As opioid crisis wears on, Buncombe County prepares to launch syringe clinic

TAKING ACTION: "I think it's important for everyone to get serious about these topics — harm reduction and drug use — because people are dying and hurting, and all of us should do something about that,” says Aidan Wallace, one of the founders of the UNC Asheville Harm Reduction Alliance. Photo courtesy of UNCA HRA

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?”

County connection

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.”



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14 thoughts on “As opioid crisis wears on, Buncombe County prepares to launch syringe clinic

  1. Richard B.

    Couple of simple words missing from the article….free will, will power, responsible behavior, consequences of irresponsible behavior.
    No where does Ms. Brown acknowledge the one and only “evidence based solution”.
    That being when an addict takes responsibility for his or her behavior and makes the decision to stop using.
    And there are several really good tax payer funded programs available to both assist those who make this decision, and to help them
    to continue on the recovery path with months of residential and outpatient programs that are immensely effective for those who stay the course.
    Free and clean needles are all the rage around the country. It seems to me, however, that if you have a good friend who is obese, you do not
    continue to offer him or her free ice cream. And isn’t that the message being sent to users, that your behavior is okay, that we perhaps condone your
    self destructive actions, but in a healthy way?
    I really do applaud all those listed above, including Ms. Brown, for their good intentions and efforts to help those suffering opioid addiction.
    However, it is a complicated cultural phenomenon, and perhaps I am playing devil’s advocate in order to curb those who opine in
    a manner that approaches self righteousness, even moral high ground. Free needle exchange programs have been around for quite a few years.
    Check in those cities to see what the rate of addiction is compared to Buncombe County. Not surprisingly, it is about the same all across the country.

    • Aidan Wallace

      I think you should read the evidence-based research on harm reduction and syringe access (supported by the CDC, btw) before you make your fallacious comments.

  2. Gail

    As we do more and more the worse the problem seems to get, especially in the areas where these clinics are located. So, it looks to me as if we are encouraging the drug habit by providing them with their supplies. I have had enough of the pampering. There are many more groups of people who have problems, that they did not choose, that could use the help.

    • Aidan Wallace

      Do you have any evidence-based research that says harm reduction and syringe access programs enable drug use? The CDC and the World Health Organization endorse syringe access programs. Syringe access reduces overdoses, HEP C and HIV rates. I’m sorry, Gail, but your statements are baseless and harmful.

      • Richard B.

        As you know, the evidence based research says little about the TREND of opioid addiction and deaths. You are talking about preventing secondary
        scourges arising from the use of injected drugs, NOT the discouragement of addictive behaviors. My arguments are somewhat broader, and concerns
        a cultural phenomenon that seems more focused on efforts to comfort addicts rather than to discourage such behavior through the usual avenues
        of shame, legal consequences, and so forth. Not fallacious, just rational thinking based on empirical data and experience.

      • Richard B.

        If I were you, I would be very cautious about saying that Syringe access reduces overdoses, in light of the obvious increase in deaths from
        opioid addiction. Why is the CDC claiming that the numbers have reached epidemic proportions? Why is everyone talking about this EPIDEMIC?
        Again, the programs you defend may make sense so far as preventing further unintended consequences. But why not do both?
        Do you not see the danger of pretending that Harm Reduction and Free Syringe Access is THE solution to opioid addiction?

        • SpareChange

          “I would be very cautious about saying that Syringe access reduces overdoses, in light of the obvious increase in deaths from opioid addiction.”

          I agree. Even the circumstances surrounding the data pertaining to the secondary issues of disease control and IV drug use are changing. When looked at in isolation it is a good thing to reduce AIDS and Hep C for many reasons. However, neither condition is nearly as life threatening today as they once were, and in the meantime all of the past research showing the net benefits of reducing those diseases has been completely undermined by the introduction of much more deadly drugs, in much more deadly concentrations. The sharp rise in deaths among drug addicts is not due to these diseases. It is due to the drugs themselves. At one time not that long ago, providing a clean needle carried some benefit in avoiding diseases which were deadly, but the risk of overdose was much less. Today the diseases are not nearly as deadly, but the drugs themselves are, and providing the needle may end up facilitating more deaths rather than fewer. I know addicts will find a way to administer the drugs they need with or without a clean needle, but the point is that the circumstances that gave weight to the case that needle exchanges save lives have changed radically.

