Commissioners, health officials discuss syringe exchange

“I’m trying to figure out, all of a sudden, since we’ve started giving out needles, it’s became pretty evident that needles are being discarded everywhere,” Pless said in December. “A lot of people are getting upset about it, and I kind of want to know if we’re getting back all of the needles.”

Haywood County’s syringe exchange program began in 2017, and is a local function of the North Carolina Harm Reduction Coalition.

Statistics released after the meeting show that in the most recent fiscal year, 87,410 needles were given out, and 26 percent of those were returned.

At the Jan. 8 meeting, those present included Commissioner Chairman Kevin Ensley, Pless, County Manager Bryant Morehead, Haywood County Health Director Patrick Johnson, Public Health Education Specialist Lauren Wood, Health Board Chairman Paul Turner, Haywood County Overdose Prevention Specialist Jesse-lee Dunlap and LEAD Case Manager Gariann Yochym, as well as Harm Reduction Programs Manager Jesse Bennett, visiting from NCHRC headquarters in Raleigh.

Citizen complaints addressed

Prompted by persistent complaints from constituents, Pless said he was concerned with a lack of accountability for syringe exchange participants to return one needle for every needle Dunlap provides them, contributing to a common perception among citizens that used drug needles are being found discarded all over Haywood County.

“About July, August, needles started showing up down in Frog Level,” Pless said. “It got to the point where it was every single day, people were commenting about this situation.”

Furthermore, Pless said he was concerned local syringe exchange users are not being given state-issued participant identification cards that legally allow them to carry used needles, further contributing to the amount of littered syringes because drug users are afraid of carrying around paraphernalia that might land them with criminal charges.

“Right now we have no accountability,” Pless said. “We don’t have an account of what we’re bringing in, we don’t have an exchange, which to me literally is one-for-one, and the only common denominator for this showing up down here is the fact that we are now giving out 8,000 needles a month and people are throwing them away, as opposed to bringing them back.”

Bennett confirmed that data shows Haywood County syringe exchange users are not returning needles out of fear for law enforcement not acknowledging their identification cards, but Dunlap said the cards are indeed being distributed.

She estimated that 75 percent of all intravenous drug users in Haywood County have, at some point, been given one.

“Best practices states that one-to-one exchange actually spreads disease,” Bennett said, explaining that such a requirement would deter program use.

Bennett said there are all kinds of solutions to the problem of syringe litter and identification cards not being acknowledged as legitimate — further training for law enforcement and outreach workers, conducting more frequent needle pickups, incentivizing needle returns and placing more biohazard bins in the Frog Level area.

During a needle pickup Jan. 4, Wood said four teams of two people went to every Waynesville hot spot that has been reported to Dunlap — Frog Level, behind Walmart, between Haywood Pathways Center and Frog Level, McDonald’s, pharmacies and on a few private properties — finding only five littered syringes during two hours of searching.

Wood stressed the importance of checking up on reports of needles, and fighting back against myths and hearsay that might be perpetuated among the public about used syringes being littered everywhere.

“These can get like telephone, right?” Bennett said. “So-and-so said they saw a syringe, and the next thing you know, 10 people down, they say they saw 100 syringes piled up at the coffee shop.”

Ensley said his business office and rental house are in Frog Level, and he has yet to see a needle since 1990.

Data shows value of needle exchange

NCHRC programs provide an array of services, beyond just needle exchange, and it’s statistically proven to successfully help drug users come off of their addictions while keeping them from dying of bloodborne illnesses like HIV, Bennett said.

“What we want to do is empower individuals to take control of their own health, and so what needle exchange does, and it demonstrates over and over with empirical evidence that people do that — they take control of their health, they start using one syringe every time, they’re using alcohol pads, they’re returning needles, what they’re getting works,” Bennett said. “They’re getting engaged in services like healthcare and dental, they’re getting food.”

Once engaged in the other harm reduction services, users become ready to make changes in their behavior, and NCHRC tries to initiate that change, Bennett said, mentioning his past as a drug user and incarcerated person whose life was saved multiple times by harm reduction programs.

“These programs work,” Bennett said. “Am I enabling somebody? Yeah, I’m enabling them to take control of their health, to be a part of their community, to be a person. That’s what we really need to start thinking about — people who use drugs are people first and foremost, and they’re people within our communities, so how do we support them?”

Under Dunlap’s predecessor, needle return rates were lower than 20 percent in the first year of the service, Bennett said. Since Dunlap has taken over, return rates are now in the 60 percent range, on-par with the state average. More on these statistics later.

