0 years ago it was extremely rare to find a needle on the beach. Now it's extremely rare not to find one. I understand the whole concept of harm reduction and I believe in it. I also don't think it should come at the cost of public safety. We need to have accountable programs. We need to have programs with expanded hours if necessary, run by professional people who again can offer counseling to people at that golden moment when they might be open to suggestion. To allow volunteers who are untrained even though eager to distribute hypodermic needles is irresponsible. Please think about that. Hi, my name is Mai Dow and I have been a resident of Mount Hermann for 20 years. And I'm here today to offer my strong support for the needle exchange program and for the harm reduction coalition as an active part of Santa Cruz initiative for the health of its city. Today, June 11th, would have been my older sister's birthday. She died a couple of years ago at the young age of 62 of early onset Alzheimer's that was no doubt due to the chronic use of opioids and prescription drugs. I've asked this question over and over and all this time. Why my older sister? Why not me or my older brother? We came from the same privileged background growing up in Cupertino attending one of the best high schools. What I do know is that this is a very complicated question to which there are no simple answers. I've racked and searched for it and that I'm still searching for years later. What was already an epidemic years ago when my sister became a chronic user has only worsened by several waves since then. And it's been hitting our community especially hard since the introduction of chronic use of pharmaceuticals. The long-term effects are only starting to be felt by this way. The bottom line is no one in this room will be unaffected by chronic drug use either their own or by a family member. They are all your family members, the chronic users in this city. They may be in another city but we shouldn't be othering them anymore than those people we seek to hopefully help our own family members in another city. Pretty much my entire family abandoned my sister when she was struggling with her opioid use. So we do we wanna abandon our citizens in this, I don't have a problem with people not caring or bearing their heads in the sand about it but I do have a problem with them throwing wrenches and intimidating and harassing anyone willing to help. Please I implore you bring these vital services to our county. Hi board members, my name is Jennifer Landford Brown and I'm here in support of the county's syringe access program. I am part of the harm reduction coalition and I have been out for every single outreach. I'm an employee right now of Beckin and Dickerson and I'm a biomed tech. I also work for the public authority here in Santa Cruz. I have a degree in political science I'm masters in criminal law from the College of William and Mary in Virginia. I have been part of harm reduction for a while. I have a son who has a substance use disorder. He's 25, he's in Virginia. He's OD three times. He has now contracted hepatitis and he is in and out of rehabilitation because they actually have beds there. So they, I am here because the county allows what the state allows and the health and safety codes. One, two, one, three, four, nine, point one through three allows secondary exchange. If we didn't do that, things like my neighbor who just contracted HIV because she didn't know she was having sexual intercourse with a man who had HIV or was HIV or AIDS. And now she is 49 years old and she never used a drug in her life. I'm asking you guys to just go by what the state recommends. In Roanoke, Virginia, they went by what best practices here in California and they almost eliminated syringe litter. It was horrible and open up the beds, open up the hours, just allow us to refer people, more people to services. Please. Good afternoon. My name is Erin McLaughlin. I'm a senior manager of residential services for Encompass Community Services. And two of our programs are Cece Puede and Santa Cruz Recovery Services which are substance use disorder treatment plans. I am speaking in support of the county syringe services program and here's why. To decrease the rates of HIV and hepatitis in our community and to increase treatment opportunities for people in this county who struggle with opioid addiction. A study by the CDC in 2018 found that syringe distribution programs decrease the frequency of syringe sharing and reuse. And this has significant impacts on decreasing the rates of infectious diseases like HIV and hepatitis which is often spread through sharing needles. The study also found that people who participate in programs like the syringe services program are more likely to seek treatment for substance use disorders. This program is an important part of the continuum of care and Santa Cruz that leads clients to participate in the treatment programs like SCR and Cece Puede. So in closing, I'd like to urge your support for this very important program which helps people in Santa Cruz County find their way to treatment and ultimately a path towards health and recovery. Thank you very much. Good afternoon. I'm a constituent of Zach Friend. My name is Katrina Lisma. I'm a nurse and associate marriage and family therapist working at the medication assisted program at Encompass Community Services. Math services are not directly involved with the syringe services program but I serve the same clients and we are a part of the substance use disorder treatment services for this county. Harm reduction is much more than needle exchange. It is a practical approach to help people change with safety front and center. What I see by working daily with this population is that meeting with people exactly where they are leads to trusting relationships where people are more likely to ask for help, make safer choices, seek and receive medical and behavioral healthcare and keep coming back. Because of the syringe services and other outreach programs, many of my clients and our community members have been linked to our services which help them recover and stop using. I support an expansion of the SSP services. Santa Cruz County needs to adopt a harm reduction model of care for providing these services. Thank you. Ma'am, can I ask you a question? Yes. So please come forward to back to the microphone. Which is where I think everyone here is interested in getting more people connected to treatment and aligning the syringe services. We constantly ask how many people from syringe services are getting, Matt are getting enrolled and the answer is we don't know because it's anonymous. But if you just made a claim that you get a lot, can you tell me what percentage of your new clients are SSP users? Were they monthly users? Like how do we know this? That's a really good question. I don't have specific numbers. I can tell you that this population tends to be rather chaotic. They can't remember things. Their day-to-day living is really chaotic so they don't necessarily track these kind of things. I can't give you numbers but I'm sure we can probably find some at some point but I know that the continuation of care as other people have spoke of, the connection to all these services happens as a partnership, a community partnership. It's a porous, a non-porous system and I see people that come in and out of all these different services, outpatient, inpatient, cross-camp treatment, the whole thing, right? So I think going forward, it would be very good to get this information. Right now it's anecdotal. Right, thank you. Thank you. Hi, I can just add there is also lots of documented research if you wanted us to share that with you outside of Santa Cruz. Yes, I'm interested in Santa Cruz, but yeah. Great, good afternoon. My name's Savannah O'Neill and I'm a manager at the National Harm Reduction Coalition, which is a national capacity building and advocacy agency. I have 12 years of providing volunteer syringe service programs. I'm an addiction treatment counselor and social worker and I first worked in syringe exchange programs here in Santa Cruz in 2008 for five years. In my current role, I work statewide to strengthen community-based harm reduction programs, link people to care and build safer communities. I support county-run, organization-run and volunteer-run programs across the state, all who provide essential lifesaving services. I support expanding services in Santa Cruz County, currently only 20% of Santa Cruz residents live within five miles of a syringe exchange program, making it really difficult for people to access. So with the addition on mobile services, we know we would reach more people. When we look at HIV rates, hepatitis C rates and overdose across all California counties and we compare to Santa Cruz, Santa Cruz is at a high comparative rate of a potential HIV outbreak and Santa Cruz has far more restrictive and less services than most counties in California, reducing people's chances to connect and the most marginalized people. In 2017, Harm Reduction Coalition, the national organization conducted a needs assessment where we talked to 70 people who use drugs and providers in the county and we heard that they were mostly only having contact with outreach workers and those outreach workers were essential links to healthcare and treatment, offering people support in the field. For these reasons, I support the expansion of services that we know are based in evidence, save lives, reduce infections and treat people with humanity. I also support because people in the county want these services and they wanna be a county that stands in support of public health. Thank you. Hi, good afternoon. My name is Jenna Haywood. I'm also with the National Harm Reduction Coalition. That was my colleague Savannah. I won't repeat some of what she said about the statistics we know in Santa Cruz, but I will share that I'm also someone who is an IV drug user for over a decade and I now do consider myself to be in recovery. And I wanna talk about the fact that we need more, not less tools for people who use drugs, people seeking recovery or people just seeking to stay alive in whatever state they happen to be in in that day. So when I hear a lot of people talk about the fact that secondary syringe programs are not equipped to actually serve the needs of people who use drugs, I wanna talk about my own experience with peer-based support. That yes, I have used medical providers and I have gone to the doctor for support, but when I struggle with my recovery, I go to peers because I know that is what works for me. And so why wouldn't that model of peer-based services and harm reduction also be effective? And in fact, we know that it is. There is ample evidence to show that peer-based support is what works for people. I also wanna mention that we have advocated at the National Harm Reduction Coalition for money in the state budget