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The Grand Canyon, a Cathedral to Time, Is Losing Its River

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The Grand Canyon, a Cathedral to Time, Is Losing Its River

As the planet warms, low snow is starving the river at its headwaters in the Rockies, and higher temperatures are pilfering more of it through evaporation. The seven states that draw on the river are using just about every drop it can provide, and while a wet winter and a recent deal between states have staved off its collapse for now, its long-term health remains in deep doubt.

Our species’ mass migration to the West was premised on the belief that money, engineering and frontier pluck could sustain civilization in a pitilessly dry place. More and more, that belief looks as wispy as a dream.

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North Canyon, an ancient tributary.

The Colorado flows so far beneath the Grand Canyon’s rim that many of the four million people who visit the national park each year see it only as a faint thread, glinting in the distance. But the river’s fate matters profoundly for the 280-mile-long canyon and the way future generations will experience it. Our subjugation of the Colorado has already set in motion sweeping shifts to the canyon’s ecosystems and landscapes — shifts that a group of scientists and graduate students from the University of California, Davis, recently set out to see by raft: a slow trip through deep time, at a moment when Earth’s clock seems to be speeding up.

John Weisheit, who helps lead the conservation group Living Rivers, has been rafting on the Colorado for over four decades. Seeing how much the canyon has changed, just in his lifetime, makes him “hugely depressed,” he said. “You know how you feel like when you go to the cemetery? That’s how I feel.”

Still, every year or so, he comes. “Because you need to see an old friend.”

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The lands of western North America know well of nature’s cycles of birth and growth and destruction. Eras and epochs ago, this place was a tropical sea, with tentacled, snaillike creatures stalking prey beneath its waves. Then it was a vast sandy desert. Then a sea once again.

At some point, energy from deep inside the Earth started thrusting a huge section of crust skyward and into the path of ancient rivers that crisscrossed the terrain. For tens of millions of years, the crust pushed up and the rivers rolled down, grinding away at the landscape, up, down, up, down. A chasm was cleaved open, which the meandering water joined over time with other canyons, making one. Weather, gravity and plate tectonics warped and sculpted the exposed layers of surrounding stone into fluid, fantastical forms.

The Grand Canyon is a planetary spectacle like none other — one that also happens to host a river that 40 million people rely on for water and power. And the event that crystallized this odd, uneasy duality — that changed nearly everything for the canyon — feels almost small compared with all the geologic upheavals that took place before it: the pouring, 15 miles upstream, of a wall of concrete.


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Glen Canyon National Recreation Area

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Grand Canyon National Park

Lake Mead National Recreation Area

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Glen Canyon National Recreation Area

Grand Canyon National Park

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Lake Mead National Recreation Area

Glen Canyon National Recreation Area

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Grand Canyon National Park

Lake Mead National Recreation Area

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Glen Canyon National Recreation Area

Grand Canyon National Park

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Lake Mead National Recreation Area

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Since 1963, the Glen Canyon Dam has been backing up the Colorado for nearly 200 miles, in the form of America’s second-largest reservoir, Lake Powell. Engineers constantly evaluate water and electricity needs to decide how much of the river to let through the dam’s works and out the other end, first into the Grand Canyon, then into Lake Mead and, eventually, into fields and homes in Arizona, California, Nevada and Mexico.

The dam processes the Colorado’s mercurial flows — a trickle one year and a roaring, spiteful surge the next — into something less extreme on both ends. But for the canyon, regulating the river has come with big environmental costs. And, as the water keeps dwindling, plundered by drought and overuse, these costs could rise.

As recently as a few months ago, the water in Lake Powell was so low that there almost wasn’t enough to turn the dam’s turbines. If it fell past that level in the coming years — and there is every indication that it could — power generation would cease, and the only way water would be released from the dam is through four pipes that sit closer to the bottom of the lake. As the reservoir declined further, the amount of pressure pushing water through these pipes would diminish, meaning smaller and smaller amounts could be discharged out the other end.

