LARIMER COUNTY BOARD OF
HEALTH – June 21, 2012
The Larimer County Board of
Health (BOH) convened its regular meeting at 7:00 PM at the Larimer County
Department of Health and Environment (LCDHE), 1525 Blue Spruce Drive, Fort
C.J. McKinney, Ph.D.
N. Mark Richards, M.D., M.P.H.
Lee Thielen, M.P.A.
Healy, RN, BHS
Liaison: Steve Johnson
Executive Secretary: Adrienne LeBailly,
Macpherson, Avie Strand, Jerry Blehm, Paula Lady
Basinger, Jennifer Chase, Christopher Grano, NCAP
Sarah Millard, Blair Bacon, Suzannah Hurja, Vincent
Dickman, Loveland Reporter Herald
Call to order -
The Board of Health meeting was called to order at 7:00
Approval of April 11, 2012
meeting minutes - Minutes of the April
11, 2012 meeting were unanimously approved.
Discussion and decision on NCAP
request to approve a syringe exchange program (SEP)
– Mr. McKinney called for discussion and decision of
Dr. Richards presented
his recommendation for approval of the SEP and provided the BOH with a document
he created outlining his recommendation to be included with the minutes of this
meeting. (Document is appended to these minutes.)
Ms. Thielen made
her recommendation for approval of the SEP.
presented his decision for opposing the SEP.
presented her decision for opposing the SEP.
presented his recommendation for approval of the SEP.
discussion Mr. McKinney called for a vote to allow NCAP the management of the
the BOH. Motion passed 3 – 2
regarding proposed Recommendations for Governing Syringe Exchange Programs
and Treatment Referral Programs in Larimer County, Agreement and Scope of Work
documents will be reviewed and revised by Dr. LeBailly and the County Attorney
before signing any agreement with NCAP. The BOH will get comments about these
documents to Dr. LeBailly via email.
Mr. Basinger thanked
the BOH for all the time and effort that has been put into the process of the
approval of the SEP.
4. Update on
Department response to High Park Fire emergency – Dr. LeBailly reported on
the department’s response to the High Park Fire. The department’s public
information officer, Jane Viste, has been assisting with the County’s public
information efforts, both at Sheriff’s Info Center and the Disaster Recovery
Center (DRC). The Health Department has environmental health and community
health staff at the Disaster Recovery Center (DRC) at CSU. We are offering
information to victims specifically on environmental dangers to them once they
are allowed to return to their homes / land and distributing N95 masks with
information on proper use. We have also been giving Tdap (tetanus)
immunizations to residents of burned areas and responders. A major concern to
public health is the impact on the watershed. Mitigation efforts will be
needed to prepare for heavy rains occur and the county is looking at potential
funding sources.. Dr. LeBailly commented on the extraordinary costs to
5. Update on
Community Health Assessment Effort – Dr. LeBailly reported on the recent
leadership committee meeting. This group has decided to keep all of the National
Prevention Strategy’s seven priority areas, as well as seven strategic
directions added by the data committee, to be considered as priorities. A
community health assessment document will be prepared to present to the
stakeholder group in late July or August.
- Dr. LeBailly said
that 16 skunks have tested positive for rabies in the Fort Collins area;
several people undergoing rabies treatment due to exposures to rabid bats.
- West Nile virus has already been confirmed in the Larimer and Weld counties,
about a month earlier than usual. About 10% of Larimer County residents are
estimated to have ever been infected by West Nile virus over the past 9 years,
so about 90% of the population remains susceptible.
- We have received no additional budget guidance at this time.
7. Next Meeting
- July 19, Meeting includes recognition of Jennifer Anderson, PhD, for 2012
Joseph Jabaily Public Health Hero Award. The award ceremony will begin in the
Extension Conference Room at 6:30 pm. The BOH will then meet upstairs at about
7:00-7:15 pm in the CHS Conference Room.
Dr. LeBailly thanked
Debbie Healy for her service on the Board. Jennifer Lee has been appointed to
a five year term by the Commissioners.
8. Meeting was
adjourned at 8:50 pm.
Lady, Recording Secretary Adrienne LeBailly, MD, MPH, Executive
submitted by Board member, Dr. N. Mark Richards, in explanation of his
recommendation to support NCAP’s request to establish a syringe exchange
Syringe Exchange Program
proposed by the Northern Colorado Aids Project (NCAP)
Mark Richards, MS, MD, MPH
June 21, 2011
I strongly recommend that the Board
of Health approve the proposed Syringe/needle exchange program proposed by the
Northern Colorado Aids Project. My position is consistent with the following:
- A syringe/needle exchange program (SEP) is meant for intravenous
drug users who are unable to stop self-injecting recreational drugs.
- The purpose of a SEP is to reduce the risk of transmitting
viruses including Human Immunodeficiency Virus and Hepatitis C.