“The prevention of HIV and Hepatitis-C is there, the treatment engagements are there,” Bennett said. “People that engage in treatment through our program actually have higher retention rates than those that don’t.”

Needle exchange users are given biohazard bins and laundry detergent jugs to place their used syringes in, which are then returned to Dunlap and taken to the Materials Recycling Facility in Clyde for disposal. The number of needles collected are tallied up and reported to NCHRC, just the same as the distribution numbers, Dunlap said

Pless demands data

“You can throw a number at me all day long,” Pless said. “Everybody’s throwing numbers at me, and this is my problem with it — everybody throws a number, but nobody can back up what they’re saying.”

Pless said he spoke with seven departments in Raleigh and got transferred around endlessly, without ever locating harm reduction data specific to Haywood County.

“You’re just handing needles out. We didn’t have a problem with needles, we didn’t even see a problem, we didn’t have them laying everywhere until this started,” Pless said. “We are bringing people in.”

Pless said he has seen homeless people walking into Haywood County with all of their belongings, because they must have heard somewhere that there is a freebie going on in Haywood County.

“We’re drawing people because we’re feeding them. It’s no different than feeding a stray dog,” Pless said. “Once you feed it the first time, it’s going to stay, but if it runs across another one, it’s going to bring that one to your door, and that’s what’s happening in Haywood County, according to all the people that are calling me.”

“Just like you’re telling me my data is hearsay, that’s hearsay,” Bennett said. “Where’s your data to support that?”

“Listen, I get phone calls all the time. All I’m asking you to do is give me the data,” Pless said. “The whole reason we’re having this discussion — instead of just trying to pull the plug — is because I want the information. I want to see what we’re doing.”

Pless said people call their commissioners when they are angry about something, and with most any other issue he can get necessary figures and information to relay to citizens, who will listen and understand, whether or not they like the answer.

“This issue here, nobody can prove anything,” Pless said. “It’s just a theory that it works.”

Bennett reemphasized that empirical data supports the effectiveness of syringe exchange programs, and assured Pless that local data does exist.

“We collect Haywood County-specific everything — I’m talking about demographics, overdose, reversals, all that stuff,” Bennett said. “I’ll provide your individual county data, and I’ll highlight where year one is not good, and then I can kind of demonstrate where Jesse-lee (Dunlap) stepped in.”

Data emerges — at last

NCHRC provided Haywood County syringe exchange data on Thursday, Jan. 16, and according to those numbers, return rates were lower than Bennett said during the Jan. 8 meeting, but there is an explanation.

“The Haywood County data was prepared ahead of the Jan. 8 meeting and was reviewed by NCHRC’s management team,” said Shelisa Howard-Martinez of NCHRC in a Jan. 16 email to county administrators. “Our intention was that it be shared with you at the meeting. However, I learned today that this did not happen. I apologize for this delay.”

During the 2018-19 fiscal year, NCHRC recorded 65 unique needle exchange participants, who were given 87,410 syringes through 278 contacts within Haywood. Of those 87,410 needles distributed, 26 percent were returned to NCHRC.

Comparatively, statewide data shows more than 1.1 million syringes distributed with a 35 percent return rate in 2018-19, NCHRC data said.

The year prior, in 2017-18, fewer than 3,000 syringes were distributed to 35 participants in Haywood County, with 35 percent returned to NCHRC.

Dunlap took the place of the previous Haywood County syringe access worker in April 2019, meaning only three months of Dunlap’s work is reflected in the 2018-19 fiscal year data provided by NCHRC.

Additionally, a total of 2,197 naloxone kits were distributed in Haywood County to counter the effects of opioid overdoses, resulting in 209 overdose reversals reported to NCHRC, the data said.

Moving forward

At the Jan. 8 meeting, Pless, Johnson and Turner requested that Haywood County data be kept locally, for ease of access, rather than having to request the information from NCHRC headquarters in Raleigh.

“We live here,” Turner said. “We need data for our county.”

Morehead said it would be a good idea to differentiate local needle return data between those who have housing and those who are homeless, to see if there is any disparity between the two groups, and Bennett agreed that would be good information to have.

“I think it’s a reasonable equation to get better data,” Turner said. “That can be done, and should be done, and y’all can massage it at Raleigh, or whatever you want to do, but that’s what we want done here. I don’t think we’re negotiating. We want it done here.”

It was also agreed that more needle disposal stations should be placed around hot spots in Haywood, and disposal locations should be better advertised when syringes are distributed.

Finally, the group decided to meet quarterly to discuss the local data, and Pless said these measures were a good start.

“Sounds like we’ve got a plan,” Turner said.