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An Overdose, New Services and Uncertainty on Homelessness

A look inside an expanded syringe program and a new camp

Residents of a new managed homeless camp at San Lorenzo Park have added the trappings of home to their tents. PHOTO: JACOB PIERCE

[This is part three of a series about the health impacts of homelessness. Part four will run next week.  – Editor]

The man under the Water Street Bridge was slumped over, his skin turning purple, when fellow homeless residents and a homeless advocate found him in the bushes last Thursday.

They administered the overdose-reducing substance Narcan, and the advocate called 911. Medics did chest compressions, gave him oxygen and attempted life-saving measures, but the man died of a presumed drug overdose. (The coroner has yet to release additional information.)

His death came less than one week after a local health group, which does Narcan distributions, announced that it would be expanding its operations. It isn’t Narcan that typically draws attention to the Harm Reduction Coalition of Santa Cruz County’s work, though—nor do the bandages, condoms, lubricants, tourniquets, water, bleach or cotton balls that they also distribute. 

Instead, the attention normally goes to the syringes that the group hands out. That’s also the aspect that’s expanding, with the California Department of Public Health certifying the coalition as a certified syringe exchange. Exchanges of used syringes for clean ones are designed to reduce infections, disease spread and other preventable health risks.

Critics of the Harm Reduction Coalition—including county supervisors and law enforcement officials—point to the large quantities of syringes found in public spaces as a bigger priority. It isn’t clear, however, whether syringe exchanges are part of that particular problem. Needles are available for purchase in pharmacies and online, and both the Harm Reduction Coalition and the county-run Syringe Services Program take in more needles than they give out. Advocates and county public health leaders say the existing evidence points to managed syringe exchanges correlating with less waste, not more.

Although syringe exchanges aren’t specifically a homeless issue, many clients are homeless, according to county survey data. And according to the 2019 homeless census, 30% of the county’s homeless suffer from alcohol or substance abuse. 

In response to the concerns about litter, the state expanded the Harm Reduction Coalition’s scope, awarding the group extra funding and adding litter abatement to the project. Members of the public will be able to report syringes found littered in public spaces, and the coalition will come pick them up.

County Supervisor Bruce McPherson continues to have concerns, though, about syringe litter. He wants to find a better way to track where the distributed syringes go and where the littered needles come from. Although the coalition is independent of the county, he hopes the group stays engaged and refers clients to the county’s addiction services. 

State decisions aside, McPherson still believes the county can improve its own Syringe Services program. 

“The decision’s been made, and I’m going to do the best to improve our county program, even though the state approved this application over our objections,” he says.

COOPERATIVE LIVING

Over at San Lorenzo Park’s benchlands, a new homeless camp—a partnership between the county and the city of Santa Cruz—has essentially pulled off the vibe of a run-of-the-mill apartment complex.

One camp resident laid out a welcome mat in front of their tent. Another planted a small garden in vegetable pots. Occasionally, a squabble breaks out in the camp, like in any neighborhood, explains Jeremy Leonard, the camp’s assistant manager, but, for the most part, it’s been peaceful.

“People have a safe space that they’re not getting kicked out of all the time,” explains Leonard. 

The tents are spaced out from one another. There are showers, and there’s a hand-washing station. Residents must wear face masks when they leave their tents to prevent the spread of the novel coronavirus that causes Covid-19. Leonard and his colleagues have been able to offer some residents grief counseling and others access to addiction services. The Homeless Person’s Health Project came in to do some medical outreach.

The camp has expanded to meet more campers, and it’s a low-barrier facility, meaning that staff doesn’t turn anyone away. It doesn’t have a no-drug policy. Leonard presumes that may make some locals uncomfortable, given that the facility takes government money. But he says this model is the best way to get the homeless off the streets, reduce neighborhood impacts and help people.

“We can house people that couldn’t go other places or couldn’t get a housing voucher. At the bottom line, these people are human beings. No matter what trauma they’ve been through, they deserve a place to stay,” he says.

The Covid-19 pandemic has the potential to shift just about everything about homelessness. Local government budget crises created by the shelter-in-place order are prompting cuts to safety nets across the country, even as there are calls to give homeless individuals safer living conditions. 

To that end, there are bright spots, as well. The county is housing 180 homeless individuals on state hotel vouchers. Earlier this month, the county Board of Supervisors approved a six-month work plan on homeless systems and accepted $1.9 million in emergency state funding.

On Aug. 11, the Santa Cruz City Council accepted an advisory report, gave direction for a new community engagement homelessness plan, greenlit a study of city facilities suitable for homeless services, and took steps toward expanding shelter and navigation services on Coral Street.

Meanwhile, the state’s homeless population could be headed for an untimely growth spurt. Although there’s still time for a legislative deal, California eviction protections are set to expire at the end of the month.

No one can say what exactly the potential looming cliff means, but a recent Aspen Institute analysis found that an estimated 30-40 million people nationwide could be at risk of eviction by the end of 2020.

CASH INJECTION

The Harm Reduction Coalition’s state-supported syringe services program is set to roll out this fall with one distribution site at its normal location, as well as with delivery services.

Denise Elerick, the group’s founder, says the coalition will purchase supplies from a clearinghouse in Washington state, just as other state programs do. A newly approved $405,000 in state funding will go toward three years of salaries and stipends for the coalition.

The group didn’t always plan to put quite so much focus on home deliveries. The Harm Reduction Coalition withdrew the previous version of its application last year over criticism that the group hadn’t reached out before proposing new distribution sites in Watsonville and in Felton. The coalition left those sites out of its revised application, which the state subsequently approved.  

Over the past year, unsubstantiated rumors spread, however, that there had never been a syringe exchange in Felton or anywhere else in the San Lorenzo Valley.

Those misnomers are perhaps indicative of the way misinformation spreads on this topic. In fact, a previous volunteer-run effort, the Santa Cruz Needle Exchange Program, held distributions in Felton and in Boulder Creek two decades ago, according to the program’s training manual, its written policy, and two recent interviews by GT—one with a volunteer and another with the program director.

Former volunteer Rokki Baker remembers the needle exchange project as being uncontroversial in the late 1990s and early 2000s. She first got involved in the local harm reduction community after her husband, who had AIDS, died of a drug overdose in 1991.

“It’s been a great education. I’ve met a lot of people. I’ve helped a lot of people. I’ve lost a lot of people,” says Baker, a former addict who later led a drug recovery organization. “It’s been quite a ride. And it wouldn’t have happened if my husband hadn’t ODed, so I have to say it’s for him.”

The USC Center for Health Journalism’s 2020 California Fellowship supported reporting for this project.

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