this year for peer navigators to link people to treatment who access services at syringe services programs. So it is at the governor's desk right now. There'll be $15 million. Every authorized syringe program, syringe services program can have a peer navigator. Why did we do this? Because we talked to people who use drugs that said we wanna get into treatment. We don't necessarily trust mainstream medical providers all the time for different reasons because of oppression, because of trauma. And so there actually are going to these programs and that's what's helping to link them to care, but programs don't have enough money to do that warm handoff, to actually help somebody get to the treatment provider. And so with this funds, hopefully it will pass and this will allow Santa Cruz some more resources to meet that unmet need. But we have to support all of the different kinds of ways of reaching these people and that's why I encourage you to expand these services but also to really rethink the secondary syringe. It's legal and it works. Thank you. Hello, my name is Patricia Olson-Reiman and I am a 40 plus year resident of Santa Cruz County and my children have gone to public school here. My husband has his own business here and I've been working in the nonprofit world for over 20 years here. Right now I am the program manager of the Santa Cruz AIDS Project at Encompass Community Services as well as I work with the Encompass MAT program. I'm only here to just say a couple things and mostly is that it's highly imperative that we support the SSP. If not the best practices. Watching the presentation was really wonderful to watch but the 20 hours a week was kind of a little bit of a discrepancy for me. Working in the nonprofit world we are working in the frontline. Very rarely do you come to a situation such as this and see reports such as the presentation today. We're working with the people every day and we are seeing their suffering. We're seeing their disease and how it's progressing and we're seeing their isolation and depression and anxiety. And so I think what I just want to say is I just really want to support the county's program. And I want the county to work with us. I think that's the other key thing. I think there's a missing link and really working together with Encompass Community Services the MAT program and the Santa Cruz AIDS Project. We're seeing the people at our offices and we need to be able to have that relationship with the county to work with them closely so that we can have them over and have them do the hand warm off to the medical services there. Thank you. Good afternoon board. My name is Damon Bruder. I'm an addict and recovery. I'm here with my personal experiences. I'm here with my family, my grandchildren. Nobody that I've heard speak so far today is against the Surin Services program. Everybody is for harm reduction. Everybody believes that harm reduction does good for our community whether it be the addicts or just your average citizen. Nobody wants to step on a needle. That's part of harm reduction. Keeping the citizen safe as well as the clients. That being said, as an addict, I needed to have wraparound services to help me get clean and sober. I needed to be able to walk into a place and get told, hey, there's an option for you.  We're here to help you. That doesn't happen in the field. Any expansion of the SSP should be done under the umbrella of the county and our health services agency. Ms. Hall and Ms. Herrera have both shown a great interest in being more transparent and fixing and tweaking the things that are wrong with the program and trying to make it better for everybody. We're working hard for that. I'm part of their advisory panel at the moment, hoping to be of more help to them in the future. What we need, we need more hours of accessibility for the SSP. We need more beds for the people that need help. There has to be a bed available when people want help. And we need to close the loophole of the secondary exchange. We need to put a cap on that of approximately 50 needles per secondary exchange. The secondary exchange that was going on by the Harm Reduction Coalition dropped the client numbers seen at the SSP by over 40% in a three month time. 40% of the people that used to go and get their supplies from the SSP stopped going, stopped having access to medical, mental health and recovery possibilities because the secondary exchange took needles to them. It was room service. Please do something about that loophole. I'm available anytime. Anytime anybody wants to talk one-on-one. I'm easy to find. Hi, my name is Savannah Carlson. I graduated from Cabrillo and I work as a caregiver with adults with developmental disabilities in Santa Cruz. I'm here today to support every expansion of services around harm reduction. I hope that the Board of Supervisors today can vote to allow the program to begin to move towards the advisory groups recommendations, which are backed by both local and national data on how to best support public health. The program has been stopped from enacting best practices for a long time and it's time to move towards science-backed policies, which all forms of harm reduction are. Also to make it personal, my mom has been addicted to heroin for a long time and I am honestly grateful that she doesn't live here. She lives in a county where services are much more expanded, including peer-based support and those policies have saved her life multiple times. I wouldn't have a mom without them, so thank you. My name is Olympia. I'm a recent graduate from the community studies program at the UCSC. I've lived in Santa Cruz for almost four years and in the past year, I spent six months doing a participatory observation at the Homeless Persons Health Project and also volunteering at the county syringe services program. During my time at HPHP and SSP, I met people who were current and past drug users, some of whom access county services regularly, visiting the exchange on a weekly basis. Many clients I built relationships with, however, were not accessing SSP for a variety of reasons. The data presented on SSP demonstrates a clear need for programs like this in our community. However, after six months of outreach, it became clear that SSP sees only a fraction of drug users in our community. While the lack of hours at SSP was one of the barriers to accessing services, trepidation about entering county buildings guarded by security officers, as well as mobility issues preventing people from actually getting to the Emeline campus to exchange needles seemed to be an even larger barrier. In order to fulfill its goal of acting as a gateway to integrated services, the syringe service program should be complemented with mobile exchanges and street outreach in order to engage with folks who aren't able to access the Emeline campus or the Watsonville location. As has been stated in previous comments today, harm reduction means meeting people where they're at and that means symbolically, but also physically, which is what mobile exchanges do. Thank you. Good afternoon. My name is Josie Roberto, and I'm speaking to you today as a concerned mother. I have four adult children, two teens, and two, three young children, including my grandchildren. They're all being raised in Santa Cruz County. I am here in support of the syringe services program and best practices. I'm not as versed in what that is, but I can tell you my experience in the community and my concern about prevention and about holding compassion for all our community members and what I've seen. We spend a lot of time downtown and local beaches and on West Cliff and we do participate in beach cleanups and we have found needles. We have interacted with people on the streets and I think it's important that the board remember they are human beings and I teach my kids and raise them to treat people with respect, even if they seem, you know, doesn't mean I want them to know them, but treat people with respect. We don't know where they've come from and what they've seen and what they've been through. And you know, I'm gonna remind the board what we've been doing in our cannabis industry for the last four years. The board encouraged us to instead of attacking other members in our community or other programs or other neighbors, you encourage us to listen to their side with respect, you encourage us to make the compromises necessary to come to agreements and I thought that was a really important lesson. I actually bonded with the people that were absolutely opposite side of the scale as what I believed in and by finding that common bond and respect, I think that the county can find a way to not demonize these people and to not attack these other programs because they're coming from a place of compassion and they wanna help. Thank you very much. Thank you. Hello, my name is Danny Drysdale. I'm a constituent of Zach Friend and a lifelong resident of Aptos. I was born and raised here. I'm speaking with strong and unequivocal support for all possible strengthening of the county SSP and I have that same level of support for our secondary exchange program. I am a proud and active volunteer with the local harm reduction coalition's secondary outreach efforts. I go out there every week. I believe that my support to other addicts as their peer is deeply important to the health of our community. I went to Aptos Junior High and Aptos High School. It was there when I was 13 years old that I started using drugs very heavily. When I was 14, I became a daily user of cocaine. That same year, I found out that my mom also had the same addiction when she was my age and I spent my entire teenage years struggling with that. Because of the common beliefs around addiction that are especially prevalent in Santa Cruz, I came to believe that I was broken. I was racked with shame and I almost took my own life on multiple occasions and kids here should not be growing up with that shame imposed on them. A community that believes itself to be progressive should not be flooded with these narratives that I learned as a teenager and it should definitely not have some of the most restrictive programs in the state. But as I'm learning now, Santa Cruz is a massive aberration. It is a specifically regressive community on the question of drugs. I blame that fact directly for my traumatic teenage years. There is no data to support the claims of opponents of harm reduction, the SSP, or the secondary exchange. The arguments against secondary are in complete contradiction with public health research.  