My decision is based on the
- The preponderance of evidence from studies of existing
programs clearly shows that such a program can reduce the incidence of new
blood-borne infections such as HIV and Hepatitis C in intravenous drug
- Some have stated that the science in all the published
studies is of poor quality and does not convincingly demonstrate a
reduction in incidence. It is a mistake to require that adequate studies
include only placebo-controlled, randomized studies, even though this
study design provides the strongest evidence. This study design is
almost impossible to implement in the context of an operating SEP. If
this design is required, progress can never be made.
- The National Academy of Sciences has reviewed studies of
SEPs in multi-component programs between 1989 and 2003 to evaluate the
strength of evidence for and against SEPs. The majority of evidence
comes from observational studies, including numerous prospective cohort
studies, supplemented by ecological and cross-sectional studies. The
review concluded that:
- “Moderate evidence from a large number of studies and
review papers—most from developed countries—shows that participation in
multi-component HIV prevention programs that include needle and syringe
exchange is associated with a reduction in drug-related HIV risk
behavior. Such behavior includes self-reported sharing of needles and
syringes, safer injecting and disposal practices, and frequency of
- Although some SEPs have failed to achieve a positive
result, as can be expected, the majority of well-managed programs have
- Some are concerned that a SEP will increase the number of
needles discarded in the community, resulting in an increased risk to
children and adults living in the community, garbage collectors, law
enforcement officials, and others.
- The Larimer County Environmental Advisory Committee has
assessed this risk carefully, and concluded that:
- SEPs help to address, but do not solve, the problem of
improper disposal of the syringes used by injection drug users;
- Based on the available literature, it appears that SEPs
do not result in an increase in environmental degradation due to
improper disposal of used syringes.
- SEPs have the potential to increase the rate of safe
- Many respected local, national, and international
organizations concerned with public health policy recommend the
implementation of SEPs, including:
- The Health District of Northern Larimer County
- The Larimer County Medical Society
- The Boulder County syringe exchange program, in operation
for about 20 years to date.
- The Surgeon General of the United States
- The U.S. Department of Health and Human Services
- The U.S. Centers for Disease Control and Prevention
- The National Association of County and City Health
- The Institute of Medicine, the medical branch of the
National Academy of Sciences,
- The World Health Organization
- The SEP proposed by NCAP should be part of a comprehensive
program, because the most effective programs reviewed in the literature
are multi-component programs.
- NCAPs proposal includes, in addition to the exchange of
syringes and needles: outreach to IV drug users in its service area to
recruit new clients, health education about injection and sexual behavior
risk reduction, condom distribution, bleach kit distribution, referral to
drug treatment programs, safer sex education, and referral to other
health and social services programs.
- The cost of preventing infection with HIV and Hepatitis C
would be far less than treating these diseases.
- It has been estimated that it costs about $400,000 to
treat a single person with AIDS. The cost of preventing this infection
in a population of IV drug users is far less than that.
- I believe NCAP has the management and professional
expertise to implement a successful SEP.
- I view addiction to intravenous recreational drugs as a
chronic, relapsing illness that is difficult to treat, an illness with
serious adverse personal and social consequences. Although the use of
these drugs is illegal, drug addiction is not a moral issue but an illness
that must be managed and treated as responsibly as possible. All
available avenues should be undertaken to reduce the personal and social
consequences of addiction, including a syringe exchange program.
I recommend that the Board of
Health, if it approves the NCAP proposal, include the following requirements:
- NCAP should implement an ongoing program evaluation method
to determine the effectiveness of the SEP, over time, in
- Increasing the number of IV drug users who are served by
- Increasing the retention rate of clients in the NCAP
- Reducing the rate of seroconversion to HIV and Hepatitis
- Reducing the rate of self-reported needle sharing
- Increasing the rate of utilization of drug treatment
- Increasing the proportion of supplied equipment that is
returned for disposal
- Reducing the number of discarded syringes and needles in
- The Board should consider obtaining expertise in program
evaluation design to advise the Board and NCAP in an evaluation method.
This expertise could be drawn from within the Department and from experts
elsewhere in the community.
- NCAP should convene an advisory group to monitor the
syringe exchange program, advise NCAP on its implementation, and assist
NCAP in its relationships with the general and professional community.
- NCAP must provide acceptable periodic reports to the
Department of Health and Environment and the Board of Health on the
implementation and impact of the syringe exchange program.
- NCAP, in conjunction with area drug treatment programs and
the Department of Health and Environment, might consider a significant
community education program to inform interested citizens about the
purposes and value of its SEP, and address their concerns. The program
should be offered at intervals throughout the year while the syringe
exchange program is in operation. However, any decision to implement such
a community education program should be carefully considered, weighing the
potential for a positive impact of such an educational program and the
negative potential for arousing public antagonism.
- If the Board of Health authorizes the needle exchange
program, the Board is required by law to conduct an annual review of the
program. The program’s contract can only be renewed after consultation
with the Larimer County Department of Health and Environment and the other
- NCAP should be granted a reasonable amount of time to
demonstrate its program effectiveness, because it will take time to
implement the program as designed, make program improvements as the
opportunity is recognized, train its clients in program participation,
and introduce behavior change in its clients.