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A bearded explorer wearing a cap and a green hoodie, in the foreground, walks on a ribbed section of the North Canyon that looks like a series of giant, rusty-brown, naturally occurring steps.

A spring that looks like a narrow waterfall cascades out of a hole in a canyon wall down into a calm part of the Colorado River. The canyon walls are rust-red.

North Canyon, and a spring at Vasey’s Paradise.

If the water dropped much more beyond that, the pipes would begin sucking air, and in time Powell would be at “dead pool”: Not a drop would pass through the dam until and unless the water reached the pipes again.

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With these doubts about the Colorado’s future in mind, the U.C. Davis scientists rigged up electric-blue inflatable rafts on a cool spring morning. Slate-gray sky, low clouds. Cowboy coffee on a propane burner. At Mile 0 of the Grand Canyon, the river is running at around 7,000 cubic feet per second, rising toward 9,000 — not the lowest flows on record, but far from the highest.

Cubic feet per second can be a little abstract. As the group paddles toward the canyon’s first rapids, Daniel Ostrowski, a master’s student in agronomy at Davis, says it helps to think of basketballs. Lots of them. A regulation basketball fits loosely inside a foot-wide cube. Draw a line across the canyon, and imagine 9,000 basketballs tumbling past it every second.

At Mile 10, the scientists float by a more tangible visual aid. Ages ago, a giant slab of sandstone plunged into the riverbed from the cliffs above, and now it looms over the water like a hulking Cubist elephant. Or at 9,000 basketballs per second it looms. At higher flows — 12,600 basketballs, say — it’s submerged to its knees. At three times that, the water comes up to its head. And at 84,000, which is how much ran through in July 1983, the elephant is all but invisible, a ripple at the river’s surface.


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The big problem with low water in the canyon, the one that compounds all others, is that things stop moving. The Colorado is a sort of circulatory system. Its flows carved the canyon but also sustain it, making it amenable to plants, wildlife and boaters. To understand what’s happened since the dam started regulating the river, first consider the smallest things that its water moves, or fails to move.

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The Colorado picks up immense amounts of sand and silt charging down the Rockies, but the dam stops basically all of it from continuing into the Grand Canyon. Downstream tributaries, including the Paria and Little Colorado, add some sediment to the river, but not nearly as much as gets trapped in Lake Powell. Plus, when river flows are weak, more sediment settles on the riverbed.

The result is that the canyon’s sandy beaches, where animals live and boaters camp at night, are shrinking. Beaches that were once as wide as freeways are today more like two-lane roads. Others are even scrawnier. The sandy space that remains is also becoming overgrown with vegetation: cattail and brittlebush, arrowweed and seepwillow, bushy tamarisk and spiny camelthorn. Before the dam came in, the river’s springtime floods regularly washed this greenery away.

A blue raft rides a choppy portion of the Colorado River. Ocher canyon walls stretch into the distance. The water is green with whitecaps, and the overcast sky is light gray to white.

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Tall, pale green grass grows on the banks of the Colorado River and surrounds a leafless tree. The water is rust-colored, and so are cliffs that rise in the distance. The overcast sky is gray.

Loss of silt-laden water is harming the ecosystem.

A lusher, less-barren canyon might not sound like a bad thing. But grasses and shrubs block the wind from blowing sand onto the slopes and terraces, where hundreds of cultural sites preserve the history of the peoples who lived in and around the canyon. Sand shields these sites, which include stone structures, slab-lined granaries and craterlike roasting pits, from weather and the elements. With less sand drifting up from the riverside, the sites are more exposed to erosion and trampling by visitors.

Also, not every place in the canyon is becoming greener. Drought can sap the water that courses within the porous stone walls, water that, where it spurts out, sometimes feeds eye-popping bursts of plant life. Lately, some of these springs, like Vasey’s Paradise at Mile 32, have dried to a dribble for long stretches. But a few bends downriver, the U.C. Davis scientists spot several hanging gardens that, for now, are still thriving.