When public health data and the stories of victims were completely ignored, leading directly to the loss of many thousands of lives. There was a point in the AIDS crisis early on where half the country believed that all AIDS victims should be quarantined and forced into that kind of care. And we have the same kind of messed up, misinformed public opinion here in Santa Cruz and I don't think that should trump public health opinion. I don't think it should trump the need for care that me and my fellow volunteers provide every week in this county. Good afternoon, Board of Supervisors. My name is Melissa Freebarron. I'm a registered nurse. I'm a former Matt nurse. I'm a nurse who've worked at your local jail and I currently am a supervisor at a state prison in Soledad. I come here to advocate for vulnerable populations like I have since the beginning of this campaign. Drug addicts deserve the same level of medical care and outreach that every citizen in this county deserves and what that means is that we don't leave this population in the hand of unqualified. While they mean well, it is misguided. Untrained volunteers going and handing out needles and Narcan and not being able to offer somebody HIV, Hep C testing on site. Not really understanding what that means when they hand the Narcan. I understand that. I am that nurse who runs to a man down of an inmate who is blue, who is dead. I pump on that chest. I administer five doses of Narcan in a correctional setting where yeah, I work around a lot of people who don't think and feel the same way that these people are still human beings even after they've committed a crime and they're incarcerated because what's missing from this conversation with all these people is that the end result of a heavy duty drug addiction is that you will end up dead, you will end up incarcerated or you will recover. There is nothing else. There is nothing else unless you are extremely wealthy and you can maintain a heroin or meth addiction over the course of your lifetime and that is paid for by someone else. So I am in full support of the county taking this program back and stopping secondary exchange by people who are not trained. They cannot link people to services. They have zero data to support that they can help anybody and until they come under the umbrella of the county, you have to stop this. Hi, my name is Dane Enderton. I work for the HIV Education and Prevention Project of Alameda County. I'm here because I originally moved to Santa Cruz when I was four and I lived here until I was 27 and I really feel like I call this place home because it was the place that raised me and it's the place that I really feel like is special in California. I'm also here because I wholeheartedly support the Syringe Service Program and all of its best practices and harm reduction. I have lived in this county. I've been homeless in this county. I spent a primary portion of the time that I lived here in the mountain area of Santa Cruz. I first moved up to Long Pico and then I lived in Boulder Creek and then Lomond and Felton all over that area. I can tell you because it is a more removed area, it is very difficult to get access to the program in Santa Cruz and throughout my entire time growing up, I knew people who suffered from addiction who really needed the help that the Syringe Services Program offered in Santa Cruz and it was very difficult for any of them to get down there. I work in data so I can tell you from a data perspective, from a science perspective, secondary syringe services work, all of these programs, all these best practices actually work, they help save the county money, they help reduce syringe litter. If we really wanna see reduced syringe litter, if we really wanna see more people in recovery, if we really wanna see this county get more help, expanding the syringe services program in every way possible is the best way to do that and there's lots of data that shows why. So please, if you could do that. Good afternoon, I'm Scott Graham and I'd like to refer to this item 20. You got it as 20.i, exhibit nine. It's in your folders and it's from the office of AIDS, the California Office of AIDS and it says the Department of Public Health advises syringe exchange programs to needle-based distribution policies with the goal of ensuring that participants have a new sterile needle each time they use. Under the program that you currently have at Emeline, you're doing a one-for-one exchange which is not needs-based. No, there's different levels of exchanges. There's like the one plus where people can get more than one needle and what is the best practice according to this document is the needs-based where the person comes in and they might not even have needles. They might have put all their needles into a bin somewhere. So having the ability to get the number of needles they need is what's gonna be the healthiest thing. I had friends that died of AIDS and it's possible that that epidemic could come back if you let it. So I would urge you to work with the Harm Reduction Coalition to work out a way that that program can exist in this county and help them work with the different areas where they wanna do distributions and go into those areas and do public relations with you and the health department to ensure that these things happen. Thank you. My name is Danny Contreras. I'm the Health Service Manager over the Medication Assisted Treatment Program for the County of Santa Cruz. I would urge you to accept or approve the county's recommendations. I say this because I started at the county in 2016 and I worked in the Syringe Service Program for about a year and a half and through that I was able to connect with people that probably nobody else can connect to and through those services I was able to get people into IVH to specialty mental health, to medication assisted treatment and sometimes that is just building a relationship with people every single time they come in. Yeah, they might not be looking good but hey, you got an abscess. Let me get you to the nurse. Are you ready for treatment yet? Here's my phone number. Every single time. Here's my phone number. Here's the brochure. Here's some other services. You might not want it but here keep it just in case you want it later or you change your mind. All of our drug and alcohol counselors we have five drug and alcohol counselors underneath me who all are doing shifts in the Syringe Service Program and all of them are providing those services or connecting people to services throughout the county whether that's whole person care, IVH, drug Medi-Cal, connecting to Encompass, C-Suppoy, the Santa Cruz residential, Alto, whatever drug program that is but it's basically just working with people where they're at and providing the services and we're just laying it out for them. You know, we're showing them love when sometimes somebody else won't show them love. And we're being a voice or advocate for them when sometimes nobody can hear their pain or what's going on with them. Some of these people have severe trauma, severe stuff that you don't know or that nobody knows, that they've never shared with people. I have watched people come from the bushes and have nothing. When we didn't have the MAT program in Watsonville Health Center yet and we were still rolling it out, they would get homeless, try to find a bus or a ride to HPHP to get MAT and continually strive and struggle. And that came through the Syringe Service Program. One of those persons, a couple of those persons wanted to come here today but they were not able to because of work and they're getting housing some of the other persons but they got full-time jobs now, they're going to college, they're working on becoming drug and alcohol counselors and they're doing a lot of awesome, amazing work and they're helping people else recover too. Thank you. Good afternoon. My name is Matt Nathanson. I have been a resident of Santa Cruz City in the county for 25 years. I'm a constituent of Supervisor Coonerty's. I also am a public health nurse. I've worked for 21 years in homeless services for this county and I'm here to speak in support of the recommendations. I actually think there is more that we could be doing but I think they represent a political compromise of where sort of the community is at. I don't think they necessarily represent the best science but the good things in it, I guess what I would want to say is first of all, Santa Cruz used to be a leader in syringe exchange back in the 90s when I started working here. We were a model for other places and I think that was largely in response to the HIV epidemic at the time. I think part of the problem has been over the last several years. We've lacked leadership in the health department to move forward on this issue and I'm really excited today to see the health department leadership bringing forward these proposals. So I think that's great. I think what I want people to, there's a lot of focus on this syringe and as a nurse my view of this is I want some, if somebody is gonna be injecting drugs, I want them to be injecting drugs with a clean needle every time because every time they use a dirty needle they're at risk of contracting as we've heard HIV, hepatitis. There's lots of people with endocarditis in the hospital with really severe abscesses. There's a huge economic cost as well as personal costs.  I want them to not reuse their needles. I want them to use clean needles. There's no moral judgment there. It's just about people's safety. I also think that I'm glad that there is the study about syringe litter. I think that that issue causes a lot of fear for people and I understand that but you can ask your epidemiologist how many people in the county have contracted HIV or hepatitis from an accidental needle stick in the environment stepping on it versus how many people have gotten it from sharing needles. You'll find the numbers are dramatically different. Anyway, I'm out of time. Thank you. You can pull it down. No, no, not that one. The other one. What's going on? Don't start, reset my time. Okay. Hi, my name is Annalisia and everyone I came here with today lives in Santa Cruz County. Okay, let's make that clear off the bat. We've been talking about this for a long time and I'm proud to say that everyone, at least that I've heard that it stood up is not against the SSP. That's not what this is about. We're for harm reduction. We believe that that is absolutely part of the answer. I do sit on the sheriff's advisory team and the harm reduction coalition did come in and I did get a chance to hear them out. I was really alarmed and I hopefully all of you have read all the holes that have been put into this harm reduction coalition state application that went through but things like questions about data. So how many people did you refer to rehabilitation or any kind of services? This person has hit rock bottom. They have said, I need help right now. What, okay, what do you do now? Are you ready?  