Fresno County Supervisors on Tuesday all agreed that the San Joaquin Valley Free Medical Clinic in downtown Fresno helps many of those hardest to reach.

Where they differed was on the free needles and drug pipes given to patients, and thus the clinic’s lease was ended on a 3-2 vote.

Supervisors Nathan Magsig and Garry Bredefeld said they applauded Dr. Marc Lasher’s care but objected to the needle exchange.

“There is a fine line between providing assistance and then enabling,” Magsig said.

Supervisors asked if Lasher’s work could be done without the free needle and pipes. Lasher responded that he wouldn’t have access to the 327 people who entered drug treatment without offering needles and pipes.

“The needles are the calling card,” Lasher told supervisors. “These are people coming in for their problem. They know they have a problem — they also know that they can get help once they decide to step out of their addiction.”

Lasher is looking to continue the clinic at a new location.

“First off we’d like to thank the Board of Supervisors for allowing us to provide our services at the Health department for the last 20 months,” said Dallas Blanchard, the clinic’s program manager. “In that time we’ve been able to increase the quality of our services and increase the number of folks in drug treatment and harm reduction services.

“Yes, we will be continuing our services at a new location and expanding our services. We have a few buildings we’re looking at renting while also expanding our delivery services.”

80% of Clinic Expenses Come From Nationwide Opioid Settlement: Lasher

In 2022, supervisors voted to allow the clinic to operate out of the Department of Public Health building. After the 20-month pilot program, supervisors Magsig, Garry Bredefeld, and Buddy Mendes voted Tuesday to end the lease with Brian Pacheco and Luis Chavez opposed.

In addition to the needles, patients get treatment for heart conditions and diabetes, and help connecting with social programs.

The program cost the county about $90,000 a year — mostly staffing to have employees on Saturday help with workflow and coordinate with patients, said Joe Prado, assistant director of the Public Health Department.

Pacheco described most of those costs as something the county would pay anyway — including heating, air conditioning, and staff rescheduling.

Operating on Saturdays from 9 a.m. to noon, medical personnel treated about 150 people a month. The program distributed about 400,000 needles and 7,800 pipes a year. The clinic gives drug users everything they need to use, something they call a “starter kit.”

Funding for needles and pipes came from opioid class action settlement of state attorneys general against Purdue Pharma and the Sackler Family — which funds about 80% of the clinic’s expenses, Lasher said.

Of the 327 people who went into treatment, 100 stayed in it, Lasher said.

The move to downtown from a cul-de-sac near Roeding Park reduced visits by about 43% and needle distribution by 50%, Prado said.

He attributed the decreases to protocols in working with the Health Department such as asking patients questions or requiring them to wait in the lobby.

Lasher said the free drug pipes helped turn people away from needle use, which means fewer overdoses and fewer treatments of abscesses. Studies show people who inject fentanyl are 40% more likely to overdose and 253% more likely to have an abscess.

In addition to the kits, clinicians give out about 75 boxes of naloxone a week — the nasal spray used to save people overdosing on drugs.

Of those, clinicians get about 15 to 20 reversal reports back a week, Lasher said.

“Approximately 15 to 20 people a week live because someone in our clinic was given a box of Narcan that they were able to use,” Lasher said.

Magsig and Bredefeld Say Needle Exchange Doesn’t Treat Problem

Bredefeld said the program encourages drug use with no accountability.

“The needle exchange and crack pipe program only continues their addiction, it doesn’t treat it or end it,” Bredefeld said.

Fresno County Sheriff John Zanoni also supported the clinic but opposed the needle exchange. He said there are too many dirty needles in public. The needle exchange doesn’t require turning in dirty needles to get clean ones.

Pacheco said when he met with Lasher, he wanted to know if he could do his work and leave out the drugs and needles. Lasher, however, told him that was non-negotiable.
Pacheco said the benefit of having the clinic outweighs the moral cost of giving out needles and pipes.

“We’re not going to change people’s habits — although Dr. Lasher has convinced over 300 to seek treatment — but the people that are going to do drugs are going to do drugs anyway,” Pacheco said.