The Santa Cruz County Board of Supervisors on Tuesday passed an ordinance that would prohibit the sale of recreational nitrous oxide, and also made changes to lab services in the Health Services Agency.
The supervisors agreed to outsource the Health Services Agency’s (HSA) laboratory services to Quest Diagnostics, a move that is expected to save roughly $1.5 million annually.
That was part of a staff recommendation to “right-size” HSA’s budget as looming budget cuts from the Trump Administration to Medicare and Medi-Cal threaten to decimate health care programs nationwide.
But the board opted to use one-time funds to keep its X-ray and other radiology services for another year, despite staff recommendations that it would save the county an additional $500,000 annually.
Supervisor Justin Cummings, who made that motion, also asked that the HSA look for ways to work with SEIU to continue radiology services in the future.
County Administrative Officer Carlos Palacios warned the supervisors about using one-time funds to pay for ongoing expenses, explaining that doing so is bad practice at a time when cuts from the federal government will likely worsen.
Over the next two years, he said, an estimated 20–25% of people who depend on Medi-Cal will lose their coverage, which will have a devastating impact on health care providers.
“We’re going to be in a big battle just to keep our own clinics open over the next few years, and the hospitals are going to be in a battle just to stay open,” he said.
The discussion to make cuts to the HSA began on June 10, when the board approved the department’s budget that called for the deletion of 74.4 FTE positions, 11.6 of which were filled.
Most of these have either retired, left or been placed elsewhere.
At the same time, the board approved funding to HSA that supported an extension of lab and radiology services through Sept. 30.
County Chief of Health Center Services Amy Peeler told the board that the county’s financial crunch is not unique as expenses rise faster than revenues.
“We are not alone in this,” she said. “We are all experiencing this cut in margins in revenue, and we are looking at some truly significant financial hits, with changes to Medi-Cal at both the federal and state level.”
Making the reductions in laboratory services, she said, helped the county save money while affecting the fewest number of employees.
“As we delved into all of our different services, lab and radiology stood out,” Peeler said. “They are essential services for primary care, but there are options to provide these services to patients in a different way and in the community.”
Under the new model, staff from Quest Diagnostics will be responsible for collecting samples such as blood draws, and sending them to be analyzed.
She pointed out that only two county employees remain that perform blood draws.
County staff at the Homeless Persons Health Project and Juvenile Hall will still be responsible for collection.
HSA director Connie Moreno-Peraza said the county looked at many other areas of the agency to find any other carve-outs.
“The fact is that we don’t have an alternative that saves us close to $2 million with only 8 positions being affected,” she said.
The item will come back to the board on Sept. 30, when the board will determine where the one-time funds will come from.
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In other action, the supervisors unanimously approved an ordinance which—if approved upon the second reading on Sept. 30—would prohibit the retail sale of nitrous oxide for recreational use.
Also known as “laughing gas,” nitrous oxide has several legitimate uses, such as an anesthetic for some medical procedures, and in restaurants to make whipped cream.
But because it also causes a brief euphoric “high,” it has been widely abused, particularly by young people. And while state law prohibits its sale to minors—and for the purposes of intoxication—proving that can be a challenge, said Supervisor Kim De Serpa, who authored the ordinance.
“This gap leaves enforcement powerless where retail shops openly sell nitrous,” she said.
Also known as nitro, N₂O, NOS, nangs, whippets, hippy crack and buzz bombs, the gas works when the user inhales it.
According to county officials, it is classified as a dissociative drug that can alter perception, mood and consciousness similar to psychedelics.
It can cause dizziness, disorientation, blurred vision, loss of balance, numbness, nausea, headaches, vomiting, impaired memory, and slowed cognition or motor performance.
Heavy use may also cause chest tightness, impotence and clumsiness. Chronic use can cause vitamin B12 depletion, which can lead to nerve and brain damage, bone marrow suppression, muscle control loss, tinnitus, incontinence, weakened immunity and increased risk of heart attack.
The ordinance, De Serpa said, “is about protecting public health and public safety.”
She pointed to several recent incidents in which drivers were caught under the influence of the gas.
“We’re just seeing more and more of it,” De Serpa said.
During the summer, she said, SCSO investigators received a tip about a gas station in Felton that was selling “shelves and shelves and shelves” of nitrous. Employees later sold products to a minor decoy in a sting operation.
Later, investigators learned that the shop sold more than 900 units in four months, which was enough for 235,000 doses, De Serpa said.
“This is not small-scale,” she said. “It is industrial-level distribution for recreational abuse.”
Similar ordinances have been adopted in Orange, San Mateo and Humboldt counties.
De Serpa said that she expects local cities, along with the counties of Monterey and Humboldt, to follow suit.
Amber Williams, who runs Janus of Santa Cruz—a nonprofit that helps people overcome substance use disorders—said that withdrawal from nitrous oxide is difficult to treat. Two young people have recently gone to treatment for it, she added.
“The more we can ban it and get it out of our community so we can actually treat the other issues we’re already dealing with in substance use disorder services, the better,” Williams said.
Santa Cruz County Sheriff’s Lt. Nick Baldridge said the ordinance will help law enforcement close the loophole that allows retail sales.
“This would just allow us to help keep that off the street, help keep our community safe, and take that enforcement action to keep it out of our retail shops in this county to try and limit that access for our youth,” he said.
If adopted later this month, the ordinance will take effect 31 days later.