The answer was I have no information about that. Did you follow up? Did you call, like find that guy? Hey, you know, what happened with that? No, this is secondary services problems. This idea of getting needles from the SSP and calling ourselves a client, this is shady. This is shady things. And I want you to look through all this shadiness that all of us have been seeing on this state application which I see Swiss cheese that doesn't have this many holes in it. And I want you to think about what we're doing and who we want to be as a county. I want every single person who wants help to find it. And I know you guys read the grand jury findings and those weren't all their findings. It's things like that, little bits of information that are kept out of the conversation when they're brought to you and when they're brought to the community. Thank you. Hi, I'm Denise Ellarick and I'm the supervisor of Friends Constituent. And I was at a different meeting that Annie Alicia is speaking about because I explained the data that we do collect. We have collaborated with Mimi Hall and Jessica Altman's. We collect data on male, female, age, do you use the SSP? Naloxone distribution, all that. And we turn it over to Jessica. So the county data includes our secondary data. And you need to know that excessive data collection is not best practices for any syringe program be it the public health department or all volunteer. And what I'd also like to highlight, I know everybody wants to see how many people are cured but curative substance use goes a spectrum of it can be decades. And so if somebody doesn't use for one day and they're on Suboxone, but then the next day they use that's still a win. And it's gonna be very hard to ask for measurable outcomes on substance use curing when you're not using an evidence-based practice program. The real measurement of effective program is when you get that client into medication assisted treatment, are they HIV negative and do they have hepatitis C? And do they have endocarditis? Are they dying in the hospital of pneumonia from an unsafe, unclean injection? Those are measurable outcomes that we all have control over. And I value the syringe program incredibly. I don't have a fake account. I go in there, we talk by name. I'm a Sherpa. I met people that asked for this program because it was raining cats and dogs. The programs closed on Mondays. The holidays, they were closed on Fridays after Thanksgiving. And people were incredibly needy. They are in wheelchairs and walkers. Mud, it was an insane winter. And I look forward to connecting with our community. I have driven people to the SSP. I have driven people to the Emeland Clinic for wound care. I drove a gentleman. I have driven two men to the emergency room.  But there is a way to connect people to services. And it's done every day all over the state of California. We're not here to talk about any supplemental program. We're here to say thank you to Mimi. Thank you to Jen. Go with expansion of your program. Thank you very much. Good afternoon, Supervisor Coonerty and Board of Supervisors. My name is Erika Padilla Chavez and I'm the CEO of Pajaro Valley Prevention and Student Assistance, located in the heart of the Pajaro Valley in Watsonville. We provide counseling and outpatient substance abuse services to youth living in the greater Pajaro Valley. And that of course includes our beautiful community and APTAS. We are very proud to be a partner in the county's behavioral health continuum of care. And when I say behavioral health, I'm talking about mental health and substance abuse services. Well, at PVPSA, we work really diligently to prevent youth from swimming deeper into the continuum of need. We recognize that there are people along that entire continuum. And so it is therefore imperative that we provide services no matter where people are at in that swimming pool, whether they're at the shallow end or at the deep end. And therefore, I'm here today to say that the SSP proposal before you is a very sound and very public health-minded approach to addressing the needs of the people on the deeper end of the pool. It articulates a very comprehensive and systematic approach to increasing the opportunity for wellness for those individuals while ensuring the public's health. I want to thank the county team for being so diligent with conducting all the research and gathering the information needed to present to you a very articulate and a very research-based proposal. I am very excited to be a partner knowing that I have partners around me that do have expertise in working with folks that are in that deeper end of the pool. And I stand ready to work with them in whatever way possible to expand whatever service needs to be done. But I will continue to try to prevent our youth swimming deeper into the pool. Thank you. Chairman Coonerty, members of the board. I'm Arnold Leff. I'm a resident of Boulder Creek. And former currently a retired health officer. All I can say to all of you is do what needs to be done to decrease the amount of substance use in this community. By increasing the availability of the Syringe Services Program, you will in fact do that. By increasing the Syringe Services Program, you ultimately will decrease the amount of syringe waste in the community, not increase it. By allowing the county to increase their hours, give them as much flexibility as you can. By doing that, you will decrease the substance use in this community and you will decrease the amount of syringe waste in this community. All the evidence shows that. All the science shows that. Please follow the evidence, follow the science. Don't do what some people in Washington do and reject the evidence and the science that supports these programs because they do in fact prevent disease. They do in fact decrease the amount of syringe waste in the community and as importantly, they save a lot of illness and a lot of resources that have to be used to correct serious disease. Thank you. Hi, my name's Eric. So at the beginning of the presentation, the director said that SSP is not just about needles but the third party is about needles. When you've got two people handing out 600 needles a day, they're not sitting down, they're not doing testing, they're not having peer counseling. They're handing out needles and I just, I think one to one is the way to go. So the numbers show that there are fewer visits but more needles being handed out. So again, that's not consistent with it being not just about the needles. And finally, I'm not a health service worker, I'm a finance guy, I know money, I know numbers. So they say that they collected more needles than they distributed by weight. So I have to ask you, if I came and paid my property taxes by weight, would you accept the container and trust me? Thank you. Hello, my name is Craig Reinerman. I'm a 30 year resident of Santa Cruz, retired professor at UCSC and a member of the Syringe Services Program Advisory Group. I was around in the early 90s when we did an evaluation of the Santa Cruz AIDS project, the Santa Cruz Needle Exchange project under Santa Cruz AIDS project. And I was struck by how many people we learned, that was the first step. Showing up and exchanging needles was the first step they had ever taken in their lives to take responsibility for their own health. Nothing has convinced me otherwise since then. Syringe services do not cause drug problems by themselves. And I'm here just to add my voice to support the expansion of the hours and the services, the connection to HPHP, and particularly the distribution of fentanyl strips, which will help prevent overdose deaths. Thank you. Thank you. Speaker. Good afternoon. Hold on just one second. Is this our final speaker? Is there anyone else who'd like to speak to us? This will be our final speaker. Good afternoon, everyone. My name is David Junini, and I'm a recovered alcoholic and drug addict. 29 years clean and sober. What, it's emotional for me because what I see before me is so much possibility. So much can be done when we have an opportunity to interact with someone who's in the throes of addiction. Being able to garner the trust of that person when they make that rare decision to do something about the situation that they're in, that is a golden moment. And however you decide to structure this program, I would advise you to keep in the back of your mind the possibility of having trained professional addiction counselors available when a person has that golden moment where they wake up and they decide that maybe I can do something about my life. Maybe I don't have to continue to live this way. Whatever, however you structure this program, please keep that in mind. Thank you. Thank you. Thank you. So that concludes the public comment. I'll bring it back to board for deliberation discussion. First I wanna begin by thanking everyone who came out today. This is the most thoughtful and respectful conversation I've heard around this issue in 15 years in politics. And I think we're all much closer than often, not least on social media, we appear. And I wanna thank everybody for the thoughtfulness and for taking the time and sitting in a warm room as well to make sure your comments are heard. I'm gonna call myself first. I have some broad comments. And then I supervise it with Ferrisen and I have some motion that we'd like to bring forward and then have discussion and changes. So the first thing I wanna say is I very much support SSP and I think and I wanna congratulate them for the good work they do and the public health staff at the county are absolutely amazing. I've seen them from early childhood and babies all the way through disease prevention and Dr. Les' heroic efforts around hepatitis A last year saved many lives. It was stated that there were three goals for the SSP program and I believe that there are three goals, but I believe that we've overemphasized one at the exclusion of the other. And when we talk about reducing needle litter, the goal has to be there is no needles in our parks, beaches, neighborhoods or other public spaces. Once a week, a parent comes up to me and says I no longer or a grandparent, I no longer take my child to a park, to the parks or to the beaches or to the library because we went once and there was a needle or I heard about a needle. Now I can tell them what the epidemiologists say but that is not a conversation that they want to have or will believe. And so father of a young children there is no conversation that I can have where my child steps on needle, it's okay because the relative chances of disease are small. It has to be a zero possibility and when you have whole sections of our public no longer engaging in our public spaces out of fear that's a public health crisis and it needs to be treated as seriously as the spread of disease. Similarly, the efforts to expand access to treatment and I commend the HSA staff who's expanded treatment and hopefully will continue to expand it going forward and the work from people like Danny at HSA, I mean that is exactly what the kind of outreach and compassion and passion that we need to help people get treatment. So the short answer is we have an obligation to serve the needs of the entire community and I'm not sure the answer to too many needles is