From North to South, mountains to coast, North Carolina is now home to 26 unique syringe exchange programs. The exchanges operate out of churches and harm reduction programs, pawn shops, treatment centers and drug user unions, ambulances and fire departments, recovery programs and AIDS care service organizations, health departments, peer support programs and much more. Some have budgets and fixed sites, while others operate out of the trunks of cars, fueled by the passion of those who want to bring health, wellness and empowerment to people who use drugs.
After one year of operation (summer 2016 to summer 2017) the exchanges have collectively distributed over 1 million syringes across the state, reported over 2000 overdose reversals using naloxone, made over 3,500 referrals to drug treatment, and administered over 2600 HIV tests. Many are also distributing fentanyl test strips, which allow a person to test their drugs for the presence of fentanyl, which could increase their risk of overdose, before taking them. More importantly, the exchanges usher in a new way of approaching people who use drugs – one that emphasizes compassionate, evidence-based solutions over the purely punitive policies of the past.
Loftin Wilson, who runs an exchange in Durham via the North Carolina Harm Reduction Coalition, says “We work hard to build relationships with our members based on warmth and trust and unconditional positive regard. Having those interactions can mean a lot to people when they are going through really difficult times. One time a participant told me, ‘you don't treat me like an imposition, you treat me like a hero’ [for taking positive steps to take care of my health]. I loved that and I think that's a good representation of how I want all our participants to feel.”
Out in Asheville, Hillary Brown, who helps run The Steady Collective exchange, tells a story of how some of her participants have been impacted by the exchange.
“Last week I had a couple come in for naloxone kits,” she says. “The woman admitted she had overdosed twice in the previous week and it had been a difficult wake up call for her and her partner. They were struggling with the fear of death and said they had kids together but hadn’t been allowed to see them in a long time. They wanted to go into treatment. They said they hadn’t opened up about the overdoses with anyone. They were walking around with fear and trauma and grief and had no one to process it with, cry about it, and admit that they wanted a different life. In our harm reduction role at the exchange, sometimes we end up acting as grief counselors for people who have no one else to process their pain with.”
The exchanges have created positive impact in the communities they serve, but the programs are not without challenges. For Jessie Garner of the North Carolina Harm Reduction Coalition, who runs a Fayetteville exchange, the biggest challenge has been gaining trust from community members suspicious of the programs.
“It’s hard at first getting people to trust me and to believe that the exchange is legal and we are not working for the cops,” he says.
While many sites have enjoyed support from law enforcement, others have struggled with issues such as officers arresting participants, ripping up their ID cards that show participation in an exchange, claiming the exchanges are bogus, or charging people for offenses that will ultimately get thrown out in court. Another law enforcement-related challenge is that often the disruption of drug supply through law enforcement work can have the unintended consequence of reducing the quality of an existing drug, leading to a spike in overdoses.
“Out in western North Carolina, law enforcement have cut off a lot of the supply of heroin,” says Hillary Brown. “That, coupled with doctors who have stopped prescribing opioids means that supply is getting low. Opiate users are getting desperate and taking whatever they can find so they don’t get dope sick. We see people inject drugs they know aren’t safe because they are so afraid of being sick. We see a lot of people mixing drugs or injecting meth laced with fentanyl. We are dealing with a lot of deaths because of this.”
In addition to some law enforcement-related challenges, the issue of syringe access through pharmacies continues to be a problem throughout the state. Most pharmacies do not sell syringes over the counter, though legally you do not need a prescription to buy syringes in North Carolina. And while 26 exchanges may be an impressive number in such a short time, it is woefully inadequate to address the needs in all 100 counties. Many of the people running the exchanges have expressed the need for pharmacies to step up and help the problem by selling syringes to anyone who asks for them.
“Participants are tired of being embarrassed at being turned down by pharmacies,” says Hillary. “We are not asking pharmacies to give syringes away for free. We are just asking that they sell them to people who need them to prevent the spread of disease.”
Another major challenge to syringe exchanges is how to meet the needs of people who do not inject drugs – or better yet, how to encourage people who currently inject drugs to consider smoking instead. When it comes to spreading infection or overdosing, smoking drugs is safer than injecting, yet while syringes are now legal to hand out, pipes are not.
“Many people tell me that they would rather smoke drugs than inject, but if they can't access a pipe or legally carry one, then they will inject,” says Loftin. “As someone who is there to provide a public health service intended to reduce harm, it doesn't feel good to be able to give someone who is primarily an injection drug user everything they need to reduce their risk, but only be able to offer someone who primarily smokes drugs tools that may actually increase their risk.”
The final major challenge confronting many of the new exchanges is lack of resources, time and staffing to meet an overwhelming need.
“Our exchange covers 7 counties, but we are people with regular jobs who run the exchange in our free time,” says Karen Lowe of Olive Branch Ministries, who runs an exchange in Catawba and surrounding counties. “We need a designated mobile unit where we can keep our supplies so we don’t have to use our personal vehicles and we need more staff and time to reach all these different counties.”
For the Raleigh exchange, which recently acquired a van for mobile outreach, the problem is lack of a fixed site. “We need an office space that people can visit during the day where we can store supplies and have a location for educational and support groups in the evenings,” says Jesse Bennett of the North Carolina Harm Reduction Coalition.
Louise Vincent, President of the Urban Survivors Union in Greensboro, needs extra staff to keep up with the growing demand at the exchange. “We recently started new programs such as a women’s group focused on reproductive justice, dealing in underground economies, and the difficulties of seeking treatment when they are afraid of losing their children if they admit to drug use. We also started a North Carolina chapter of the National Association of Medication Assisted Treatment. We are running focus groups for people living with hepatitis C. There is so much going on it can be overwhelming sometimes.”
Despite the many challenges and lack of resources confronting the exchanges, all the people I interviewed spoke of how warmly the exchange had been received in their community overall. Says Loftin, “I really was not expecting how positive and welcoming everyone in the community has been towards us. Over and over again folks stop us on outreach to tell us they think we are doing something that is good and desperately needed. We hear this not just from participants who are directly affected but also from neighbors and local business owners. One time even a mail carrier delivering mail stopped to thank us.”
Margaret Bordeaux, who helps run an exchange in Wilmington, says, “We want people to have a welcoming space where they don’t feel marginalized. We want to be there for them in a time of need and to offer a service they can’t get anywhere else.”
To help some syringe exchanges manage the barriers and challenges they face, as well as to share successes with each other, the North Carolina Harm Reduction Coalition will be hosting a monthly conference call to allow exchange organizers to discuss challenges and share ideas. Information on the call is TBD. In the meantime, the heroes who run the exchanges continue moving forward to create lasting, positive change in the lives of their participants and to empower those participants to lift up each other.