Jason Jackson was addicted to heroin for 10 years until this spring and remembers well the almost daily struggle to find a needle to shoot up.
Jackson, now 37 and enrolled in a methadone program in Raleigh, said too often he would rely on a needle already used by other intravenous drug users, despite the risk of infectious diseases such as HIV or hepatitis C.
“A heroin addict is going to use a needle when it’s time to get high,” Jackson said recently. “It could be one on the side of the road. One needle might be used by eight people getting high.”
That changed for Jackson and hundreds of other addicts last year, after then-Gov. Pat McCrory signed into law a bill that allows drug users in North Carolina to exchange used syringes for sterile ones. The legislation was a milestone in the state’s changing approach to drug abuse, which politicians and even law enforcement agencies increasingly see as a public health problem and not merely a crime.
There are now more than a dozen syringe exchange programs in North Carolina – in Raleigh, Durham, Chapel Hill, Hillsborough, Henderson, Greensboro, Fayetteville, Charlotte, Asheville, Wilmington, Manteo, Winston-Salem and High Point. Southlight Healthcare on Garner Road in Raleigh has handed out 4,240 needles since January, after making contacts with 70 people who are using drugs. Workers and volunteers with Durham’s program, which started in August, have handed out 15,829 syringes after making 398 contacts, said coordinator Loftin Wilson.
With the needles comes access to health screenings and treatment programs. Jackson, who is on parole for what he described as a “drug-related” felony conviction, and lives with his fiance, credits the needle exchange program at Southlight Healthcare with enabling him to enroll in the agency’s methadone program in March. Each time he received clean needles, he said, the outreach worker would encourage him to seek treatment.
“It was like a seed planted in my head,” he said.
The needle exchange law garnered bipartisan support at a time when an opioid crisis is plaguing North Carolina and the rest of the country. The number of people who died of overdoses of heroin and other opioid drugs in North Carolina has exploded, from 150 in 1999 to 1,110 in 2015, according to the state Division of Public Health.
State lawmakers were swayed by decades of research that shows syringe exchange programs are effective in lowering the rates of HIV and hepatitis C. Acute hepatitis C cases in North Carolina have more than doubled over the past four years, while the costs of treating Medicaid patients with the disease rose from about $8 million in 2013 to more than $50 million in 2014, according to the state Department of Health and Human Services.
Supporters of the new law say legal syringe exchanges have filled a gaping hole in North Carolina’s defense against opioid-related deaths and illnesses. The 10-month-old program has also provided another indicator of how pervasive illicit IV drug use has become in this state. Public health workers and volunteers have distributed more than 180,500 clean needles in a little more than four months this year, while making 1,584 contacts with people who have drug abuse disorders.
The first programs in Asheville and Greensboro were up and running by July, the same month the bill was signed into law. Both programs had existed underground before the law was passed, said Tessie Castillo, a lobbyist and communications coordinator with the N.C. Harm Reduction Coalition, a statewide nonprofit that advocates for people addicted to narcotics such as heroin and synthetic opioids.
The availability of clean needles through underground exchanges was the exception before the new law, Castillo said. She says most addicts would share needles with each other or, worse, scrounge through trash cans and bins to find used needles.
“It was horrible, what was happening before,” she said. “Other people who had prescriptions, like diabetics, would use their syringes one time and sell them.”
Syringes can be purchased at drug stores for about $3 for a package of 10. But Castillo said many pharmacies will not sell syringes to people unless they have a medical prescription.
“They thought they were helping the problem by not selling the syringes because that would enable people,” she said. “It’s for that reason that many pharmacies have policies against selling them without a prescription.
“The other reason is there’s a concern that if they let people get syringes they would shoot up on the premises, in the parking lot. They didn’t want ‘those type of people’ in their store.”
The state does not provide any money to purchase syringes for needle-exchange programs, which must rely on grants that stipulate areas where health workers and volunteers can serve.
When the syringe exchange program started at Southlight Healthcare in late November, only two people visited the treatment center each week to exchange their dirty needles, said Jessi Ross, a regional coordinator with the N.C. Harm Reduction Coalition. Now, Ross says, about a half dozen residents visit the center a week, and a far greater number are reached through the program’s mobile outreach and by relying on “peer exchange,” program participants who have greater access to fellow users.
“Drug users and sex workers are going to be the ones to reach the most marginalized people in our communities,” Ross said.
Someone might think I’m the cops, but then someone else there might know me and they’ll say, ‘No, she’s cool. She’s the needle exchange girl.’
Jessi Ross, a syringe exchange coordinator in Raleigh and Fayetteville with the N.C. Harm Reduction Coalition
Ross, 32, stuffs the backseat and trunk of her black Honda Accord with brown paper bags, each filled with 10 syringes, two condoms, a tourniquet, tiny balls of cotton in plastic bags, two tin-metal cookers, bottled water, snacks and a sealed opioid overdose kit.
“Sometimes I might give one person supplies for four or five people,” she said. The extra kits are for peer volunteers who are able to get the supplies to “people who don’t feel comfortable, or are isolated.”
Ross’s mobile outreach takes her to motels, gas stations, suburban homes and college campuses. She relies on word of mouth, the internet, fliers and community organizations to get the word out about the syringe exchange.
She says addicts relate to her because she is a former sex worker and was a drug user in her late teens while growing up in Richmond, Va.
“I don’t have a habit anymore, and I’m not in recovery and that’s very important to me,” she said. “But I’m a community member, and there’s a certain level of trust because they know me. Someone might think I’m the cops, but then someone else there might know me and they’ll say, ‘No, she’s cool. She’s the needle exchange girl.’ ”
The new law gives those who receive clean needles limited immunity from criminal charges for possession of drug paraphernalia and residue. Once they have registered with the program, they are given an enrollment card to show to an officer who might question them about the syringes and paraphernalia.
“If they still have to go to court, we’ll provide them with verification to get the charges dropped,” Ross said.
On a sunny late April afternoon, Ross met with Jesse Bennett, a 39-year-old N.C. State University student who is studying social work, in the offices of Live It Up!, a community service nonprofit on Hillsborough Street. The syringe exchange program has an office at Live It Up! that’s about the size of a walk-in closet to house syringes and other supplies in the outreach kits.
Bennett works part-time as the Harm Reduction Coalition’s statewide volunteer coordinator and manages the coalition’s syringe exchange inventory. He also conducts kit-making workshops and does overdose prevention workshops with college student organizations, businesses and community groups across the state.
I want active drug users to feel empowered, living healthy and getting into drug treatment.
Jesse Bennett, a N.C. State University student and statewide volunteer coordinator for the N.C. Harm Reduction Coalition
Bennett is a recovering opioid drug addict whose habit led him to prison in Georgia and North Carolina. He has been sober since Jan. 1, 2012, after spending 16 months in long-term treatment at the Healing Place, now known as Healing Transition, just south of downtown Raleigh.
Bennett completed the treatment program in March 2013 and earned an associate’s degree from Wake Tech in May 2015. Later that summer, he started volunteering with the coalition, distributing syringes, even though it was illegal.
“It was actually easier underground,” he said with a small laugh. “Now we have to keep all the paperwork and data and get people enrolled.”
Bennett said being on both sides of the epidemic has enabled him to understand the plight of those suffering from addiction.
“I think that when I was addicted, I didn’t feel empowered. I felt like the world was against me. When I was in and out of the penitentiary, I felt like I was wrapped up in the war on drugs,” he said. “I want active drug users to feel empowered, living healthy and getting into drug treatment. Things like that. I don’t preach to them. When people want change, I help facilitate that.”