New Coalition Aims to Expand Syringe-Exchange Program in Charlotte 

Cat Nelson was introduced to heroin at age 13 by a friend's parent. Now 32, she looks back on it as a fateful experience.

"I kind of sought it out. From a young age, I always wanted to get high. I think I was born this way," Nelson says, a mischievous grin on her face. She began looking to get into recovery at around 18, but continued relapsing after accumulating more time clean each time she tried. Then, at one point in her early 20s, Nelson found herself in the middle of a street in Ballantyne being pulled off of a dying friend by police who she says were more interested in questioning her than saving his life. The experience changed her life path drastically.

Nelson had just met this friend, a train hopper she had stayed up talking with all night, before the two decided to buy heroin in the morning and use, despite her having been clean for two years at that point.

While they followed a dealer to a spot where they could cop, her friend was so intent on keeping up that he urinated in a bottle in the car. Once they got their gram of black tar heroin, he didn't want to wait around, so he used his own urine to cook it up, despite Nelson's warnings that black tar didn't need to be cooked like other forms do.

The friend had never tried black tar, so Nelson warned him not to shoot his entire half-gram. He did anyway. She says she still remembers the smell of burning piss and vinegar before the man shot up, then quickly made what Nelson calls the "death rattle" — a guttural gasp — and fell unconscious.

"I hit his chest real hard, and I'm like, 'Wake up, wake up,' and I'm trying to drive still. He wakes up for a split second and then he falls back out," Nelson remembers. "And I was like, 'Well this is happening.'" She veered into a neighborhood in Ballantyne near Rae Road and pulled over in front of an upscale home. "I ran around the car, opened the door, and he was just so gray. I've seen a lot of overdoses, unfortunately, but I've still never seen someone look as dead as he did. It was just" — she pauses — "his tongue was out and his eyes were bulging."

Nelson tried giving the man CPR in the middle of the street while a woman who came out of a nearby house called 911. She would later spend six hours with homicide detectives who led her to believe her friend had died. He hadn't, but the experience shook Nelson to her core and inspired her to begin researching revival techniques.

Nelson found out about Naloxone, a medicine that reverses the effects of an opioid overdose. From there, she began learning more about harm reduction associated with drug use, and has since become one of the city's strongest advocates for harm-reduction practices, even running a syringe-exchange program out of her car for many months in 2016 and 2017 — shortly after the programs became legal in North Carolina — before eventually becoming homeless and running it out of hotel rooms and from the streets.

Since then, Nelson had backed away from the work, as it was overwhelming her. But in the last few weeks, she's been back in the syringe-exchange game, and this time she has a team behind her. In recent months, advocates from around the Charlotte area have formed the Charlotte Regional Harm Reduction Coalition, a group with a mission to bring a fully funded, 'round-the-clock syringe-exchange program to Charlotte.

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• Cat Nelson with some supplies at Queen City Needle Exchange (Photo by Dana Vindigni)

When Nelson heard about the coalition's efforts, she knew she had to be a part of it. She joined a preliminary discussion three months ago with other advocates and volunteers.

"Just talking about it again got me completely excited. I just care so much about it," Nelson says. "It's just so important to me. So seeing that there were professionals, and these people also, there were people willing to hear me out. I think the attitudes in Charlotte have changed a lot.

"[Even though] I was a recovered addict, people would say, 'Once an addict always an addict, it's just some junkie who wanted to give syringes to other junkies,'" Nelson says of her earlier experiences with exchange programs. But now things are different. "I think everyone's been touched in one way or another in Charlotte by the opioid epidemic, so people's attitudes are changing and they're becoming more open. Seeing these professionals who are listening to me, and hearing me out, and interested in helping — it's just very encouraging."

On a recent Friday, Nelson could be doing anything else to begin her weekend, but just as with every other Friday afternoon, she's sitting inside a small conference room in the Carolinas CARE Partnership offices in east Charlotte hoping someone will show up to pick up syringes. Or a cooker. Or a rubber tourniquet for tying off. Or some Naloxone.

When clients do show, Nelson casually feels them out to see if they may be ready to seek help, but her main priority is to help supply the equipment they need and not put them under any pressure.

Nobody shows on this Friday, but Nelson is not deterred. In fact, she's excited. She just received a shipment of lock boxes that people can use for their heroin supplies if they live with children or in some other communal environment. She also got a bunch of Fentanyl strips, which act as a sort of "Fentanyl pregnancy test," she says, letting drug users test their stash for the deadly substance that's been behind so many overdoses in recent years.

