Syringe Exchange Programs (SEPs) are illegal in North Carolina, although the House recently passed a measure allowing two pilot programs.
For now, a handful of determined individuals operate five underground programs across North Carolina. The closest to Wilmington is in Fayetteville.
The mission is simple: help addicts be the “best” addicts they can be. Or, in other words, acknowledge the addiction problem, minimize the risk to the public and have support services readily in place in the event that a user is ready to seek help.
Pastor James Sizemore is the force behind the CX Southeastern Exchange in Fayetteville.
For ten years, Sizemore has funded his own regular travel up to New Jersey to pick up cases of unused, expired syringes from pharmaceutical companies.
He and volunteers from his church package a handful of needles, a sterile wipe, bandage, condom and a small cup to mix the heroin into black plastic needle boxes.
With a massive bag filled with the kits and an equal number of syringes loaded with naloxone, James heads out to motels around Fayetteville for delivery.
“We ask people point blank, 'Do you know somebody who's shooting up? Are you shooting up? Do you need some needles, would you like some naloxone?’” James explained.
His compassion for addicts is personal. If there was an illicit substance to be had, James has had it.
He can vividly recount nights spent wasted, unsure if he would see tomorrow.
With all the energy he put into using, he turned toward advocating for and supporting fellow addicts once he got sober.
“The state of North Carolina, for all intents and purposes, has abandoned the drug user and the addiction community,” Sizemore said. “If you give somebody a clean syringe you're able to prevent a mass infection rate of HIV and of hepatitis. All these things that tend to destroy not just individuals but families and communities.”
It’s estimated that just one injectable drug user will shoot up about 1,000 times per year. Injection drug use accounts for about 1/5 of all HIV infections and most Hepatitis C infections in the United States.
It costs the state about $680,000 to treat a single HIV infection over the course of a lifetime, according to the North Carolina Harm Reduction Coalition. And anywhere from $100,000 to $500,000 to treat a Hepatitis C infection.
“I've seen people go into that parking lot and find rigs that people have just thrown out, and they'll use it on themselves,” said Courtland Rogers. “So they could have just caught HIV or some disease and they don't even care.”
The Fayetteville syringe operation is small but is still able to distribute between 1,000 and 2,000 syringes a month.
With legal SEPs, exchange is done at a set facility. Screening for HIV is offered as well as educational and support opportunities for addicts.
“If we think of addiction as 'bad people doing bag things we don't want to encourage' and so people are worried about needle exchange programs because they think they might be encouraging,” said Kenny House of Coastal Horizons. “We don't want to make it easy for them or okay for them to continue in a negative cycle. But we also don't want to lose them. We want them to be alive long enough to have hope of recovery.”
Sizemore was headed to meet a young man who had just gotten out of jail the night WECT met with him. The young man had been in for 90 days and one can assume, sober for that same amount of time.
“I just take them up to them and then they distribute them to their user union," Sizemore explained. “That's what we call them, their user union, where a bunch of IV drug users get together. They tend to take care of each other, make sure nobody overdoses.”
Pulling behind a motel we spotted the head of a user union, standing at the far back of the parking lot.
Sizemore tries to only deliver after the sun sets, largely to not alarm the rest of the public as his big bag of needles gets carted around.
It’s a somber interaction, each not speaking just above a whisper.
On the edge of the lot wait the rest of the user union, presumably headed to inject after the needle supply is handed over.
After a brief exchange the two shake hands, hug and a soft “I’m praying for you” is said.
And that’s the end of it.
Hours later, Sizemore received a text saying the naloxone he delivered was used that night in the union to save one of the addicts from overdosing.
“It breaks my heart to see kids that young....” Sizemore trailed off before he could finish while driving home.
Like any exchange, Sizemore collects the used syringes before dispensing a new supply.
“We're amassing an amount of used syringes that nobody will help us dispose of,” Sizemore said. “When you ask somebody, ‘Hey I've got 10,000 needles I need to dispose of,’ people just are not willing to travel that road with you. They're just not.”
After trying to find a disposal site at hospitals, clinics, nursing homes and health departments Sizemore finally relented. None would take on the liability of disposal for the volume he was taking in.
He now collects and stores the used syringes in a nearby garage, hoping a better solution is not far off.
“God, he won’t let me rest. He won't,” Sizemore said. “I think about the friends that I've lost and I think about the people who could be here today - you CAN'T stop. Even in light of this illegal situation you just can’t, you have to.”
He argues that syringes, at the very least, should be readily available at county health departments. If these outlets can provide free condoms, he believes they should do the same for needles.
While sex is not illegal and heroin use is, Sizemore points out that the purpose of free condoms is not to condone sex but to prevent the spread of disease within a community. Likewise, the purpose of free clean syringes is to prevent the spread of disease – not to make drug use more comfortable or affordable for users.
“It's an issue of society doing what we are called to do and that's to care for each other,” Sizemore explained. “And if nobody else does it I'm still going to do it."
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