Besides sand, the Colorado is failing to move larger objects in the canyon. Cobbles and boulders periodically tumble in from hundreds of tributaries and side canyons, often during flash floods, creating bends and rapids in the river. With fewer strong flows to whisk this debris away, more of it is piling up at those bends and rapids. This has made many rapids steeper and narrowed boaters’ paths for navigating them.

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Today, when the water is low, more boulders in the river are exposed at certain rapids, making them trickier to negotiate for the 30-to-40-foot-long motor rigs that are popular for canyon tours. In a future of prolonged low flows, tour companies might find it harder to run such large boats safely, cutting off one main way to experience the canyon intimately.


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Drought and low water aside, there’s another aspect of the canyon’s future that worries Victor R. Baker, a geologist at the University of Arizona. Dr. Baker has spent four decades exploring alcoves, high ledges and tributary mouths in the Colorado Basin. He scours them for the very particular patterns of sand and silt left by giant floods. The stories they tell are startling.

Mad cascades of water, ones at least as large as any the Grand Canyon experienced in the 20th century, swept through it at least 15 times in the past four and a half millenniums, Dr. Baker and his colleagues have found. Geological evidence upriver from the dam points to 44 large floods of varying sizes there, most of them in the last 500 years.

As the atmosphere warms, allowing it to hold more moisture, the risk of another such deluge could be rising. If one struck when Lake Powell were already flush with melted snow, it could take out the dam, not to mention do considerable work on the canyon.

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“I would think the future is going to be one moving toward, as they said in war, long periods of boredom interrupted by short episodes of total, absolute terror,” Dr. Baker said.

None of the government agencies with a hand in managing the canyon can do much about that, not on their own. But they are trying to beat back some of the other forces remaking the canyon from within.

Since 1996, the Bureau of Reclamation, which owns Glen Canyon Dam, has occasionally released blasts of reservoir water to kick up sand from the riverbed and rebuild the canyon’s beaches. The effects are noticeable. But the bureau conducts these “high-flow experiments” only when there’s enough water in Powell to spare. In April, it held its first one in five years.

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Eight people on a beach are dwarfed by a rusty-red cavern wall that towers and curves over them.

An explorer with dark hair and clothing sits high on an ocher cliff-face near two ancient, rectangular, doorlike openings cut into the rock. The spot overlooks the Colorado River, on the left, and faces the canyon wall on the opposite side.

Redwall Cavern, and the Nankoweap granaries, built 1,000 years ago.

The National Park Service works to preserve the Grand Canyon’s archaeological sites against erosion, even if that means leaving them swaddled in sand, where nobody sees them. “Those cultural resources that are covered by the sand are well suited by being covered by the sand,” said Ed Keable, the park’s superintendent.

Other issues, though, are so entrenched that addressing them just creates other problems. Take the spread of tamarisk, an invasive treelike shrub that has displaced native vegetation in the canyon and around other Western rivers. About two decades ago, officials decided to fight back by releasing beetles that loved eating tamarisk leaves. But the beetles loved those leaves so much, and their numbers grew so quickly, that they began threatening the Southwestern willow flycatcher, an endangered bird that nests in tamarisk.

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There is a similar no-win feeling to the bigger question of how to keep the Colorado useful to everyone as it shrivels. The dam is the root cause of the canyon’s environmental shifts, which also include big changes to fish populations. But simply allowing the river to flow more naturally through the existing dam, so water is stored primarily in Lake Mead instead of in both Mead and Powell, wouldn’t reverse the shifts entirely.

Jack Schmidt, the director of the Center for Colorado River Studies at Utah State University, has concluded that the only way to allow sufficiently large amounts of sediment-rich water back into the canyon, short of dynamiting the dam, would be to drill new diversion tunnels into the sandstone around it. That would be costly, and require careful planning to dampen the immediate ecological effects.

