But the program, the first and only one in Orange County, soon found itself under fire by critics and concerned community members. A swell of needle litter in public libraries and parks in Santa Ana collided with a worsening homelessness epidemic in the region, and the two issues became intertwined in the minds of the public and political leaders.

Transient individuals, critics said, were using the needles to shoot up in public and then improperly discarding them. And the syringe exchange program, they said, had facilitated their drug abuse and created the needle litter.

The fallout has pitted worried public health experts against Orange County political leaders, who have fielded large numbers of complaints and concerns from constituents.

The program’s leaders and various public health experts have forcefully pushed back against the attacks but have struggled to change public opinion.

“There are a lot of misconceptions about syringe exchanges despite lots of public health evidence around this. We know that syringe exchanges have been proven time and again here in the United States and internationally to reduce the spread of diseases,” said Nathan Birnbaum, member of the board of directors for the syringe exchange and a fourth-year medical student at the University of California, Irvine School of Medicine.

In December 2017, Santa Ana terminated the needle exchange’s permit. As part of an effort to remain open, the exchange requested authorization from the state’s Department of Public Health to operate a mobile, countywide program in four cities: Santa Ana, Anaheim, Orange and Costa Mesa. Last month, it was granted permission to operate the expanded program.

Now Orange County leaders have escalated their battle by suing to permanently shut down the expanded syringe exchange before it begins operating again.

“You have people shooting up in the public-library restroom. You have municipal employees who are being pricked when emptying the trash,” said Andrew Do, chairman of the Orange County board of supervisors.

The first hearing on the case is set for later this month. But it is unclear if there will be an immediate or permanent resolution to the conflict.

The state health department declined to comment on the matter, but voiced support for needle exchange programs as important public health tools.

“We really understand people’s concerns about syringe litter,” said Dr. Karen Smith, the state’s public health officer. “The challenge for us is communicating that the syringe exchange programs is one of your most potent tools for decreasing syringe litter.”

This article originally appeared in The New York Times.

Jose A. Del Real and Matt Stevens © 2018 The New York Times