more needles. Santa Clara has seven times our population and gives out one third of the needles that we give out in just 12 hours of clinic time. Monterey has 12, two times the population and gives out 20% of the needles and their disease data is not different than ours. In fact, Santa Clara is better than ours. And in fact, we followed science and we are now giving out three times the needles that we're giving out in 2014. We haven't seen a statistically big difference in the amount of disease and yet there's far more needle waste than I ever remember there being. So I think we need when we look at this to figure out how we approach this in a way that will work in this community. The slide about the reduction in the number of clients served from September 2017 of 385 clients to 167 clients last month or in April means that we're not having any of those conversations. Means that we're not connecting people to services and we don't have people like Danny who's half the conversations he gets to have with people and that means that we both are getting fewer people referred to treatment but we also when we talk about and rightfully celebrate our HEPA response which wasn't spread through dirty needles but was because we had a relationship we have half the relationships that we had in September of 2017 to be able to deal with the HEPA outbreak. For litters, the downtown streets claim has cleaned up so far and it's not even a year yet, 6,000 needles. It was not the purpose of the downtown streets team to be a needle abatement strategy. They just happened to be out cleaning trash and it's job training program but for that program which had nothing to do with needles we would have 6,000 needles in our community. We have 217 reported by Save Our Shore, thousands by the city parks environment, thousands by community members. We have to figure out a way to drive that to zero so when I look at some of the solutions I'm absolutely supportive of kiosks. I've gone to city council members and asked them to put up kiosks but we had a kiosk at the gateway camp that was 20 feet away. We had HPHP that was a stone throw away and there were hundreds of needles on the ground in our waterway when that camp disbanded with a kiosk, with services there. When I look at the Citizen Connect I in general like the idea but San Francisco spends $700,000 a year to have a 24-7 needle program and San Francisco is an unmitigated disaster for needle waste so it's trying to figure out how we address that without spending $700,000 a year.  That is an expensive proposition and I'll tell you talking to City of Santa Cruz they're not gonna send people they expect us to send people we're distributing needles so the county is gonna be running a county wide program trying to connect people. And then when we look at expansion whether it's and I do believe I am supportive of some expansion but if you look at HPHP Coral Street is a complete public health and public policy failure right now. You have every child that's trying to participate in a summer program driving through an open-air drug market it's a totally unacceptable situation and to add yet another service into that area without talking to the neighbors and without having a strategy for what's going on we cannot have Coral Street look the way it is and ask to expand programs. Similarly I am supportive of expanding it but if you look at but if the third prong is really about community outreach how many conversations have we had with the neighborhoods before we advocate for expansions? So I think I wanna support and I will support SSP I will support the very good public health people who are trying an expansion of treatment but we just can't keep saying we have these goals of litter abatement and then I mean but for the fortune of bringing in the downtown association connecting with streets team there's 6,000 needles that would have been picked up by citizens, parks workers or somebody else and that's 6,000 needles that shouldn't have to be picked up in the first place and so I think I appreciate the efforts but it's not working right now and so it's very, very challenging to advocate for expansions when it's very much not working and in other counties that have much, much smaller programs even though they're dramatically larger their programs are working so it's hard to figure out what exactly is going on here when you wanna look at the data and you wanna look at best practices. Thank you for indulging me and I'm gonna ask Supervisor Fierce and then we'll work our way around the board everyone can have comments. Thank you, I agree with that. I, you know syringe exchange, excuse me, syringe exchange has been an important element in reducing our communicable but disease nobody disagrees with that and it's a proven positive outcome here and elsewhere and I'm really grateful for it and I wanna thank the Health Services Department and the agency too having brought this report to us and having to air this out as we should do probably more than each every two years but I think that we have, the county does have an obligation to find out what our program may be contributing to or against or for the program. A needle exchange has been in my district and Supervisor Caput's district up to now. I'm also troubled as stated that according to SSP we've seen the number of unique ID clients fault 40% in the past four years but then we also have syringes that we're giving out have nearly tripled. We're seeing fewer clients and we're giving out more needles. That's troubling to me. That doesn't seem to fit right. Doesn't make good math to me. We must help more people treat their addiction rather than just manage it and I do agree with much of what Supervisor Coonerty said. I would, if it's proper to like to move a motion it's a pretty lengthy one of one I've thought about and would like to move a motion to approve the recommended action and to accept the HSA biennial report for SSP and that we give this additional direction and there's seven points that I've been down. Direct the HSA to reduce the maximum number of clean syringes exchanged per person per visit at SSP sites from 100 to 50. Syringes returned to the county should be in clear containers as to be visible to staff receiving the syringes. And be weighed. This step will more closely align our procedures with our board approved one to one exchange policy. Second, in order to encourage more people to use primary exchange as a six month pilot that we direct Health Services Agency to increase the hours at the M-Lan and Watsonville clinics to 15 hours per week and to conduct a community meeting to address any concerns. I would ask for a report back in six months to determine whether the increased hours and fewer needles per visit serve the purpose of encouraging greater use of our exchange. Number three, direct the county administrative officer to manage a 90 day waste stream assessment using marked syringes to determine the extent to which syringes exchanged by the county, this county are contributing to the needle litter. That's an unanswered question now. The assessment should be conducted by an independent provider that is near the county or state department of health. The assessment will be confidential and conducted for a period of time with specific markings not made known to the SSP clients and the results were reported back to the board within six months of completion. Four, direct the Health Services Agency to return to the board by September 24th, 2019 with an ordinance to change the SSP advisory group to a seven member SSP advisory commission subject to the Brown Act with one seat appointed per district and two seats appointed at large. Five, direct Health Services Agency to work with the local jurisdictions to explore additional options for installing safe sharps disposal containers at HSA's expense if jurisdictions agree to the placement of the containers. Six, direct the HSA to start tracking the number of SSP clients successfully referred to medically assisted treatment. And lastly, number seven on mobile services and the homeless persons health project. While there may be benefits to the county providing additional services by public health in the future, now it's not the time given our concerns about the current exchange. And mobile exchange should involve community input about appropriate sighting and timing if that decision is to be made. That's the motion I have. And I'll second that. Supervisor Caput. I think we're pretty much ready for a vote. I wanna thank everybody for coming here and it's an honor to be a part of the board and actually showing everybody we're ahead of what it looked like was coming down from the state. It was very disorganized and we've always, we've been on top of this for quite a while and we're trying to improve it. So we're ready to go. I think this is good for South County and it's good for the rest of the county. So I think it's a slam dunk on the phone. Supervisor Leopold. Thank you, Chair. Thank you for everyone's testimony today. I really appreciate it and I continually learn from the public as I engage in conversations about this. I've had the place of watching needle exchange or syringe services over the past 25 years when the county passed its first ordinance about this in 1995. I was the executive director of the AIDS project. And so over that period of times I've seen the ups and downs of this program. And there's a couple of things that stand out to me. One is that when there has not been a strong institutional program, volunteers have filled the gap because we are a compassionate community. And so it was that way when it started back in 94 is the first time I became aware that there was a needle exchange program in Santa Cruz. Eventually the Santa Cruz AIDS project took it over and then as that organization was suffering great difficulties, volunteers then showed up again as street outreach supporters. Their actions caused the county to take the program over but we have consistently shrunk our program and that has resulted in volunteers stepping up to fill the gap because regardless of how you compare us to other counties we have people who inject drugs in Santa Cruz County. The other thing that is kind of clear to me is that when you have a well run program that's actually following best practices it can do good things. And for 15 or 17 or maybe more of those years that there was some kind of needle exchange or syringe services program we didn't hear and did not see needle litter in the same way that we have in the recent past. We should not feel comfortable with the level of needle waste in our community. It's unacceptable, it's unhealthy and we shouldn't just look at it as an HSA problem because it's a waste problem. And as a waste problem that HSA is connected to it because there's a public health strategy that involves needles and then there are needles out in the community. It doesn't mean that HSA is the one that's