It's just another day at the Queen City Needle Exchange, which Nelson runs from 2 to 6:30 p.m. every Friday. In its first month of existence, the program has been slow to get started because people don't know about it and because intravenous drug users don't often wait around for a specific time window.

"I get calls throughout the week, but when people want supplies they want them then and there," Nelson says. "And so I tell them, 'Wait until Friday and then come in,' and then so many people don't show up because when they need syringes, they need syringes then. Until we can be open like five days a week, we're going to be slow, because people will find other ways to get syringes."

Nelson does not want them to find other ways to get syringes, and that in essence is the driving force behind the many people who are now working to get a fully funded syringe-exchange program in Charlotte.

The harm reduction coalition is named so after the practice of prioritizing public safety by reducing negative consequences associated with drug use while respecting the rights of drug users. Harm reduction practices have become more popular recently, as the opioid crisis has ramped up around the country and fact-based research has proven the practices to be effective.

While critics of syringe-exchange programs say they are simply enabling addicts, decades of research has shown that the programs do not cause any increase in drug use, according to the Institute of Medicine; in fact, they decrease drug use by connecting users with people who can help them find treatment.

According to a groundbreaking report in the Journal of Substance Abuse Treatment in 2000, syringe-exchange participants are five times more likely to enter drug treatment than non-participants.

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• A lock box available at the Queen City Needle Exchange (Photo by Dana Vindigni)

The programs have also proved to increase public safety. A 2004 study on the return rates at syringe-exchange programs showed that more than 90 percent of syringes distributed by exchange programs were returned, as opposed to being left out in public spaces, putting children and others at risk, or jammed into bags or scattered in cars, endangering police officers during searches.

Perhaps the most impactful effect of syringe-exchange programs has been to curb the sharing of needles and stop the spread of blood-borne illnesses like HIV and Hepatitis C.

Nelson points out that almost every heroin user, no matter what they tell themselves going in, will end up sharing a needle if they don't have access to a clean one. "Everybody says, 'I'll never share needles,'" Nelson says. "Of course, everybody thinks that. But the thing is, when you're faced with being in withdrawal for the rest of the night or sharing a syringe with people who tell you, 'Oh it's clean, everyone's clean,' then it happens slowly. You mess up one time, but then the next time it's not so hard to do it and then you kind of slip into it. Sharing just happens."

According to North Carolina's Department of Health & Human Services, the cost of treating the state's Medicaid patients with chronic Hepatitis C rose from about $8 million in 2013 to $50 million in 2014, and has continued to rise.

While it's legal to purchase syringes from a pharmacy in North Carolina, it's up to the pharmacy technician to decide whether they feel comfortable selling them to a specifc customer. For Nelson, with her pink hair and stereotypical punk look, that can cause problems.

Now, as members of the CRHRC are pushing to get funding for an exchange program here, they are finding that a big city like Charlotte has more barriers to launching a syringe exchange than many of the rural towns that have seen success across the state.

Local advocates have found that the limited resources they get from the N.C. Harm Reduction Coalition, of which the local group is a chapter, are placed into rural towns with a need, the impact can be much greater than it would be in Charlotte, where more funding would be needed to effectively serve such a large population. Other obstacles include the high degree of difficulty in creating networks among all the different organizations that are involved in a syringe-exchange program, including law enforcement, hospital systems, mental health providers and more.

Angela Allen, executive director at the Center for Prevention Services in Charlotte, says she has written two unsuccessful grants to get funding for a syringe-exchange program in Charlotte, but will continue trying.

"The magnitude of this opioid issue is frankly making grant money very difficult to get, because there's a lot of competition for it. I totally understand they can't fund everybody, but there's only so much we can do without the funding," Allen says. "It's not that people don't want to give us money for this, but there are lots of worthy programs out there doing really needed things, and they have to make hard choices about who gets the money and who doesn't. We keep plugging away at it, but it's tough right now."

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• Cat Nelson at the Carolinas CARE Partnership offices where she runs the exchange.(Photo by Ryan Pitkin)

On a recent Monday morning, members of the CRHRC hosted a community discussion about harm reduction at Hal Marshall Services Center in uptown Charlotte. The discussion was the third one held since the coalition's founding, aimed at helping folks in all the related communities understand the details and advantages of a syringe-exchange program in Charlotte.

After Nelson gives a speech on harm reduction, as well as local drug rates and crime rates, Paisley Murff of Carolinas CARE Partnership discusses the prevalence of HIV and other blood-borne viruses in the community.

Then, Whitney Schwalm of the Cabarrus Health Alliance describes her experience launching a syringe-exchange program in Cabarrus County just over a year ago. Her firsthand knowledge is invaluable to the roomful of county workers, healthcare officials and drug prevention experts.