“Like everything else in that damn river system,” Dr. Schmidt said, “there’s a consequence to everything.”


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It’s the U.C. Davis scientists’ sixth night on the Colorado, and it comes after several numbing hours of paddling against the wind. As the sun touches the canyon walls with the day’s last glimmers of orange and gold, the graduate students sit in camp chairs chewing over what they’ve seen.

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They are preparing for careers as academics and experts and policymakers, people who will shape how we live with the environmental fallout of past choices. Choices like damming rivers. Like building cities in floodplains. Like running economies on fossil fuels. Once, those were first-rate answers to society’s needs. Now they require answers of their own — a whole wearying cascade of problems prompting solutions that create more problems.

“It becomes overwhelming,” says Alma Wilcox, a master’s student in environmental policy, sitting by a scraggly, haunted-looking grove of tamarisk. It helps, she says, to focus: “Having control over a really small aspect of it is empowering.”

Two blue rafts navigate a wide, calm section of the Colorado River. The water is murky and brown. Flanking the river are high lumpy canyon walls of dark brownish-gray rock streaked with lighter brown and pink.

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Water trickles down a canyon wall of dark brown rock – the color of dark chocolate – streaked with lighter brown and pink.

The basement rocks: dark schist and pink granite.

Yara Pasner, a doctoral student in hydrology, says she feels a duty to make sure the load on future generations is lessened, even if, or perhaps because, our forebears didn’t do us that courtesy. “There’s been a mentality that we will mess this up and the future generation will have more tools to fix this.” Instead, she says, we’ve found that the consequences of many past decisions are harder to cope with than expected.

The next morning, the group floats into the realm of the canyon’s oldest rocks. Almost two billion years ago, islands in the primordial sea crashed into the landmass that would become North America. The unimaginable heat and pressure from the collision cooked the rocks and sediment on the seafloor into layers of inky, shiny rock. This rock then lay buried beneath mountains that were formed in the collision, becoming squished and folded to create the otherworldly masses flanking the river today, which resemble nothing so much as freshly churned ice cream: dark gray schist swirled with salmon-pink granite.

But the mountains that sat above them? Those are all but gone, ground down over eons, their remnants long since scattered and recombined into new mountains, new formations.

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“There were the Himalayas on top of this,” says Nicholas Pinter, the Davis geologist who has helped lead this expedition, gesturing from the end of a raft at Mile 78. “And it’s eroded,” he says. “Worn to an almost infinitesimally flat plane, before it all begins again.”

Somewhere in among those grand happenings — within the tiniest, most insignificant-seeming snatches of geologic time — is the world we live in, the one we have.

Long shadows are in the foreground of a view of the reddish canyon walls, which loom on either side and ahead. The sky is blue with ribbed white clouds.


Map by Elena Shao.

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Produced by Sarah Graham, Matt McCann, Claire O’Neill, Jesse Pesta and Eden Weingart. Audio produced by Kate Winslett.

Additional expert sources: Ryan S. Crow, John Dillon, Ben Dove, Elizabeth Grant, Reed Kenny, Brandon Lake, Tom Martin, Abel O. Nelson, Joel B. Sankey, John Toner, Robert H. Webb, Brian Williamshen and Greg Yarris.

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California communities are banning syringe programs. Now the state is fighting back in court

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California communities are banning syringe programs. Now the state is fighting back in court

As Indiana officials struggled to contain an outbreak of HIV among people who injected drugs, then-Gov. Mike Pence reluctantly followed the urgings of public health officials and cleared the way for an overwhelmed county to hand out clean syringes.

Pence was far from enthusiastic about launching the program in Scott County, but after it rolled out in 2015, the percentage of injection drug users there who said they shared needles dropped from 74% to 22%. Within a few years, the number of new HIV infections plummeted by 96% and new cases of hepatitis C fell by 76%.