responsible for that and there was a needle litter problem before HSA was involved. So this idea that somehow that our program is the cause of this is just not borne out and it was not borne out by looking at other communities that also have needle litter program problems. Santa Cruz is not the only community that has a needle litter problem. And that is also a recent vintage in other communities as the state laws have changed about the accessibility of needles there are other places to get needles. And as a result, there are more needles in our community and other communities. We should not sit still or assume that it will just take care of itself. We need to be aggressive in that. And that's aggressive in terms of having places where people can place needles, having people to clean up needles working with other jurisdictions to also do the same. We have tried to get other communities that have that where their residents have complained about needles to take kiosk and we have been rejected consistently with a few exceptions. So as I look at this motion, I think that we're just, that is a failed strategy to just say, let's try to work with them. If Grant Street Park or Cow's Beach or another park or Coral Street has needles, we should work to place kiosk there, not wait. We should also use good science that we do care about that. We had a science march here in Santa Cruz County. We said that we cared about good science. We criticize legislators for not following good science. And so we shouldn't accept something that I understand the perfect, I understand the motivation for people wanting to do things, but it's not backed up by the research. It's not backed up by the science. And so it's hard for me to support an arbitrary cut from 100 to 50. Why should it be 75? Should it be 25? Should it be cut at all? When I see, I understand the concerns about the number of needles giving out and the reduction in the number of individuals coming into the SSP program. We could look at that as saying, you have the hours so little, under 10 hours a week, that you have to increase secondary exchange because we're just not available to people. And so people who are in need find someone to take their needles in because nine hours isn't enough. So maybe we should increase the number of hours and look at that impact in six months and assess whether that actually gets more people through the door and into the program, into the things we say we care about. Because I think HSA has worked very hard to tie in their syringe services program with trying to connect people to clinics and services. And it takes really good staff to be able to do that. We need dedicated staff, people who are used to doing it because say what you will about the harm reduction road show. And I understand the concerns that were raised there. But the idea that someone's out there trying to help people and that a secondary exchange is a bad thing if they don't include hep C testing or HIV testing. When I was at the AIDS project, we had health outreach workers who regularly met with people. They didn't give out needles. That wasn't something that the AIDS project did. But they gave out condoms, they gave out supplies for people to inject carefully. And they worked to get them into testing. And we actually at that time had a much more robust testing program and community testing spots that we don't have today or the same kind today. To link our successful and recognized program of homeless person's health project with the problems down at Coral Street. They aren't the reason that there are problems down at Coral Street. We place the program because that's where the people were, right? And so, I believe in community outreach and community meetings. I think that that's critical. But let's not say that our effectiveness in placing programs where the problems are the reasons why we shouldn't have, we shouldn't do something for that population. That was the whole strategy to begin with. I take everybody at their word. I didn't hear people speak about us against the syringe service program. I heard a lot of support for it. And I'm grateful that we're past that part of the discussion. And I think we should try to use science wherever possible because it's a very loaded issue. And there's a lot of emotion in it. And sometimes emotion doesn't make the best policy. Science helps makes it the best policy. And we can't let the perfect get away with the good, right? I understand that. And so I see that the staff has come with something that's not perfect. It's good, not perfect. And we should be aspiring to following the best practices. The State Office of AIDS, the National Association of Counties, the National League of Cities, the Republican Congress that funded Needle Exchange last year. These aren't crazy left-wing anarchist organizations, right? I mean, these are reputable organizations, organizations that we are part of, we choose to be part of. And they support this activity. And we know public health works too because if you look at our SafeRx campaign as provided in the data, we can see that the opioid prescriptions have gone down because of the interaction and the public education that's gone on. When I look at this motion, I can't support it. It's far too broad. Reducing it for 150 to me does not seem like anything that's backed by science. And it feels completely arbitrary. A six-month pilot, about extra hours. All right, that might be something that will work. The waystream assessment, again, I don't even know whether it's possible to do this. I don't know what it would cost to do this. It's hard to support something that is so amorphous that you can't figure out exactly what it is you're buying into. And to try to figure out what the, I think I've came back with a suggestion about how that would be done and what would be cost. We can make an assessment of it. But just given today what's written here, I don't feel like I could sign on to it. When I look at the SSP advisory commission, you know, I remember when we set this up and we have a bunch of professionals on there and law enforcement was invited to participate. And a couple of the members spoke today, Damon and Dr. Reinerman both spoke. I think you're both on it.  And it seems like those people who actually know something about disease prevention are useful. And whether there should be other people as part of that, okay, that's a good idea too. But I want us to be directed by good public health data and science, not just emotion. When it comes to working with local jurisdictions, I think we should have something a little bit stronger. For instance, I think we should direct the chair to write a letter to the mayor of the city of Santa Cruz and ask them to respond back to us. So there's something in writing because I've had those conversations and every council member I talked to say, well, yeah, sure, that sounds like a good idea. But we never get it to the place where there's one actually placed unless there's a crisis as there was with the Ross encampment. So I think that we should have something stronger and ask them to tell us that they don't want these things. So their citizens can understand that they don't want to participate, that it's in writing because the county has kiosks in the warehouse ready to deploy, but we don't have support from cities to place them. It's not the magic bullet. It won't make the problem go away, but we should at least attempt to place these because we've seen that where we place them, at least it collects some of the needle waste that's in our community. I don't know the answer about SSP clients successfully referred because again, you might make the referral, but if they never show up, it's hard to, I don't know what the appropriate measure for that. It's an admirable goal. And if we want to hold off on the mobile services until we see what's happening with the expanded hours, great. But for all I can tell from the discussion that's gone on about the harm reduction road show is that there appears to be people using drugs outside the city of Santa Cruz. And we should think about how we get those services available to people outside the city of Santa Cruz. And if mobile services were once part of the array of services that we had for exchange, and it stopped for various reasons, and maybe we need to think about that again. We don't have to do that right away. I don't think the staff was suggesting right away, but I'd be happy to come back and take a look at that. We should not accept needle waste and we should do everything we can, and we're gonna have to spend money in order to help clean up the community. We should use the best science to make decisions about how to practice public health because we've seen that when public health does those best practices, we have good results. And we should operate not about trying to limit this, but trying to make it successful so it actually meets the need. And the research tells us if you have a program that does a better job of meeting the needs, you can actually see less litter. That is, there is national research on that. We got information in our packet about state research on that, that's clear. And so if we're committed to that, we have to take in all those pieces. We can't just pick and choose from that. So I don't support the motion and I hope that we can talk about making some amendments to it in the hopes to make it stronger. Thank you, Chair. Before we're using our health professionals for heat stroke treatment, I'll try and make this a much faster here. I think that we can actually get to a motion that can be supported by the majority of the board. I have two brief questions of the health staff. The first one is just on the point here of reduction from 100 to 50. Do you have a number of a sense of what the average giveaway per person would be? What the reduction would mean as far as access components? I agree with Supervisor Leopold that this is an arbitrary cut. The question is, what does that cut actually mean as far as delivery services would be concerned? I think the overall- And I'm sorry, but just there's a difference, right, between 50 for primary and 50 in a secondary exchange. We're saying that essentially you treat all exchanges as primary exchanges. So for people who are primary exchanges, it obviously caused a reduction of people who are operating secondary exchanges with the idea that we're trying to drive, I'd like to see 100% increase the number of people that use the clinic. So we're trying to drive that up. So there's a lot of people who are using secondary exchange who aren't coming there and this would obviously drive, that we're trying to get those people there. So I got that, but then you would do something that regulate the secondary exchange. I mean, so meaning that you might be going out at the wrong way, if what you're trying to do is eliminate an independent or non-transparent or whatever adjective you want to use