By Taylor Knopf

The face of the North Carolina heroin epidemic is more diverse than one might think.

“People drive in nice cars and dress professionally,” said Michael Harney, street outreach worker and prevention educator at Western NC AIDS Project in Asheville, which is home to one of 22 needle exchanges in the state.

Man stands in front of a cabinet full of boxes of syringes
Michael Harney shows the different size needles available to anyone who comes to the Wester North Carolina AIDS Project needle exchange in Asheville. Photo credit: Taylor Knopf

He described some of his clients and said it’s not always “the bedraggled, homeless or poor” that many people picture.

“Sometimes they come in uniforms and forget the label is on it. They come in scrubs… I’ve seen people in here on canes. Some speak different languages,” he said. “You just don’t know. I mean anybody. You would be surprised.”

Located just south of the Asheville Mall, Harney’s needle exchange is in a beige square office building with blue awnings and a long handicap ramp in front in a mostly residential area. Inside, the walls are covered with flyers and brochures advertising addiction support groups, treatment centers and crisis numbers. Two metal storage lockers contain boxes of syringes, condoms, more brochures and a place for laundry detergent bottles full of dirty needles.

Each day, 35 to 65 people visit the needle exchange, located at 554 Fairview Road. In 2016 – the year programs finally became legal –  the program provided 512,150 needles to people coming from 32 counties in four states. If the facility were fully funded, exchange workers say they could have given out closer to a million.

They often run out of supplies and wait weeks for more.

Legally permitted

The Western NC AIDS Project has housed an informal needle exchange program for about seven years. Most of the time, it had been illegal. But state legislators passed law just last July to allow needle or syringe exchanges, making North Carolina the 33rd state in the nation to allow the service.

colorful plastic detergent bottles scattered in the bed of a pickup truck
The back of Western NC AIDS Project worker Michael Harney’s truck is often filled with empty detergent bottles donated by the local laundry mat for the disposal of dirty needles. Photo credit: Taylor Knopf

It was a long battle for advocates who tried for years to convince North Carolina lawmakers of the benefits of needle exchanges as a way to prevent the spread of AIDS, HIV and Hepatitis C.

Much of the opposition came from people who argued that needle exchanges only enable people using drugs like heroin. There are still some, particularly in law enforcement, who still hold that view which makes it difficult for some counties to get a needle exchange program.

While law enforcement approval and collaboration is not necessary, it’s encouraged, said Tessie Castillo, advocacy and communications coordinator for NC Harm Reduction Coalition. She said without that cooperation, problems can arise as the law requires a safety plan to be presented to local law enforcement.

Miles apart

One county over from the Asheville needle exchange, Madison County Sheriff James “Buddy” Harwood is adamantly opposed to a similar program in his county. He says he will never be a proponent because it goes against everything he stands for.

“Let’s say you come to the health department messed up … totally impaired, and the doctor gives you the needles,” he explained.

closet filled with supplies, the doors lined with pamphlets and posters
The needle exchange at the Western NC AIDS Project in Asheville provides lots of information about treatment programs and health warnings for those who visit. Photo credit: Taylor Knopf

He extended his scenario: “Before you get to the end of the road down here, you take that needle, load it, and shoot yourself in the arm with heroin. As a result, you die before you get to NC 213. You hit a family of four. Kill four victims in that car. Now where does the liability lie? Who gave you the needle?”

Morally, he says he just can’t support it.

“When I stand before the judgment seat of Christ, [I will not have] that blood dripping off my hands because I have enabled these drug dealers and dopers in killing an innocent family,” he said.

Castillo said she has talked to sheriffs across the state, including Harwood, and says he’s in the minority.

“Most sheriffs, once you explain it to them, they get it,” she said.

Getting people to services

Jeff Bachar, executive director of Western NC AIDS Project, said many do not understand that addiction is a disease and the science behind it.

“It’s a medical condition, and without help, it’s nearly insurmountable,” he said. “So we are meeting people where they are.”

Harney added that when someone comes into a needle exchange, they are taking the first step toward caring about their own health. That’s something Harney says he can build on.

“Then they come back to us and realize we aren’t going to judge them, we are going to offer them a bottle of water; ask them if they want a container to dispose the needles in; ask them if they want information on treatment.”

The exchange offers HIV and Hepatitis C testing as well. So an individual who tests positive can make the decision whether to seek treatment.

That’s in keeping with years of research showing that needle exchanges facilitate people getting into substance use treatment programs and getting more medical care.

Some medical providers say that just knowing you are positive with either virus will decrease risky behavior. People tend to think twice about sharing a needle if they know they are positive for Hepatitis C.

“This is not enabling,” Bachar added. “It’s empowering. There is a lot of shame associated with this. They come, and they don’t want to be here, yet the group that’s coming in to get needles has a sense that they want to protect themselves and the community.”

Click on the icons to get details about needle exchange sites across North Carolina. Information courtesy: NC Harm Reduction Coalition

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Taylor Knopf

Taylor Knopf writes about mental health, including addiction and harm reduction. She lives in Raleigh and previously wrote for The News & Observer. Knopf has a bachelor's degree in sociology with a...