The Sierra Harm Reduction Coalition wanted to keep those same diseases in check in California. The tiny nonprofit got approval from the state to deliver syringes in El Dorado County to prevent the spread of life-threatening illnesses.

Yet when the program was discussed at a December meeting of the county’s Board of Supervisors, the success story in Indiana held little sway. Faced with complaints about discarded needles and overdose deaths, the supervisors voted to prohibit syringe programs in the county’s unincorporated areas.

“These programs may work in other parts of California and throughout the United States, although I have my doubts,” Sheriff Jeff Leikauf said at the meeting. “El Dorado County does not want or need these types of programs.”

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El Dorado is among a growing number of California communities that have banned syringe programs, testing the state’s power and political will to defend them as a public health strategy. It is part of a broader pushback against “harm reduction” — the practical philosophy of trying to reduce the negative effects of drug use — as overdose deaths have soared.

Now California is fighting back. In a recently filed lawsuit, the Department of Public Health argued that local ordinances prohibiting syringe programs in El Dorado County were preempted by state law, making them unenforceable.

The state is seeking a court order telling El Dorado County and the city of Placerville, its county seat, to stop enforcing their bans and allow syringe programs to resume.

An El Dorado County spokesperson said Monday that the county does not comment on pending legal issues. Its district attorney, however, said he was outraged to learn of the lawsuit, saying that state leaders were “seeking to impose the normalization of hardcore drug use.”

“Don’t come into our county and double down on your failed policy,” El Dorado County Dist. Atty. Vern Pierson said in a statement. “Allowing addicts to use fentanyl and other hardcore drugs is exactly what has caused other California counties to experience a death rate that is out of control and getting worse.”

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Mona Ebrahimi, the city attorney for Placerville, said the city had put a 45-day temporary moratorium in place “to study the ongoing effects of syringe service programs in the city.”

“The city wants to protect the health, safety and welfare of its residents,” Ebrahimi said.

The California Department of Public Health has long endorsed handing out sterile syringes as a proven way to prevent dangerous infections from running rampant when people share contaminated syringes. Researchers have linked syringe programs with a roughly 50% reduction in HIV and hepatitis C.

“It sounds crazy: ‘Wait, you want to give out the tools to people to do this thing that we all agree is a bad idea?’” said Peter Davidson, a medical sociologist at UC San Diego. But it works, said Davidson, who called the programs “probably the best studied public health intervention of the last 70 years.”

Public health officials also see them as a crucial way to reach people who use drugs and link them to addiction and overdose-prevention services. In Seattle, for instance, researchers found that injection drug users who started going to a needle exchange were five times more likely to enter drug treatment than those who never went.

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Signs direct visitors to the syringe-exchange program at the Austin Community Outreach Center in Austin, Ind., in 2015. The program was set up to curb an outbreak of HIV among people who injected drugs.

(Darron Cummings / Associated Press)

And in California, harm reduction groups have been particularly effective in getting Narcan — a nasal spray that can reverse opioid overdoses — into the hands of people who need it.

It’s “hugely important to reduce overdose in the community, and these are the programs that do that,” said Barrot Lambdin, a health policy fellow at RTI International who studies the implementation of health interventions.

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Yet leaders in some cities and counties have strenuously rejected the health benefits of syringe programs.

In El Dorado County, local leaders asserted that the efforts of the Sierra Harm Reduction Coalition had not “meaningfully reduced” HIV or hepatitis C cases since its syringe program began four years ago and said the free needles were ramping up the risk of deadly overdoses, which they argued were a bigger threat.

Street scene shows trees with fall colors, cars and old buildings

The El Dorado County Courthouse in Placerville, Calif.

(Max Whittaker / For The Times)

Alessandra Ross, a harm reduction expert at the California Department of Public Health, disputed such arguments in a letter to county officials. Ross pointed out that in just one year, the coalition handed out more than 2,200 doses of medication to reverse opioid overdoses, saving at least 421 lives. Without the group’s efforts, she wrote, “El Dorado County could have potentially lost more than ten times as many people to overdose.”

