California is no stranger to the opioid crisis, with some of the worst metrics in the nation for heroin abuse, fentanyl overdoses, and the heartbreaking reality of innocent children being poisoned after finding fentanyl on the ground. As the state grapples with these devastating issues, it’s crucial to critically examine the approach taken by programs like the Harm Reduction and Syringe Services Program (SSP) at the San Francisco VA Health Care System.
After finding her name in extra large bold letters with her phone number on the side of a Needle Vending Machine her program is presumably responsible for, we contacted Tessa Rife-Pennington PharmD, BCGP – the Facility Syringe Services Program (SSP) lead at VA San Francisco Health Care, to ask her some questions. Still, after initially taking my call, she denied my requests for an interview.
This after requiring me to contact the Head of Media Inquiry, to whom I supplied everything asked of me in a timely manner. We can only speculate why they would deny our interview, considering the unprecedented nature of this developing situation.
The San Francisco VA’s Harm Reduction and Syringe Services Program:
The San Francisco VA Health Care System’s Harm Reduction and Syringe Services Program is a noble endeavor. Still, a deeper analysis reveals that it raises more concerns than solves. Led by clinical pharmacist practitioner Tessa Rife-Pennington, the program aims to end drug-related stigma and discrimination, prevent the spread of drug-related infections and overdose deaths, and increase connections to services.
While these goals may seem laudable on the surface, it’s essential to recognize the nuanced consequences of such a program. The harm reduction services offered by this program include harm reduction education and the distribution of various supplies to Veterans.
These supplies range from free naloxone kits to safer injection supplies, safer sex supplies, wound care supplies, hygiene supplies, and even Xylazine test strips for a drug not commonly encountered. Some of the more shocking items include safer snort kits, presumably for cocaine, and even Cook Kits, like a spoon, with sterile cotton; essentially everything you’d need to enable an addict available from the convenience of a vending machine.
The Unintended Harms:
Narcan (naloxone) nasal spray is an over-the-counter medicine used to treat an opioid overdose emergency; Narcan works by rapidly reversing the effect of an opioid. Narcan should be given as soon as possible when an opioid overdose is suspected, and then the patient should also receive emergency medical care immediately, even if they wake up. This fantastic drug has been used to save countless lives of innocent victims, from infants to adults, who accidentally become exposed to a lethal amount of Fentanyl.
However, my first concern with these Needle Vending Machines is the distribution of free naloxone kits. While naloxone is a life-saving medication that can reverse opioid overdoses, its availability in unlimited quantities through programs like SSP may inadvertently encourage risky behaviors among addicts.
This could lead to increased overdose incidents, as individuals may feel more inclined to experiment with higher doses of opioids, knowing that a safety net is readily available. Finding a balance between saving lives and inadvertently promoting dangerous drug use is crucial, and many of the items listed above seem to go beyond standard acceptability.
Furthermore, the distribution of fentanyl test strips, while appearing to be a no-brainer strategy to prevent unwitting exposure, is problematic. Most whom we’ve spoken with immediately consider the Narcan and Fentanyl Test Strips as the vending machines’ saving grace.
They, like you, understand well that Fentanyl is a highly potent synthetic opioid responsible for countless overdose deaths. Some fail to realize that the test strips may offer a false sense of security to users who believe they can accurately assess the presence of fentanyl in street drugs. These test strips are not foolproof, and a false negative, with 2 milligrams of Fentanyl being enough to kill an adult, can have deadly consequences.
What is Narcan?
The program also provides various supplies for safer drug use, including sterile syringes. While the intention is to reduce the transmission of diseases, such as HIV and hepatitis, this approach may unintentionally enable and perpetuate addiction. Providing a constant supply of clean needles gives individuals no incentive to seek treatment for their substance use disorder. This is a critical point of contention because it effectively maintains the status quo of drug addiction without encouraging recovery.
Furthermore, it doesn’t take a rocket scientist or a Harvard mathematician to realize the thousands and thousands of needles recovered by the PacOut Green Team and other local Green Zone volunteer stewardship programs come from this machine and HACHR. If HACHR and the Veterans Association O intent on Dispensing needles carte blanche via a vending machine, shouldn’t they be sending out people periodically to rid our cherished green zones of the needle litter?
Additionally, the program’s weak and disconnected – connection to therapy and medications for substance use, such as buprenorphine for opioid use disorder, is most likely insufficient to address the complex nature of addiction.
The focus on supplying unrestricted paraphernalia overshadows the need for comprehensive addiction treatment and mental health support. In this sense, the program falls short of providing a holistic solution to the opioid crisis and instead focuses on supplying a sector of it with the hardware it needs to sustain.
The Impact on Communities:
The consequences of SSPs extend beyond individual users. The distribution of drug paraphernalia in the community can, and in the case of Humboldt County, undoubtedly has led to a rise in discarded needles, creating hazards for unsuspecting citizens, including children. Innocent children getting poisoned by coming into contact with discarded needles is an unacceptable outcome, and it underscores the need to reassess the program’s approach.
California is peppered with reports from this year alone of children nearly dying, or in some cases taking their lives, by accidentally coming in contact with deadly opioids. While we are unaware of a tragedy like this happening in Humboldt, with the volume of needles and used fentanyl foil found during local clean-ups, this sentence may become a prophecy without some kind of pivotal change in policy.
With a wide-open border and incentives like amnesty, sanctuary cities, and the ability to get a driver’s license and work in California without a social security card, all work to keep the migrant train rolling north from Mexico. With tens of thousands of migrants pouring over the border every month and Fentanyl being made in Mexico, isn’t it practical to finish the border wall and send the National Guard to the open sections and the ports of entry?
Given that Opioid overdose is the leading cause of death for ages 18 to 49, isn’t securing our border a literal act of National Security? Furthermore, shouldn’t the proponents of Sanctuary policies, Harm Reduction Policies, and all the other policies that are enabling this situation to be, at the very least, temporarily shut down for reassessment?
More Harm Caused than Harm Reduced
While the Harm Reduction and Syringe Services Program at the San Francisco VA Health Care System has honorable intentions, it is crucial to acknowledge the unintended harm it may be causing. The program’s focus on harm reduction through the distribution of supplies risks perpetuating addiction, fostering risky behaviors, and endangering the wider community.
As California grapples with one of the worst opioid crises in the nation, a more comprehensive approach is needed to balance harm reduction with the imperative of addressing the root causes of addiction and preventing further devastation in communities.
More often than not, glorifying our compassion directly leads to unintended harm to the world around us. It’s time we take a sober look at HACHR and their new Needle Vending Machine and the policies they are both predicated on to make decisive actions for the betterment of our communities.