Syringe disposal units are a ‘balancing act’

In September 2018, Malaprops Bookstore/Cafe placed its first needle disposal boxes in its bathrooms.

“We were finding needles in the bathroom on the floor,” explains lead bookseller Justin Souther. Sometimes, people would open the top of the toilet tank and hide used needles inside, he says.

The Malaprops’ staff felt it was “a safety hazard … to be picking these [needles] up and not really knowing how to dispose of them,” Souther explains. So they discussed installing a sharps disposal container in each bathroom.

Thus, the bookstore became a player in the delicate statewide dance between keeping people safe while not encouraging illegal drug use.

In North Carolina, an average of nine people died from a drug overdose each day in 2020, the N.C. Department of Health and Human Services announced March 21. Over 70% of those overdose deaths likely involved illicitly manufactured fentanyl, the department said.

Syringe service programs are one of the 12 evidence-based strategies for preventing opioid overdose recommended by the Centers for Disease Control and Prevention. In 2016, N.C. legalized needle exchange programs, citing the desire to reduce the spread of HIV, hepatitis and other blood borne illnesses.

Another component of syringe service programs is “access to and disposal of sterile syringes and injection equipment,” the CDC says. The disposal units are called sharps disposal boxes, needle boxes or sharps containers.

“People are using drugs — they’re not going to stop using drugs,” Amy Upham, executive director for Eleanor Health Foundation and former opioid response coordinator for Buncombe County Health and Human Services, tells Xpress. “The only thing that not having a needle box does is give them no place to put it,” she says.

The Malaprops staff was initially hesitant to install a disposal container. “We were worried about the optics of having one in our business,” Souther explains.

Ultimately the staff realized its bathrooms, which were open to the public prior to the COVID-19 pandemic, were one of the few private places downtown where drug users might go to use, Souther explains. “Eventually, we just decided we have to have one,” Souther says of needle boxes.

Sharps disposals

Advocates attest sharps disposal boxes are an essential component of harm reduction, which is defined as “a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use,” according to the New York-based National Harm Reduction Coalition.

Anyone can anonymously deposit used needles in sharps disposal boxes. It is unknown how many exist across the county, as the boxes can be both privately purchased or publicly funded. For example, Malaprops purchased the 5-quart, mountable plastic sharps containers for its bathrooms on its own, Souther says.

The harm reduction organization Steady Collective operates a mobile syringe exchange program, where needles can also be disposed of, at four locations in Asheville. The group maintains over 20 sharps disposal boxes around the city; many are in public parks, such as the French Broad River Greenway.

BCHHS spokesperson Stacey Wood says she only has data regarding needles collected at 40 Coxe Ave, the Health Department headquarters. In fiscal year 2020, it collected 4,300 needles, which rose to 19,593 the next year. In fiscal year 2022, that location collected 32,719 needles. (It is unknown how many of the needles collected were used for day-to-day medical care and how many were used for drugs.)

BCHHS operates four large sharps disposal boxes in Asheville, Wood says. Two are located on city property; the one at 40 Coxe Ave. and another in front of Pisgah View Apartments in West Asheville.

A third sharps disposal box is located on county property in front of Pack Memorial Library; the fourth is located on the footbridge over Interstate 240, which is owned by the state Department of Transportation. BCHHS contracts with Sunrise Community for Recovery and Wellness, a peer support nonprofit, to maintain its boxes.

BCHHS is discussing with a community partner installing one large sharps disposal box, now in storage, on its property, Wood says. (She declined to name the partner.) BCHHS also has 15 small sharps disposal boxes intended to be bathroom units in storage. The boxes are free,but must be installed by the recipient (Wood advises anyone who is interested in getting a box to email ina.ponder@buncombecounty.org.)

Several groups involved in exchanging or collecting needles declined to comment.

Representatives from Steady Collective did not respond to multiple requests for comment from Xpress. Nor did Peggy Weil, chief operating officer of Western North Carolina AIDS Project. (WNCAP operates two syringe exchange programs in Asheville and Franklin, as well as a mobile unit.)

Lance Karner, harm reduction specialist for Sunrise, referred all questions to BCHHS.

‘Safety issue’

Like Souther at Malaprops, the impetus to get a sharps disposal box is usually to prevent accidental needle sticks.

Upham notes that when any needles are disposed of in regular trash cans it can present “a huge safety issue for people who work in waste management.”

She suggests every business place a needle box in its bathrooms. “​​I think we need the bigger boxes in strategic locations of heavy needle traffic that’s found on the sidewalks,” she says, citing Haywood Road in West Asheville as an example.

The county contracts with Carolina Biomedical Disposal to collect materials from the sharps disposal boxes used by BCHHS, Wood says. The syringes are incinerated at its facility.

‘Growing blight’

But plenty of people don’t dispose of used needles in trash cans or sharps disposal boxes. Frank Palmeri, owner of Asheville Beds on South Tunnel Road, says he finds a syringe outside his business at least once a week. He frequently posts about his frustration about needle litter, as well as people who use drugs, in a Facebook group about health and safety in Asheville.

“I’ve seen syringes in this area since I started my business in 2017,” he tells Xpress. “It has been an escalating occurrence as time has progressed … The growing blight in Asheville has been growing steadily worse.

“If I really looked, I could find more [needles],” he says. “They get thrown out of sight, usually, so there are always a bunch in hiding. The landscaper usually uncovers them as he is working on the property.”

However, Palmeri doesn’t think that making needle boxes more prevalent or accessible is the way to go. “I don’t think traditional solutions like extra sharps containers are going to make enough of an impact,” he tells Xpress. “I can’t see someone who is getting high have the willpower, civic responsibility or wherewithal to keep track of their needles for an entire week.”

Palmeri is angered by people who leave litter on his property, have physical fights or become “aggressive” while panhandling in his business’ neighborhood. He says he’s experienced thefts from his business, including catalytic converters from his vehicles and security cameras installed outside his store. He thinks people who use drugs are to blame.

Palmeri wants to see more “tough love measures” to address drug addiction, including permitting family members to force a loved one with an addiction into detox and rehab. He also thinks needle exchanges need to operate on a one-for-one model. (The one-for-one model is prohibited under North Carolina law, according to NCDHHS. “Giving a participant the amount of new needles … they require cannot be dependent on returning used supplies,” its website states. “Participants should be encouraged to return used syringes and supplies so exchanges can dispose of them safely.”)

‘A balancing act’

Additionally, Souther doesn’t think the role of collecting and disposing needles should necessarily fall on individual businesses. (An employee from Malaprops has in the past emptied the boxes at a Steady Collective location, as well as a BCHHS location, he says.)

“I really love what Steady Collective has been doing and been trying to do, but also they’ve signed up to do it,” he says. “I don’t know if it’s fair to everyone to be taking on that burden, even though as a human being I want to be able to help as much as I can.”

Having needle boxes in bathrooms means additional vigilance. “You have to police that a little bit on your own as a business,” he notes. For example, employees have asked people to leave when they seem to be “making a beeline” to the bathroom, he says.

Souther repeatedly calls the situation “complicated” while speaking to Xpress.

“It’s tricky — as a business, we don’t want to promote it,” he says. “At the same time, myself as a person, I don’t want to stigmatize it. … It’s hard to know what the right answer is.”