          • Richard B.

            Spare C., I appreciate your more comprehensive and understandable discussion of my earlier point about preventing secondary unintended consequences of addictive behavior vs. the overarching goal of reducing the rate of addiction.
            Well done.

  3. SpareChange

    Richard B. & Gail’s comments both raise some important questions and raise some very significant qualifiers for us to consider when discussing how best to work with or assist IV drug users. I would like to suggest that one other point shaping the discussion is the language and terminology often used in describing efforts such as those undertaken by Steady Collective.

    In particular, the term “harm reduction” strikes me as an unfortunate phrase that has come into common usage. It is a term which in many ways purposely seeks to short-circuit and otherwise limit objective discussion and debate on these otherwise very complex and often politically contentious issues. Once that term is accepted in describing certain specific approaches to the IV drug problem, how can one possibly criticize or oppose specific efforts or programs intended to “reduce harm?”

    The way the term harm reduction is being used strikes me as very similar to how federal government officials often invoke and use terms like “national security.” How can one possibly oppose efforts intended to promote national security? Yet once scrutinized one realizes that like all policies, there are functions and dysfunctions, winners and losers, and often a lot of smoke and mirrors at work to obscure the negative aspects of such policies. It is also similar to local officials when they proclaim certain policies as being “in the public interest.” The use of such language is almost always intended to strategically outmaneuver and silence critical voices. I find that “harm reduction” gets used in very similar ways.

    In the end, harm reduction programs are not all alike, have highly variable impacts (both good and bad) on a wide range of different interests and groups, and their costs and benefits should be examined and debated without rhetorical subterfuge.

    • luther blissett

      If you frame it as an abstract terminological debate, then maybe. But it isn’t an abstract terminological debate.

      Do you accept the basic premise that addiction isn’t some kind of moral failure that can be cured by “taking responsibility”? That it has public health repercussions as well as individual impacts? (It helps, sadly, that more people seem to think this in the wake of an opioid crisis that primarily affects white people.) Or do you believe, like Gail, that syringe exchange programs are run by people who think IV drug use is great and should be more widespread?

      Of course it’s possible to have a discussion on the different externalities of different approaches, but ignorant pontification — not yours, I’ll note — needs to be put to one side.

  4. Enlightened Enigma

    humans witnessed shooting up in a car in Carrier Park the other day, as heard about on the radio yesterday… Pete Kaliner Show M-F 3-6 570AM …he will keep you informed !

    • Richard B.

      Bad behavior seeks other bad behavior environments in an attempt to justify their bad behavior, in this case shooting up near sites where
      there are free needle programs. Human instinct to avoid shame by standing near another who is engaging in shameful behaviors. I believe Pete K.
      spoke to this recently, as you point out. If all these other folks are doing it, must be acceptable. The natural outcome of no consequences.
      And why no consequences? Most liberals will respond that it is because they are “Victims”.

      • Tim

        First off, you’re taking the stance that using drugs is bad behavior when in reality, and we know this from brain science and just by holding a mirror to our own lives, these behaviors are the function of a chronic condition shaped by many factors including neurochemical changes. People aren’t acting on good or bad, they’re acting on survival. Who in their right mind would want to put a needle in their arm, often times fully aware of the risks? Someone who’s brain is hijacked! When you listen to the stories of individuals who have come to develop addiction you begin to hear the many pathways that lead to it, none intentional and I can assure you it seems to happen well before the point where they’re going to a needle exchange site. We cannot shame our way out of this issue…we’ve tried that on a policy level and look where we are with addiction decades later. Shame breeds secrecy and withdrawal from engagement, not withdrawal from drug use. To treat, we need people to engage. These programs aren’t simply handing out needles, at least the ones here in this area. They’re also giving space where people can talk about treatment options and get support with engaging it when they’re ready. We give needles and medication to people with other chronic health conditions all the time knowing full that there are other lifestyle changes they can or ought to make to better manage those conditions. We know it’s not easy and often a very complicated condition so we provide a team approach to helping patients manage those conditions…how is this any different?

  5. Enlightened Enigma

    I know that many in West Asheville are getting tired of the ‘scene’…and the next panhandler that approaches me, watch out!

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