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Under state law, the California Department of Public Health has the authority to approve syringe programs anywhere that deadly or disabling infections might spread through used needles, “notwithstanding any other law” that might say otherwise.

The agency argued that the “significant state and public interest in curtailing the spread of HIV, hepatitis, and other bloodborne infections extends to every jurisdiction in the state, especially since Californians travel freely throughout the state.”

After El Dorado County prohibited syringe services in unincorporated areas, the state public health department adjusted its authorization for the Sierra Harm Reduction Coalition program, limiting its operations to Placerville. In the court filing, the agency said it made the change out of concern for the coalition’s staff and volunteers, who could be at risk of arrest if they provided syringes in the unincorporated areas.

The nonprofit said when it stopped providing syringes outside of Placerville city limits, roughly 40% of its clients were cut off. In February, Placerville city officials passed their own urgency ordinance banning syringe programs for 45 days, exempting needle provision at health facilities.

Ebrahimi, its city attorney, said officials took that step “after CDPH concentrated their use by authorizing them only in Placerville and nowhere else in the county.”

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The Sierra Harm Reduction Coalition stopped providing syringes in Placerville as well, according to the state lawsuit. The coalition did not respond Monday to requests for comment on the suit.

El Dorado County and Placerville are not alone: A wave of local bans went into effect last year in Placer County after a harm reduction group from Sacramento sought state approval to hand out clean syringes. The county’s sheriff and its probation chief said in a letter to the state that the syringe program proposed by Safer Alternatives thru Networking and Education, or SANE, would “promote the use of addicting drugs” and lead to more “dirty needles discarded recklessly in our parks.”

The Placer County Board of Supervisors voted unanimously to ban syringe programs in its unincorporated areas. Cities including Auburn, Loomis and Rocklin banned them too.

“We are the ones who should make these kinds of decisions,” then-Mayor Alice Dowdin Calvillo said at a September meeting of the Auburn City Council, “and not allow the state to just bully us.”

Public health researchers stress that studies have found that free needle programs do not increase crime or drug use, or worsen syringe litter. Yet as much of Placer County became a no-go zone, SANE withdrew its application for a syringe program there.

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“Our political processes are not well set up for us to make reasoned, scientifically sound judgments about public health,” said Ricky Bluthenthal, a USC sociologist whose research has documented the effectiveness of syringe programs. It doesn’t help that “the populations at risk are often marginalized or not politically active.”

Our political processes are not well set up for us to make reasoned, scientifically sound judgments about public health.

— Ricky Bluthenthal, a USC sociologist who studies syringe programs

The California Department of Public Health declined to address whether it planned to challenge local bans on syringe programs elsewhere in the state, saying it “cannot comment on active litigation strategy.”

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Syringe programs have long faced public skepticism: In a 2017 survey, only 39% of U.S. adults said they supported legalizing them in their communities.

Experts say the programs have faced increasing jeopardy as public concern wanes about the threat of HIV and frustration swells over other problems like soaring numbers of overdose deaths and the spread of homeless encampments. Even in Indiana’s Scott County, local leaders voted three years ago to shutter its needle exchange.

Clashes are also arising because programs are making moves into new parts of California, bolstered in some cases by state funding. California officials also have taken steps to help syringe programs overcome local opposition, including exempting them from review under the California Environmental Quality Act.

“It’s not surprising that cities and counties are motivated to protect the public health and safety of their residents through whatever tools they have at their disposal,” said attorney David J. Terrazas, who represented a group that successfully sued to overturn state approval of a syringe program in Santa Cruz County.

In that case, a state appeals court ruled last year that the California Department of Public Health conducted an insufficient review of a program run by the Harm Reduction Coalition of Santa Cruz County. The department didn’t do enough to consult with law enforcement agencies in the area, among other shortcomings, the court said.