third-party exchange and everything would be under the controls of the county, then make that statement. I mean, just ban them. But then what you would do then is then not regulate what the county says is the best practice in the distribution under that regulated model, because those are mutually exclusive things. So what I'm asking then is, is what the reduction from 100 to 50 would mean? I did actually hear, by the way, remarkable amount of common ground, even though people were approaching it differently, which was interesting. So I think that there's a way to actually get there that would, even if people didn't actually recognize it, actually make this motion something that could be done. So if we went from 150, how detrimental in essence would that be? To me, I would be willing to keep it at 100 unless I could be shown that there's a reason that the reduction would actually do something that would meet the public health interests that are being expressed, or concerns that are being expressed by my colleagues. Ms. Hall. So that's actually moving in the wrong direction. We were very conservative in our request to the board because we recognized that we're not close to best practice. What we're trying to do is balance what capacity and resources that we have and expand it slowly. I truly believe, and I believe that Dr. Gilarducci and Jen, you may also chime in. But I think the first thing that we need to do is expand access and availability. The primary reason I believe that we're seeing this large reduction in folks physically coming in is because we don't have access. Being open 10 hours a week, or five hours a week in Watsonville does not. But Ms. Hall, you were open 10 hours a week in 2014 and you had 40% more people. So the hours haven't changed and you're seeing your access fall. What has changed is that someone in the community or a few someones in the community recognized the gap and decided to step in. So my understanding of how the secondary exchange started was last a year ago Memorial Day. I wasn't around, but from what I understand of the history, the county was closed on a Monday on a county holiday. And it started kind of informally to provide the service to folks because we only provide it three days a week. So if we have a county holiday on a Monday and or a Friday, that three days a week turns into two or one days a week. And what we have heard in terms of feedback from our clients is that they'll carry around 100 needles waiting for the exchange because they're not exactly sure that they can actually access us every time we're open. And so I think it would be more prudent to allow us to expand our hours, see how those hours change because now we have different items at play now than we may have had a couple of years ago. The other thing that I wanna say is our program has changed dramatically. When I first got here, I've been director for seven months.  Our clients didn't have a proper waiting room. We have changed that so that there is a dedicated space. It's bright, it's open, it has privacy. It has the ability to conduct multiples of exchanges at one time. Everyone at Danny's, Matt staff, they staff a shift. Every one of those shifts are staffed by public health nurses. Every one of those shifts. So I would say that the changes that we've made have just happened very recently and it's only been since February that I asked Jen to transition this under the Communicable Disease Unit and we've made these changes. So I ask that the board allow us to test the changes that we've had to continue to document the successes that we have, grant us what we're requesting so that we can come back and show if it makes a difference. What I really fear from a scientific standpoint is that we pick some kind of arbitrary marker or information and make an assumption that that means some certain kind of outcome. Our program is staffed by an epidemiologist, a physician, public health nurses, myself as a public health professional, certified addiction counselors. I feel like we have the best brains on staff and we have a great community advisory group as well and so I feel. But come at this from different angle, which is I believe all that and I want more people to go to return who were using Amaline, who stopped using Amaline to return to Amaline to do all the things that you want. But in a world of secondary exchanges, they won't return because, and there may be lots of public health reasons for, but if we want to eliminate secondary, as a policy matter, if we want to eliminate secondary exchanges and in an anonymous system, somebody comes in with 100 needles, how do you know it's their needles and they're not getting some from somebody else? There doesn't seem to be a way to eliminate a secondary exchange without reducing this number. Well, may I make a suggestion? I think a better way would be to ask staff to examine what that way could be. So I admit we have a lot of work to do. There was a constituent that said we hadn't updated our policies and procedures. Again, we've been really busy revamping this program and we're happy to address our shortfalls. But one of the things that we can do is examine our secondary exchange practices. We have talked about things like having training standards, protocols, policies, having certain kinds of entities enter into agreements to conduct exchange on our behalf. There are all kinds of possibilities for us to provide that I think the accountability that the board and some of the public is looking for and we're happy to pursue that. We could come back to the board in September after putting some thought into that and provide some recommendations for the board. I think that that's a better path than to choose, reduce the number that we exchange than to kind of take a stab at different strategies. And then we can test that and see if it really works. Okay, may I continue on this? So that answered the question and for me, I'm comfortable with it being, so we all received, you know, over a thousand emails and contacts associated with the harm reduction road showing a lot of suggestions. Overwhelmingly what people said, except for the outliers, was that they wanted this to be run by the county, that they wanted it to be under the county's control. I think one of the things that's important then is you have to accept the fact that that means an expansion of county services, what that actually means. I mean, I don't know that everybody's necessarily internalized what that really means, but that actually means that you'll see more hours. What I would like to see before we move into a world of mobile that may have externalities that we can't account for yet is to at least expand the fixed point location to a point that we can at least say that it is or is not meeting the need of the community after a certain period of time. What I'm seeing here is a movement toward that on number two, but I think that we should move toward what's being requested, which is a 20 hour a week on that with the same six month return. I think that some of these other recommendations are actually okay. I mean, I'm maybe in slight disagreement with my colleague on item four, which is in creation of this group, the SSP advisory group, because I think there should be community buy-in too, and I think that one of the ways that you do that is actually by having community members that aren't necessarily from the field sometimes have say an input into the system, because as you can see, most of the people that are showing up are from the community and feel a sense of powerlessness in regards to a program that they don't really understand, that they don't feel like they can control, and feel like is being thrust on them in a way that they aren't having any kind of input in, and I don't think that's reasonable. I think that there should be that element. I agree with my colleague as well that the chair should write the letter on number five. I think number six is what it is, and for number seven, I just think that you adhere it to the same timeline of a six month return. So I mean, I think that there's a way to do this, which is I'm gonna make a proposed an amendment to the motion and we'll see whether we can get there. I think that we eliminate number one. I think we change number two to 20 hours. I think we can try number three because we'll see whether it works. I think that we may find out that it actually doesn't. I'm fine with keeping number four. Number five, I say we reword it to say direct the chair to write local jurisdictions and request a response. Number six, we'll see whether tracking SSP clients as possible. And number seven, that should be a six month as well. I'll make that as an amendment to the motion. I would second it. It would just be helpful on number three if we could get some report next week about what this might cost. I mean, we're doing budgets hearings. I have no idea whether this is a $5,000 thing or a $50,000 item. And it would just be good to know as to whether that's it's actual possible. And so if I would, I want to second your motion and I hope that you see that as a friendly amendment. With a comeback during budget to explain what number three would mean financially. I guess, well, I would say this, which is on the number one, okay, but we're not going to expand hours until we know what their plan is to reduce secondary exchange. Because if you're just expanding hours and it's just more needles out the door, like bringing forward a plan that matches the hours that makes me feel comfortable, but just expanding hours and then maybe having a secondary plan that we don't know yet is okay. Yeah, I just the secondary, I mean, somebody can come in and get hundreds of needles and we don't have any idea where they're going. All right, yeah, I get it. That's just nuts. I think the board's unanimous in that, Bruce. The question is whether or not what you're proposing gets you there and we're trying to get the board's trying to get there. And I think that it may not be just, if you can cut it down to 25 needles, 50 needles and I saw 10 people, 15 people show up from a road show that are ready to get another 50 people that'll now just be 50 people with 50 needles. So I mean, if you're trying to get rid of the secondary exchange, there is going to get more people to show up with less needles to each person. That's not accomplishing your goal. Your goal is accountability on a contract. Well, at least we have a contract though. If those people show up, they're violating that code. Maybe Ms. Hall, you have an idea of what it would take to come back to us with a plan for increased hours and managing the secondary exchange in a more meaningful way. I mean, is that something that could be done in by August or September? I mean, I think the interest here and the chair can correct me if I'm wrong. I think we do have an interest that we want as many people as possible going into this county program that we feel