As CHA's harm reduction program coordinator, Schwalm was there from the beginning of the county's syringe-exchange program. She and her team have since enrolled 115 participants and carried out 627 interactions with clients. They've handed out 2,300 syringes.

Schwalm and and Marcella Beam, chief community health officer at CHA, later share with Creative Loafing their experience with fighting the stigma that sometimes comes with launching a syringe exchange program. They say the team took six months from the time the program originally received funding from a private donor to the time it launched in June 2017. They wanted to make sure CHA fully educated everyone who would be connected to the program.

"When you're wanting to implement an intervention that some might see as a little bit progressive, the last thing you want to do is set off people's own personal sides or perceptions," Beam says. "You want to include them in the conversation. What we always try to do is get everyone to the table [where] everyone can have open discussions about what's working, what's not working, what would work. You have them involved in the beginning and you're not backing into the corner at the end to say, 'Well, we're going to do it anyway.'"

Schwalm says that after she leaves her post for a new job she recently accepted, the Cabarrus Health Alliance will still be involved in a partnership with the Charlotte coalition, as some of the Cabarrus clients come from Mecklenburg County to participate in the program.

"We'll be sharing our resources, sharing our experience...," Schwalm says. "We're hoping to really make it a partnership versus just, 'We're telling you this is how we're doing this,' but continuing to combine efforts in reaching the folks who really need to be reached."

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• Lauren Kestner (left) collages with Hillary Belk, fellow co-founder of R Creative Collective (Photo courtesy of Lauren Kestner)

When it comes to educating the residents of Mecklenburg County about the advantages of a syringe-exchange program, Lauren Kestner will play a large role. Kestner, a prevention specialist with Center for Prevention Services, teaches youth programs on resilience and empowerment, while also working in marginalized communities in Mecklenburg and surrounding counties. She also helped found R Creative Collective, an arts collective made up of creatives in recovery, in 2015.

Kestner is playing host at the Hal Marshall Center discussion, giving context between speakers and sharing bits of her own experience. At one point she tells the crowd how syringe-exchange programs were "life saving" for her. When we speak after the event, she explains what she meant.

Kestner did not have access to a syringe-exchange program where she lived in Newark, New Jersey, but she would often cross over into New York City, when possible, to get needles at a syringe exchange there. It was there that she began to learn things about her drug use that helped her stay healthy up until she was ready to seek treatment.

"I was provided with all kinds of lifeboats, if you will: I was able to learn how to use bleach if I had to share needles, I learned how to shoot without blowing out veins [and about] wound-care kits," Kestner says. "The beauty of syringe-exchange programs and what a lot of people don't realize is that it's an access point, and the things that saved my life — the shared information of how to use safely and how to get clean needles and all of these awesome tools — offered me the idea that my life had value and I wasn't worthless and it reduced a lot of the shame that I had around being an IV drug user."

Kestner got involved with CPS after meeting Allen and applying for a part-time position before being offered a job full time. She says that as an artist, she never imagined doing this type of work, but now sees it as serendipitous.

"I tend to think that it happened haphazardly, but it's not by coincidence," Kestner says. "When I look at harm reduction, it's so creative and open-minded and inclusive, and embracing of just who you are on a very soul level — and that is art for me. That is creativity for me. So these two worlds are very much in sync with one another."

Kestner's enthusiasm for the work she's now doing with the CRHRC shines through in everything she says. She is ready with stats that back up all of her points about harm reduction, and it's not hard to tell she's optimistic about creating a syringe-exchange program in Charlotte.

However, despite her optimism, Kestner is also a realist, and she emphasizes that there is some hard work to be done to be able to introduce harm reduction to a city as big as Charlotte.

"I have a lot of hope, but what I hope doesn't happen is I hope it's not lip service," Kestner says. "I hope people are very serious about changing how our community approaches this issue and takes a really serious interest in meeting a person where they're at, and allowing them to facilitate the course of their path in recovery and not making it so difficult by saying it's got to be one way, but giving them options. I hope that happens."

Nelson has kept her hope alive, as well, and for the time being, while Allen plugs away at funding, Nelson will continue to spend her Fridays at the Queen City Needle Exchange, hoping to help someone get clean, or shoot clean — whatever it is they need.

As Nelson points out, though, before she can help anyone, they need to show up.

"It isn't doing good if no one knows about it," she says, with all of her supplies out on the table in front of her. "Syringe exchanges, when you look at the numbers and the statistics and the studies, they speak for themselves. It sounds crazy giving people the tools to use drugs with, but in actuality, it always works. It saves money for everyone. It saves lives."

Now the question is, how to spread the word to help stop the spread of disease?