Free clinic and needle exchange will find a new home in Fresno County’s health department

Fresno County will provide an indoor space for hypodermic needle exchanges for the first time as part of a pilot program that will also offer a suite of other medical and social services.

On a split 3-2 vote Tuesday, the Fresno County Board of Supervisors authorized a zero-dollar lease for the San Joaquin Valley Free Medical Clinic and Needle Exchange to use space inside the county’s Department of Public Health building in downtown Fresno from noon to 4 p.m. on Saturdays, when the health department is otherwise closed.

For 25 years, the program has operated at various times from inside an old school bus, a U-Haul trailer and, currently, an old RV parked each Saturday afternoon in a cul de sac near West and Hughes avenues in central Fresno, not far from the Fresno County Farm Bureau offices, said Dr. Marc Lasher, president of the free medical clinic. “We’re basically moving out of the alleyways into mainstream medicine, into the Public Health department.”

Lasher said the program typically exchanges between 16,000 and 20,000 needles from drug users during the two hours the program is now available each Saturday afternoon.

Exchanging needles isn’t the only service offered. The mobile clinic provides medical care for drug-related problems, as well as low-barrier entrance into treatment programs for drug and alcohol addiction. Lasher said that 150-200 patients use the needle exchange each week, another 15 receive free medical care, and about six each week enter drug treatment.

Over almost two years, the program has provided more than 15,300 doses of Narcan, a nasal spray that counteracts opiod overdoses. Users have reported more than 2,200 overdose “reversals” as a result of using Narcan, Lasher said. The program also distributes test strips for users to test their drugs for fentanyl, a substance widely blamed for an increase in overdose deaths in recent years.

David Luchini, director of the Fresno County Department of Public Health, said bringing these services into a county facility for a two-year pilot program will allow for inclusion of other services from county departments, including mental health services, housing assistance, food aid, employment services and more.

Offering clean needles to addicts, Luchini added, “will reduce the risk of blood-borne pathogens such as hepatitis B and C and HIV/AIDS,” and “reduce the number of infections that would later require treatment in overcrowded (hospital) emergency rooms.”

Two of the supervisors, Nathan Magsig and Steve Brandau, voted against allowing the move, based on concerns over the needle exchange portion of the program and lack of evidence over its effectiveness.

“I did not hear from staff that exchange needles lowers drug use,” Magsig told The Fresno Bee after the vote. “While providing wraparound services is commendable, providing needles enables drug use.”

Brandau said he voted no because “San Francisco-styled harm-reduction policies like needle exchange programs are based upon a lot of assumptions and don’t have enough supportive data.”

But Brandau and Magsig were outvoted by Supervisors Buddy Mendes, Sal Quintero and Brian Pacheco, who offered an impassioned testimonial to the work being done by Lasher and others with the free clinic.

“I think for many of us on the board, the clinic aspect of this is a no-brainer,” Pacheco said. But “it’s the needle exchange that is the anchor that’s always kind of weighed this down.”

Pacheco said that his perceptions of the exchange program and the clinic were changed after he paid a visit. “What I saw is that this program grants access to medical care to the most vulnerable and under-served in our community, and does so with dignity and respect.”

“With the exchange for clean needles, I think it keeps people from going to hospitals and I believe you’re actually saving lives,” Pacheco added. “It prevents the improper disposal of dirty, used needles that are going to be found in parks, schools or other places visited by our children or just community members. … You collect over a million needles a year that would otherwise be found in our general environment.”

Following the vote, Lasher discounted concerns that providing needles promotes drug use. “People in their addiction, they’re going to do what they’re going to to,” he said. “We just want them to be safe during that period of time, and also meet with a health professional as opposed to their connection on the street in providing sterile needles – and also edging them into treatment.”

Dr. John Zweifler, a physician with the needle exchange, added, that the move from the street into the health department represents a commitment to dealing with major social issues including substance abuse from a public health perspective, that we can look at harm reduction strategies to improve the overall health of our population.”

Lasher and Zweifler said that drug addiction can affect people from any walk of life, not just the homeless or those with behavioral health issues.

“If someone that we loved or someone that we cared about did start using drugs, would we want them to have access to clean needles?” Zweifler asked the supervisors. “At an ethical level, moving the needle exchange into the public health department lobby signals that we are prepared to treat everyone with dignity and respect, including individuals who inject drugs.”

Lasher added that “most of us and our families have been affected by the drug problem, the overdose epidemic of opiates, so talking about this issue isn’t about other people – this is about us, this is about our families, this is about our community.”

“This is a very at-risk population, at risk for many things from overdose, infection and also spread of disease,” he said. “This plan (for) wraparound services would take care of a lot of the needs of this very vulnerable population.”

Lasher said that he expects it will take a month or two for the clinic and needle exchange to make its move into the Health Department building at 1221 Fulton St., between Fresno and Tuolumne streets. The mobile clinic will discontinue operations at that point, but will have people at the old site to direct clients to the health department and, in some cases, provide shuttle services from one site to the other.