like has all the elements that we want, right? And so the question is, how do we best get there? And if the concern is secondary exchange and we want to try to find a way to do hours and have some limits on secretary, let's talk about what that plan would look like. And it wouldn't stop us from doing the advisory commission if this waste thing is, you know, whatever that is. But before we expand hours, we get information about what that program might look like with expanded hours and costs. You know, I think that's a win for everybody. So I will say that the current program that we have, we dramatically changed our program from what it looked like six to nine months ago to what it looks like today without expending more dollars. What we did was we took advantage of leveraging the additional staff that we had that we were able to acquire through Drugmatic Cal, through our MAT grants, through whole person care. And we layered the staff that we already have to ensure that their expertise was lent to the Syringe Services program. So it's not so siloed as if, oh, we need X number of new dollars in order to expand these hours. It will mean us going to the drawing board, taking a look at how we schedule people's shifts. How, you know, so I think that there's a possibility that increasing to 20 hours could cost no extra dollars. There's a possibility that we find a way that we feel is better that would cost extra dollars. And I think that we would have an idea of what those extra dollars might be after the governor's budget passes. Regarding the kiosks, we do have kiosks sitting in a warehouse ready to be rolled out. I'm absolutely, actually, I had talked with staff about rolling out those kiosks in some of our other jurisdictions or maybe other areas of the county. And in the case where it was in other jurisdictions, I agree with you, Supervisor Leopold. I believe that we, if we didn't have a Syringe Services program at all, we would still have a syringe litter problem. I was able to order a box of 100 syringes from Amazon for less than $18, and they were delivered to my doorstep. Nobody asked me if I was over 18 or where I lived. So I know that there is an ability to access syringes through other methodologies. We- But people who have homes aren't ordering from Amazon and then leaving syringes in the street. No, I understand that. What I was gonna say about the kiosks is we had actually talked about internally with staff that we would be willing to fund the cost of servicing the kiosks for the first year. And if it showed that they were well utilized in other municipalities, have an agreement with that municipality to take over the cost, because it is for the benefit of that municipality. So there are lots of different options that we could. So let me just say, so my, our motion is that we would maintain the, we were maintaining those in perpetuity. We're the ones disturbing the needles. We will pay for the kiosks. We're gonna pay for the cleansing. So my expectation of what I was going to send to the cities was that HSA would maintain that on an ongoing basis. And I would say that there are about just over 2,000 tons of needles a year we collect in the kiosks over and above what we distribute and collect in our personal services. They're coming from somewhere outside of our program. Yeah. So just to address this issue though, we were asking something very specific. And so Chair, I hear what you're saying, what Supervisor McPherson is saying is that you don't want to extend hours until you know that the secondary exchanges, there's a plan for that, correct? Okay. Could a plan come back on September 24th for addressing the secondary exchange issue that I think the Board unanimously has a concern with? Yes? I believe so. Okay. Then why don't we just... You're saying yes. Okay. Then why don't we, if this is true then, then we would get rid of number one. In essence, we would get rid of number two contingent upon this coming back. So number two would come back on September 24th with a plan for how to manage the secondary exchanges. We would keep number three. We would keep number four. But come back during budget hearing so we know what we were buying. Excuse me. On number three, the budget hearing component, sorry, Mr. Palacios. Number five would be to direct the Chair. Number six would say, and number seven would also, well, we had a six month after that we actually increased the hours. So it would be six months past the time when those hours were increased. So that's all fine, although I would expect that you would hold a community meeting in advance in the affected neighborhoods before expanding hours. Yeah, we're happy to do that. Yeah, and I hope that when we hold meetings that it involves both supervisors who represent that area. You know, I represent the Emeline area, the vast majority of it, and a lot of surrounding neighborhoods as well. So I would hope that in the future when we do that, that we have meetings that both our offices are aware of. Sure, yeah, I mean. So those are, I pose those as an amendment. And there is a second to the amendment. So I think we're accepting them as friendly. I'll accept those as friendly amendments. So we're gonna come back at budget hearings on number three, is that right? Correct. That's correct, with the cost estimate and feasibility analysis. This is something that people just wanna get an assessment. You're right. There's nothing we can do about these orders, you know, through Amazon or wherever. That's out of our hands. We just have to try to do, manage our situation better than we're managing it now. And I wanna say that my hands off to the Health Services Agency and everybody's been working on this. This is not easy. This is not always friendly, so to speak. But I think there's a vast room for improvement and it's not your fault for why we need to improve it. We just need to improve it because it's not working well right now and there's two parts. As we go to stop the expansion of communicable diseases and reduce the number of improperly discarded syringes. That's the key point probably that we wanna get to as much as anything right here. We just have to earn the trust of the general public and they don't have it in our syringe exchange program right now. Thank you. And so I think we're all close to it. Let me just say, I think a waste stream study is science and that waste stream studies are done all the time and we have a lot of talk about it's our needles, it's not our needles, it's from Amazon. Like we should know where the needles are from and also the Citizens Connect proposal in this thing, as I pointed out, is a several hundred thousand dollar a year running a 24 seven county wide cleanup operation. I agree. Is a major, major cost. If we're gonna do it in a way that the community expects which is I see a needle in front of my house, I expect to be cleaned up within an hour or two. That is no small task. So let's be clear that if we're serious about addressing needle litter, we're looking at a huge expenditure. And that is why we're suggesting that we attempt to pilot, gather information, do a process evaluation and report back to the board because it allows us a chance to evaluate the success or lack of success and what the resources may be needed. And I do wanna say I appreciate the board working together. I know that there are members with different points of view and I appreciate the public and as well as our staff. I think we have an amazing staff that has worked really hard, especially in the last year to take this program from what it is and what it has been, which is harm reduction, but grow it into something that brings so much hope to our community and the ability to really meet people where they're at, get them into any kind of service, whether it's healthcare services, medication assisted treatment. And I do believe that with all of the expansion of the services that we've had on the behavioral health and the healthcare side that this is our way to reach our most at risk clients. And so I wanted to thank the board for their work and also our staff. Great. Are we clear on the motion? I do have a question. Thank you, chair. Does your recommendations and amendments, Supervisor McPherson circumvent the recommendations that the HSA has made on their report? Thank you. Okay, so we have them, except we are accepting the HSA report. All right. Yes. Okay, so we have a motion. One last thing, the syringe litter study. Don't we want that also to move forward? I did. I mean, so the question is superseding. That's what, to be clear, what? The number three supersedes what the recommendation from. We reviewed health. From us, we reviewed the Orange County study and it wasn't what we were trying. It just doesn't provide the information that we were trying to get at. So we thought this would be a better use of time. So the waste streams assessment is you're saying in place of or can it be in addition to? I mean, is there a reason? Maybe I look to staff on this. I don't know whether the California Department of Public Health is paying for that study. So there's no cost to us. And so I like the belt and suspenders method, right? I mean, if we can do this waste assessment and do this study and have a couple points, because our goal is to reduce needle litter in our community and the best ways to do that and to figure out where it's coming from, right? I mean, that's what we're interested in. So that's why I'm asking the question and if someone else is paying for the study and the staff could still work on it, I don't see the downside. I feel like we're asking a lot of staff between now and September on a small program. I'd like to, you know, I'd like to do this and then come back. And if we don't get the answers we need, we can go to and we can engage in the state. But it- Is it too much? Let me just ask. No, it's, well, it was our recommendation and to answer your question, yes, the state is financing it. They have federal dollars as well as state dollars and they use a consultant that has been doing this type of work. So it's part of the reason we made the recommendation is because we can have an outside entity that runs the office of aides do this on our behalf and then use that data to develop our litter program. So I just- Sure. I think we accept the report, we do the study, we do the change, the amended motion, that's what we're voting on. And you're fine with the maker? Sure. Let's find the second one, okay. Okay, I'm sorry, so one quick. Sure, sure. So the recommendations with the friendly amendments and then Mimi, including seven of your recommended, or C of your recommended actions. Correct, it is seen, yes. Okay, thank you, Carl. Great, okay, thank you. We got a motion and we have a second. All those in favor, please say aye. Aye. Opposed? That passes unanimously. We are going to adjourn to our budget hearings which will be available next week starting at 9 a.m. here on Monday.