After years of advocacy efforts, North Carolina legalized syringe exchange programs in July 2016. Three months later, 15 syringe exchange programs have sprung up across the state with more on the way. The programs take on a variety of forms ranging from fixed site locations, health department exchanges, peer exchanges and mobile services run out of cars, in parking lots, or in people’s homes, but the one thing they have in common is the passion and dedication of the people who run them.
The nonprofit employees, health department staff and volunteers who are implementing syringe exchange became involved because they know the benefits: reducing HIV and viral hepatitis C infections, protecting law enforcement and the public from needle-stick injuries, and connecting people who inject drugs to resources and services, to name a few. As they set up these exchanges, often with no funding or paid staff at all, they have encountered numerous challenges, but have also seen some incredible results.
One of the challenges echoed by several of the exchange operators has been overcoming initial wariness, skepticism, and stigma against syringe exchange programs.
“People are still getting over the initial disbelief that syringe exchange is a legitimate program,” says Hyun Namkoong, who is setting up an exchange in rural Brunswick County. “If you offer them syringes, some people are worried that law enforcement is waiting around the corner.”
Ed, who volunteers at the Raleigh syringe exchange, reports that some people “have a strong visceral reaction to the syringes when they first see them. Stigma against injection drug use is still there even in people I would expect to be more open and understanding.”
Initial skepticism is to be expected in a state where possession of syringes has long been considered a criminal offense. But even just a couple of months after the law changed, some people are already starting to see the tide turn.
Cat Nelson co-founded an exchange out of Charlotte. She describes a phone call from a concerned mother who had discovered her 20-year-old son participating in the exchange.
“The mother felt that her son’s drug use had increased since he started receiving services from us and she was disturbed at him coming home with boxes of needles and other injection supplies,” says Cat. “She and I and her son sat down and decided to do a one-for-one needle exchange. Normally I don’t do that because it’s not best practice, but in this case we did so the mother would feel better.”
The son also began volunteering at the exchange to complete a court requirement. After a short time, the mother began to see the positive influence that the exchange had on her son. He was healthier and excited about giving back to the community. She also realized that his drug use had not increased since he started participating in the exchange.
“The mother saw that fear and stigma had caused her to think that way,” says Cat. “She later agreed we could do regular exchange with her son, where we give him as many syringes as he needs instead of one-for-one. She sees that him helping at the exchange increases his self-esteem because he is participating in improving the health of the community and his own health. And the judge was so pleased that the son had volunteered in something directly related to his charge that he dropped all the charges!”
While some exchanges are working on building trust and a client base, others are struggling with the opposite problem – overwhelming demand.
“Since the law passed, it’s like the floodgates opened and people have come out of hiding to ask for syringes,” says Pastor James Sizemore of Fayetteville. Pastor Sizemore has run an exchange underground out of his church since 2007, but has noticed a marked increase in demand since syringe exchanges were legalized.
The Needle Exchange Program of Asheville (NEPA), the longest running exchange in North Carolina which operates out of the Western NC AIDS Project, has seen their clientele more than double in the past three months. “We were passing out about 30,000 syringes a month before the law passed, but now we are up to about 60,000 per month,” says Executive Director Jeff Bachar. “Our biggest challenge is running out of supplies.”
Loftin Wilson, who runs exchanges in Durham and Vance counties, describes people “flocking to [his] truck” when he pulls up on busy street corners to do mobile exchange. “People are really excited about the exchange and they have been offering us advice on where else to visit and asking how they can volunteer,” says Wilson.
High demand, lack of resources and overcoming initial skepticism are only a few of the challenges facing exchanges across North Carolina. Others include finding good locations, transportation in rural communities, and in some cases, issues with law enforcement. A young woman from one of the syringe exchanges was recently arrested by a deputy from a Sheriff’s Office for possession of syringes, even after she showed the deputy her ID card from the exchange. The deputy had not heard of legalized syringe exchange before and did not believe it to be legal.
