The Needle Exchange Program of Asheville’s Michael Harney has been handing out free needles and other supplies to those who use injection drugs since 1994. It’s a simple way, he says, to prevent the spread of disease and protect the health of a vulnerable group of people.
Now that Buncombe County has announced it will begin providing a similar service at its 40 Coxe Ave. Department of Health and Human Services facility as soon as July, Harney has a simple message: “Bring it on.”
At an April 23 meeting with community groups dedicated to reducing the harms associated with drug use, Harney says the county stressed that “they were not going to be in competition with NEPA or the Steady Collective.”
Turf isn’t an issue. “It’s not a competition; it’s like, make more supplies available,” Harney says. His organization — which operates under the umbrella of the WNC AIDS Project — distributed about 473,000 needles in 2018, and even that number didn’t meet all the demand. Supplies often gave out when NEPA had spent its monthly budget, meaning the organization was out of stock on a third to half of its operating days.
Hillary Brown of the Steady Collective agrees that the need outstrips the available resources, noting that her small nonprofit gave out around 129,000 syringes and 2,200 overdose reversal kits in 2018. Those figures represented a big increase over 2017, despite the group not expanding its services in 2018 and spending a significant part of the year in a zoning dispute with Asheville officials over the clinic it operates on Tuesday afternoons at 610 Haywood Ave. in West Asheville.
With drug users coming to NEPA from 32 North Carolina counties and four states, Harney says, it’s past time for public health departments to pitch in. “It’s our tax dollar at work,” he notes. “You get condoms, you get your vaccines, you get care for being pregnant, you can get primary care, dental care. You can get all kinds of care at the health department. Why can’t you get a 10-cent needle to protect you against HIV, viral hepatitis, endocarditis, skin wound care, abscesses?”
When it launches in July or August, the county’s syringe access program will serve patients who already receive health services at the Coxe Avenue facility, says Dr. Jennifer Mullendore, the county health department’s medical director. Caregivers at the clinic currently screen patients for substance use, she says, but the county has had to refer patients to other providers for syringes, related supplies and peer counseling.
That will change with the launch of the new service, which is supported in part by a $98,000 grant from the N.C. Division of Public Health that runs through Aug. 31, says Jan Shepard, public health director for the county. “The purpose of those funds is for us to develop policies and procedures, develop our standard operating guidelines to deliver those syringe service programs at our clinic and all of the elements that are included, such as safe needle disposal, provision of naloxone and education,” she explains.
Providing clean syringe supplies helps the county health department achieve its mission of stopping the spread of communicable diseases. Hepatitis B, HIV and, increasingly in Buncombe County, an invasive form of Staphylococcus aureus infection (sometimes called “flesh-eating bacteria”) are all transmitted by intravenous drug use, Mullendore says.
Because the new program will only serve established county health department patients, neither county health leaders nor their nonprofit counterparts expect the availability of syringe supplies at 41 Coxe Ave. to put a big dent in the numbers of needle users served by NEPA and the Steady Collective.
“In the short term, it probably won’t change much for us in the day-to-day operations,” says Brown. “It’s pretty clear that WNCAP and Steady are just doing a ton of volume that is very hard to keep up with in terms of finances.”
While Steady Collective used to receive grant funding from Buncombe County, that revenue stream ended last year during a zoning dispute with the city of Asheville that has since been resolved. For now, Steady is operating on a $25,000 donation from an anonymous donor, a $20,000 grant from Grace Covenant Presbyterian Church and a number of smaller contributions, Brown says. The organization also receives naloxone kits as an in-kind donation from the N.C. Harm Reduction Coalition.
For his part, Harney urges the county to leverage its resources to serve more drug users. “I’m hoping that after a very short time, they open it up to anybody who walks in there,” he says.
Education on campus
At UNC Asheville, a group of students is responding to the crisis of campus drug use and overdoses. Sociology major Aidan Wallace explains, “We decided that it’s time for a harm reduction organization on campus because of the drug epidemic, especially because of the death of a student on the A-B Tech campus not too long ago.”
At an April campus health fair, Wallace says, about 15 students signed up to help the Harm Reduction Alliance get off the ground. The group will work through the summer to provide training in the use of the overdose reversal drug naloxone to UNCA staff, he says, and will facilitate student training and forums on drug use in the fall.
“A lot of people have some sort of connection to the drug epidemic. They know someone who’s overdosed,” Wallace says, noting that a member of his family died after using cocaine combined with fentanyl, a synthetic opioid identified as a major driver of recent overdoses and overdose deaths.
“Students do drugs, and fentanyl can be put in anything: prescription pills, even methamphetamine or MDMA,” Wallace points out.
While the UNCA HRA won’t hand out needles or supplies directly, it will educate students and community members on where to get those items. Naloxone, Wallace says, is available for free at the UNCA Health and Counseling Center.
While Wallace credits the center’s director, Jay Cutspec, as “very helpful,” Cutspec noted in an email that there’s still some “legwork” to be done before the HRA becomes an official student organization. “This is important work, and we are excited that the students are devoting their time for these efforts,” Cutspec wrote.
Based on the evidence
For public health professionals and local activists alike, it all comes down to giving people the tools to protect their health.
“People are trying hard to take care of themselves,” Harney says. “They are trying hard to have a clean needle for every injection.”
While expressing appreciation for Buncombe County’s support of Steady Collective, Brown also says much more is needed to get a handle on the still-increasing levels of drug overdose and death in Buncombe County (see sidebar, “Still rising”).
“We need a real change culturally in terms of thinking about, if the quote-unquote opioid crisis is a core issue for the county and it’s a big focus, then we need to allocate a lot of resources toward dealing with it,” Brown says. She believes much of that support should go to making naloxone kits readily available and supporting existing harm-reduction programs that provide direct services like syringe exchange, wound care and education.
“A lot of money is still going to treatment programs that aren’t evidence based, recovery programs that aren’t evidence based,” Brown asserts. “So we need more money in the South, in Appalachia, in Buncombe, to go toward evidence based solutions like harm reduction.”