Cirque Meadows by Adam Johnson




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 Collins, CO


           Members Present:                   C.J. McKinney, Ph.D.

                                                N. Mark Richards, M.D., M.P.H.

Lee Thielen, M.P.A.

Steve Yurash

Debbie Healy, RN, BHS


Commissioner Liaison:             Steve Johnson

Executive Secretary:               Adrienne LeBailly, M.D., M.P.H.

Staff:                                         Marie Macpherson, Avie Strand, Jerry Blehm, Paula Lady


Public:                                       Jeff Basinger, Jennifer Chase, Christopher Grano, NCAP

Sarah Millard, Blair Bacon, Suzannah Hurja, Vincent Papalio

                                                  Pamela Dickman, Loveland Reporter Herald


1.   Call to order - The Board of Health meeting was called to order at 7:00 PM.  


2.   Approval of April 11, 2012 meeting minutes - Minutes of the April 11, 2012 meeting were unanimously approved.


3.   Discussion and decision on NCAP request to approve a syringe exchange program (SEP) – Mr. McKinney called for discussion and decision of the SEP. 


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. 


            Mr. Yurash presented his decision for opposing the SEP.


            Ms. Healy presented her decision for opposing the SEP.


            Mr. McKinney presented his recommendation for approval of the SEP.


            After group discussion Mr. McKinney called for a vote to allow NCAP the management of the SEP with

            oversight of the BOH.  Motion passed 3 – 2


After discussion 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 departments county-wide. 


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.


6.  Director’s Report

- 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.






_________________________________    _____________________________________________

Paula Lady, Recording Secretary                      Adrienne LeBailly, MD, MPH,  Executive Secretary

Document submitted by Board member, Dr. N. Mark Richards, in explanation of his recommendation to support NCAP’s request to establish a syringe exchange program:


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 following criteria:

  • 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 users.
    • 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 injection.”
    • Although some SEPs have failed to achieve a positive result, as can be expected, the majority of well-managed programs have been successful. 
  • 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 disposal.
  • 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 Officials
    • 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 NCAP
    • Increasing the retention rate of clients in the NCAP program
    • Reducing the rate of seroconversion to HIV and Hepatitis C infection
    • Reducing the rate of self-reported needle sharing
    • Increasing the rate of utilization of drug treatment programs
    • Increasing the proportion of supplied equipment that is returned for disposal
    • Reducing the number of discarded syringes and needles in the community
    • 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 interested stakeholders.
    • 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.



Background Image: Cirque Meadows by Adam Johnson. All rights reserved.