Later, a representative from the North Carolina Harm Reduction Coalition called the Sheriffs Office to report the incident and clarify the new law. The charges against the young woman were immediately dropped. Allegedly, the deputy had not read a memo sent out to all employees informing them of the existence of the exchange. Incidents like this illustrate the need to educate law enforcement about syringe exchange programs so that erroneous arrests do not occur and erode people’s trust of the programs. But in general, most people have reported that law enforcement is supportive of the syringe exchange programs.
“Law enforcement have been incredibly supportive of our syringe exchange efforts here,” says Rebekah Paulsen, who runs a mobile exchange in Dare County. “They see this as a public safety and disease prevention issue.”
Another challenge facing health departments in particular is the prohibition on the use of public funding to purchase syringes. This creates a hurdle for many health departments, though it has not stopped the Orange County Public Health Department from setting up two exchanges at their locations in Chapel Hill and Hillsborough.
Robin Gasparini, Public Health Nursing Supervisor, says, “We are proud to be the first health department to start this initiative. We recognize that this is a highly stigmatized problem and we welcome more awareness and healthy discussion around how we can support this public health need.”
One of the most common themes reported by people running the exchanges is that syringe exchange is much more than just passing out clean injection supplies. It’s an opportunity to open dialogue with people about their health and community involvement.
Hillary at the Steady Collective syringe exchange in Asheville recalls that earlier this week she had a conversation with someone who refused a naloxone kit because. He said he only uses drugs alone so there would be no one around to save him if he overdosed.
“He started to tear up as we spoke and then he turned and walked away,” says Hillary. “I ran after him and we talked for a while about the dangers of using alone and brainstormed ways he could find other people to be around him. He ended up taking a naloxone kit. He also talked about wanting to stop using drugs but not being ready for detox quite yet. Now that a relationship has been established, if he ever becomes ready, he knows where to look for help.”
Loftin Wilson recalls how at the Vance County exchange he gave his number to a woman who was concerned about HIV. They texted for over a month while she expressed nervousness and hesitation about getting tested. Then finally, she built up the courage to come back to the exchange and ask for a test.
“Sometimes it takes weeks of asking questions and repeated contact with a person before they are ready to take certain steps to improve their health, says Wilson. “Syringe exchange is unique because it puts that scaffolding in place. You see the same people over and over again and that dialogue leads to positive change.”
Positive change can mean many things, from managed or reduced drug use to overdose prevention, wound care, HIV and viral hepatitis testing, or entry into a substance use program. Several exchanges have successfully referred people to drug treatment. Karen Lowe in Hickory recalls one client who hadn’t known where to go for recovery options until participating in the exchange. With her help, that person entered a treatment program.
Mike Page in Wilmington also reports stories of people who have successfully entered treatment thanks to resources and referrals from the exchange. “I don’t push people to get treatment, but when they ask about it I go out of my way to help them,” says Page.
Louise Vincent in Greensboro describes a member who was struggling with chaotic drug use after her best friend died of a drug overdose. “After she got involved with the exchange, she stopped using heroin. Now she comes into volunteer with us. She is so excited about harm reduction because it’s a different philosophy that she didn’t even know existed. None of the other recovery programs have worked for her, but the incremental change within harm reduction has made such a difference.”
Some syringe exchanges connect participants to community organizing, advocacy projects, and support groups in addition to health services. People come into the exchange talking about things they want to change in the community.
“Syringe exchange is about more than just physical health or disease prevention,” says Louise. “We have always been told that the best way to get people to stop using drugs is to punish them or to shame them. But here we know that building up self-esteem, participation in advocacy groups, making people feel needed, essential and empowered are what really creates change. That is what syringe exchange programs are really about.”
For more information about syringe exchange programs in North Carolina or to request information on how to start one, visit http://www.nchrc.org/syringe-exchange/.
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