and an increase of knowledge among enforcement. Lack of understanding doesn't allow progression."
Barbour is used to skepticism. Critics—city council members, law enforcement from around the county and Orange County residents—insist OCNEP normalizes drug use, encouraging people to stay addicted instead of trying to get sober. "It's like saying because condoms are available, people are going to turn into sex machines," Barbour says with a laugh. "That's obviously not true. It allows people to have sex responsibly, without getting or spreading STDs. That's what the needle exchange does, too: It allows people to use drugs responsibly without spreading life-altering, devastating diseases."
Diane Goldstein, a retired captain of the Redondo Beach Police Department and board member of Law Enforcement Against Prohibition (LEAP), says the obsessive focus on reducing drug supply as opposed to reducing demand perpetuates a groupthink mentality among many police departments and do-gooders. "Such rhetoric is still heard far too often in law-enforcement circles," Goldstein wrote in an essay for Substance.com, a website dedicated to understanding the relationships people have with drugs and addiction. "[It] ignores the proven efficacy of harm-reduction programs at protecting both people who use drugs and public-safety professionals, while enhancing positive public health outcomes—including the reduction of crime."
Barbour says he wants his clients to get off drugs, which he knows is a goal for a lot of them. He gets inquiries about treatment at every exchange, but, he admits, the resources in OC are "terrible."
"Abstinence-based treatment programs don't work for a lot of people," he says, but "it's nearly impossible to get people on suboxone unless you have money," referring to a drug that helps people transition off heroin without withdrawal. "Methadone is available through Medi-Cal, but if you're homeless or don't have a means of transportation, it's going to be really hard to do it. You have to show up every day or every week to get the injection, you're only given a limited supply, and there are rigid rules if you miss appointments."
OCNEP co-founder McQuade adds that injection-drug users are society's most stigmatized addicts, which ultimately reinforces their lack of dignity and confidence, as well as their self-loathing mentality. OCNEP, however, operates with a no-judgment rule, accepting and treating with respect every client. That's why the group works with other like-minded nonprofits. The Aids Foundation of Orange County donates HIV and hepatitis tests so examinations can happen onsite. Meg Muñoz, the founder of Abeni, a nonprofit aimed at providing a safe and confidential place for Orange County sex workers, shows up at every OCNEP gathering. She provides condoms for both men and women, lube, feminine-hygiene products, and pregnancy testing.
"We serve sex workers, sex workers who are LGBTQ, people who are hustling. We serve females in the sex trade, males in the sex trade, whether they're using drugs or not," Muñoz says. "But by serving sex workers, you're actually taking care of people who are being trafficked. You can't tell the difference on the street. No one knows who's who, which is why offering our services at OCNEP is so important."
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"This is what a true harm-reduction program provides: multiple services to people who don't have access to anything," says Barbour. "It wouldn't be possible without the other groups who work with us."
The gatherings are also starting to welcome people just released from the nearby Orange County Jail, many of whom were jailed on drug offenses or got hooked in the pen. "This, I believe, is key to their safety," says Susan, an OCNEP volunteer who works specifically with the recently incarcerated. "Having access to sanitary supplies, condoms, naloxone, medical services, free treatment and access to basic survival needs . . . is critical to their health and well-being."
"I had a person last week tell me that [the volunteers at OCNEP] are the only people in his life who treat him like a person," says McQuade. "Imagine if everyone in your life treated you like you weren't a human and gave you no respect whatsoever. Giving these people respect and treating them with compassion is what gives them hope. It helps them heal and can help them see that life is possible without heroin."