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Although the state health department had considered some comments from law enforcement, “it never engaged with them directly about their concerns,” the appeals court concluded. Internal records showed department staff had decided not to respond to some of their comments and called one police chief an “imbecile.”

Terrazas said local officials are best poised to know what works for their communities. But Denise Elerick, founder of the Harm Reduction Coalition of Santa Cruz County, argued it made no sense for law enforcement to hold sway in public health decisions.

“We wouldn’t consult with them on what to do about COVID,” Elerick said.

A bag is filled with boxes of Narcan nasal spray for distribution to people living on the street in Los Angeles.

A bag is filled with boxes of Narcan nasal spray, one of several harm-reduction supplies distributed to people living on the street in Los Angeles.

(Francine Orr / Los Angeles Times)

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Weeks after the court ruling, the state health department rolled back its approval for a syringe program in Orange County that would have been run by the Santa Ana-based Harm Reduction Institute, saying it wanted to consult more with local officials.

The decision was celebrated by city leaders in Santa Ana, who had banned syringe programs in 2020 and sharply opposed efforts to restart one. At a recent meeting, interim city manager Tom Hatch said a previous program was “an epic failure” that left its downtown littered with used syringes.

Orange County is currently the most populous county in the state without any syringe services programs — to the alarm of health researchers who found that syringe reuse increased after a local program was shut down.

The Santa Cruz court ruling was also invoked by the Santa Monica City Council, which directed city officials to investigate how Los Angeles County came to approve a program run by the Venice Family Clinic. That program sends outreach workers into Santa Monica parks once a week to offer clean syringes, Narcan and other supplies and connect people with healthcare, including for addiction.

A woman hands out Narcan to a man at Tongva Park in Santa Monica

Devon O’Malley, left, a harm reduction case manager with the Venice Family Clinic, hands out Narcan to Ken Newark at Tongva Park in Santa Monica.

(Mel Melcon / Los Angeles Times)

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Critics want the program to relocate indoors, which they say would better protect parkgoers from discarded syringes. In addition, “if someone has to walk inside, there’s a chance for counselors to suggest strongly that it’s time for them to get off the drugs,” said Santa Monica Mayor Phil Brock, who wants the city to formally express its opposition to the program. “We can’t just facilitate their demise.”

Last month, a group called the Santa Monica Coalition filed suit to get L.A. County to halt the program it approved, saying it should instead be in a government building.

But Venice Family Clinic staffers said unhoused people can be reluctant to leave behind their belongings to go elsewhere. Even offering services out of a van reduced participation, said Arron Barba, director of the clinic’s Common Ground program.

“Bringing the service directly to the people is what we know works,” Barba said.

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Opinion: How measles reemerged as a threat in California and elsewhere

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Opinion: How measles reemerged as a threat in California and elsewhere

The measles virus is resurging in the U.S. despite the long-standing availability of a vaccine that provides nearly life-long immunity. In the past few weeks, hundreds of people were exposed to a child with the virus in a Northern California healthcare facility; our state is one of 17 jurisdictions with reported measles cases in 2024, higher than seen in recent years.

Measles is an extremely transmissible pathogen: On average, one infected person infects 12 to 18 unvaccinated people. The airborne virus can linger in floating aerosols long after someone has left a room, and the common symptoms, which include rash, a high fever, watery eyes, cough and a runny nose, typically take a week or two to appear.

Infections can also cause immune amnesia, in which your immune system becomes better at fighting measles and worse at fighting other infections you were previously protected against. In rare cases it also leads to death, more often in children than adults, from respiratory or neurological complications, including a type of brain swelling in young children that can appear years after the initial measles infection.

Before the measles vaccine was introduced and licensed in 1963, the Centers for Disease Control and Prevention cites an annual average of 549,000 cases (with likely millions more going unreported), 48,000 hospitalizations, nearly 500 deaths and 1,000 people with chronic disability. By 2000, thanks to vaccination, measles was declared eliminated in the U.S. But because of cases from people arriving here from other countries, combined with pockets of low vaccination, we are seeing outbreaks among unvaccinated people.

