A New York Needle Exchange in Action - Page 2

By Sarah Beller 05/29/13

The Fix reports from the Washington Heights Corner Project, where participants and staff members share some surprising truths about how harm reduction works on the ground.

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Needle exchange is about more than clean needles. Photo via

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Robert, a WHCP peer, is one of the center's heroes. Last year, he personally gave out more needles than the whole of the rest of the office combined. Originally from Puerto Rico, he's 57 and grew up in the Bronx. He wears glasses and a Yankees hat, and speaks in a slow, hoarse voice.

"It all started with being homeless," he says. He worked as a printer for 25 years and as a maintenance worker for 12, but then lost his job. He wound up "here in the Heights, and met some guys I'd hang out with. All addicts." Robert himself had first used heroin at the age of 14. But one of the men he met was a peer at WHCP. He told Robert, "This place can help you." At the center, they got him an ID, examined and treated him at the clinic—"They found a whole mess of stuff wrong with me: Diabetic, high blood pressure, kidney stones, aneurism in the abdomen"— and helped him get Medicaid. They also put him on the road to finding housing.

Meanwhile, Robert noticed that a lot of the addicts he knew would pick up dirty needles and use them. He told them, "I don't understand; you can easily get boxes of needles, yet you don't. At 3 am I see you hunting for dirty needles. I'm gonna start carrying needles for you so you won't have to use dirty ones." Little by little, Robert says, people started to come to him for needles. When a peer job was posted, Robert's case manager encouraged him to apply. "I don't know anything about harm reduction," Robert said. "You're already doing it," the case manager replied.

That was two years ago. Robert still uses heroin: "I don't use as much as I used to but I'm not gonna sit here and lie to you. But I don't drink and don't smoke crack." He now has an apartment, but homeless participants trust him because he was out there with them and knows what it's like. "A lot of people think we're homeless because we don't want to work," he says. "I worked all my life; never in my life did I think I would be homeless. I used to see homeless people and say, ‘Why would I give that person money when they are going to spend it on drugs?’ I never thought, were they maybe really, really hungry?"

One vital element of training is overdose prevention. Staff, peers and participants are all trained in administering Naloxone, which reverses opioid OD. Part of outreach includes handing out Narcan (the brand name for Naloxone) rescue kits, which WHCP is licensed to do. In 2006, New York State made it legal for a non-medical person to administer Naloxone to another to save their life. “It doesn't do any damage if the person is not overdosing on heroin,” says Frost, “so there's really no downside." Sometimes participants carry around the kits with notes attached: If I'm blue, spray this in my nose.

Though safe injection sites are illegal in the US, needle exchange programs end up providing de facto "oversight" that is otherwise lacking.

Frost says her team has reversed many overdoses—20 or 30 at the center alone. After administering Narcan, they call 911. But Mata says he often tells participants that if they’re in that situation, they shouldn’t mention overdose: In spite of New York's 911 Good Samaritan law, ensuring that the caller won't get arrested, discrimination means that ambulances tend to take longer to respond to OD calls. Mata tells participants just to say that someone "stopped breathing."

Besides discrimination from medical workers, there's the police to worry about. Although state law says anyone with a Syringe Exchange Program (SEP) card can legally carry syringes—even, as of 2010, syringes with "drug residue" on them—the laws are often not known or ignored. Mata says that sometimes police even throw away the SEP cards and arrest participants anyway. WHCP works to strengthen its relationship with the police; staff attend morning roll call at the precinct, to show SEP cards to cops and explain how they work. "We're not telling them how to do their job," says Frost. "We're just saying, 'Don't tack on a syringe charge to an arrest.'"

WHCP doesn’t only supply clean syringes to heroin and crack users. There’s a big need in the transgender community: "Some people use needles for hormones, or for silicone injections," Frost says. Syringes are also delivered to several gyms, because "men are injecting steroids there." These deliveries are made by bike, though Frost says she'd love to have the money for a truck. While most participants are local, plenty come in from New Jersey; drug users from across the river report that needle exchange spots there are always out of syringes.

If the federal funding ban were lifted, programs like WHCP would have far more potential for expansion, such as the ability to stay open 24 hours. Ideally, Frost says, US drug policy would also allow supervised injection facilities, like Insite in Vancouver. "People are overdosing and dying because they don't have a safe place to use," she says. "People need to not be in a rush when they inject drugs, and they need appropriate oversight."

Though safe injection sites are illegal in the US, needle exchange programs end up providing de facto "oversight" that is otherwise lacking. The Harm Reduction Coalition, a national advocacy organization, has a weekly podcast, with one installment entitled "Bathroom Etiquette: Injecting at the Exchange." The host explains that "A lot has been written about…supervised injection sites, and yet not very much has been done around bathrooms in needle exchange programs... We don't want to think about staff injecting in bathrooms, we don't want neighbors to think that's what’s happening. But how are organizations actually making needle exchange bathrooms safer?”

All the interviewees on the podcast—staff from needle exchange programs around the country— are anonymous because of how controversial the subject is. One woman who works at a needle exchange program in "Wichita, Kansas" says that there they line up participants and have them do push-ups and drink water. This makes injecting easier and faster, so there’s less of a hold-up for everyone waiting for the bathroom. The interviewer comments that there are, in effect, "injection facilities throughout the program that no one talks about." How did this happen? The woman explains that when her program started, "we did not allow bathroom access, then we'd get complaints from neighbors saying that people were injecting near the site. So…the thing to do is say, ‘We have had fatal overdoses in public restrooms in our neighborhood, so it would be negligent not to have safety precautions at our own location.’"

At WHCP, many participants are homeless—and New York, as Frost notes, "has a severe shortage of public bathrooms." So what’s their policy about injecting drugs in their bathroom? "People will do what they're going to do,” says Frost. “There are no cameras in the bathroom... It is not a supervised injection site, but it is meeting an important need that is being ignored. People are using in public bathrooms anyway, and ours is a better option than Starbucks or a public library." Of the numerous overdoses that have occurred on site, not one has been fatal: “We have a system in place to prepare for overdose and administer Naloxone."

Executive director Taeko Frost

As we're talking, Frost points at a plaque on the wall. It says we’re in the "Michael Carden Memorial Conference Room." Michael Carden was a WHCP board member who was also a project director at SUNY Downstate Medical Center in Brooklyn, and held a position at the Center for the Study of Hepatitis C at Weill Cornell Medical College. He recently died from a heroin overdose. Frost says that many people were surprised that someone so successful was a drug user—and that people often have the same reaction when they visit WHCP. “Med students, volunteers always say about participants, 'I would have never guessed he was a heroin user,'” she says. “Drug use comes in many forms, just like mental illness. For anyone critical of what we do here, I'd really urge them to come check it out."

Sarah Beller is a writer and social work intern who lives in Brooklyn. Her work has appeared in The HairpinxoJaneLilith Magazine and Thought Catalog and frequently in The Fix, where she recently reported on drug courts.

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Sarah Beller is a writer and the Executive Director at Filter. She has written about drug policy with a focus on harm reduction for Substance.comThe Fix and Salon. She has worked as a social worker with formerly incarcerated people in New York for a number of years. Her writing has also appeared in McSweeney’sThe HairpinThe ToastReductressThe Rumpus and other publications. You can find Sarah on Linkedin and Twitter.