Policy can worsen the issue. Last month in Florida, following an outbreak at an elementary school, the state’s surgeon general left the decision to parents whether to send their children to school, citing high levels of community immunity as the rationale for not following the usual protocols. That cavalier response risked a much worse outbreak. A more standard response would have called for unvaccinated students and staff to be vaccinated and quarantine for 21 days (the time frame in which the disease could develop).

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It might be tempting to Californians to dismiss this as a Florida problem. But our state has a measles time bomb on our hands. Ideally communities should hit at least 95% vaccination to achieve herd immunity. But a recent nationwide survey found that Southern California alone has 350 schools falling short of the desired vaccination threshold, meaning a single measles case in these schools could easily become an outbreak among the unvaccinated.

Misinformation around the measles vaccine has been an issue for years. A debunked but influential 1998 research paper in the Lancet, a British medical journal, suggested a link between the vaccine, which babies can receive starting at the age of 12 months, and autism. The paper was retracted in 2010 (and the authors were later reported to have committed fraud). But measles vaccine rates dropped in England throughout the early 2000s.

In California, a 2014 outbreak at Disneyland was connected to more than 140 cases in North America, with declining vaccination rates one contributing factor. A recent systematic review of the reasons why parents reject measles vaccination for their children found fear of autism the most cited concern. Those who were hesitant more frequently cited the internet and social media as information sources on vaccines than those who were not hesitant.

In recent years hesitancy has grown as misinformation about the COVID vaccine has made some parents doubtful of routine inoculations. Vaccination exemptions during the 2022-23 school year reached the highest level ever reported in the U.S., increasing in 40 states and Washington, D.C., and 10 states reaching exemption rates of above 5%. According to the CDC, the 93.1% vaccination rate among eligible children puts about 250,000 kindergarten students at risk for measles.

Encouragingly, we’ve seen in our own state that vaccine hesitancy can be reversed. Marin County had among the lowest measles vaccination rates in the state in 2011 and now has coverage close to 99% among children entering school. State contact tracing efforts that were strengthened during COVID-19, including the California Connected program, have been useful to track the contacts of measles cases.

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But as the recent scares remind us, we still aren’t where we need to be with vaccination. Following the Disneyland outbreak, in 2015 California passed a law to remove the “personal belief” exemption from required childhood vaccines, meaning people must provide a medical reason to decline it. The law broadened the criteria for medical exemptions, which increased the year after it passed. Although the state tightened up medical exemptions with a new law in 2019, with the pandemic disrupting routine vaccinations and increasing homeschooling, the percentage of kindergarteners not up to date on vaccinations went up by 2021.

Vaccine exemption laws vary widely across the U.S., with some states allowing only medical exemptions, some also allowing religious exemptions and others permitting philosophical exemptions too. And outbreaks from one state can spill over across borders quickly.

That means decisions by Florida’s public health department, and vaccine hesitancy anywhere, can affect us all. California has to close the gap for communities that are not well-protected against measles.

Abraar Karan is an infectious disease doctor and researcher at Stanford University, where Julie Parsonnet is a professor of infectious diseases and of epidemiology and population health.

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Video: SpaceX Launches Starship for Third Time

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Video: SpaceX Launches Starship for Third Time

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SpaceX Launches Starship for Third Time

The rocket, a version of which will eventually carry NASA astronauts to the moon, traveled almost halfway around the Earth before it was lost as it re-entered the atmosphere.

“Five, four, three, two, three, one.” “This point, we’ve already passed through Max-Q, maximum dynamic pressure. And passing supersonic, so we’re now moving faster than the speed of sound. Getting those on-board views from the ship cameras. Boosters now making its way back, seeing six engines ignited on ship. Kate, we got a Starship on its way to space and a booster on the way back to the Gulf.” “Oh, man. I need a moment to pick my jaw up from the floor because these views are just stunning.”

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