As Overdoses Soar, This State’s Largest Needle Exchange Is Being Evicted - The New York Times

2022-04-02 03:55:03 By : Ms. Alan Feng

Syringe-access sites have been proven to reduce opioid overdoses and curb disease. New Jersey is about to shut down its biggest one.

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ATLANTIC CITY, N.J. — The tattoo etched on Norman Rivera’s left shoulder looked as fresh as it was plain: “R.I.P. Martha.”

Martha, his wife of seven years and partner of 30, died recently of cancer, he said, derailing his fragile recovery from a drug addiction that had dogged him half his life.

Four days clean, he walked into Oasis, New Jersey’s largest needle-exchange program, which operates from a squat brick building on an Atlantic City side street, a few blocks from two casinos and the carnival rides that jut out over the ocean on the Steel Pier.

He traded in a handful of dirty hypodermic needles for sterile ones. If he slipped up, he said, he did not want to risk another bout with hepatitis C, or worse.

“So far, so good,” said Mr. Rivera, 53.

Soon, it may also be so long.

Atlantic City’s syringe-access program, born in the wake of the AIDS crisis, has been ordered to close amid two new health emergencies: a record-setting spike in opioid overdoses nationwide and a pandemic that has exposed profound flaws in the health care safety net, particularly among the poor and in communities of color.

“It comes at the worst possible time,” said Gregg Gonsalves, an AIDS activist and associate professor at the Yale School of Public Health. “In the middle of one gigantic new pandemic, do we really have to revive old ones?”

A majority of the Democrat-led Atlantic City City Council voted last month to evict Oasis after expressing frustration that it was the only place in southeast New Jersey where intravenous drug users can trade in needles. This, they believe, draws transient addicts to a city that has been down on its luck for decades.

“We think there should be other people helping us in the fight,” said Kaleem Shabazz, a councilman who represents the tourist district where Oasis operates.

“We should not have to take the whole weight by ourselves,” he added.

Oasis is expected to be forced to stop distributing syringes from its South Tennessee Avenue location by early November, 17 years after the city unanimously endorsed the efforts of its pioneering former health director, who agitated for needle exchanges long before New Jersey became the last state in the country to make them legal.

Last year, a record 93,000 people died nationwide from overdoses, according to preliminary statistics from the Centers for Disease Control and Prevention. Of these, 3,046 lived in New Jersey.

Yet across the country, harm-reduction programs like Oasis are increasingly under fire.

In June, a rural Indiana county voted to close down a needle exchange that opened with approval from then-Gov. Mike Pence and successfully quelled a large H.I.V. outbreak in 2015. West Virginia adopted a law governing needle exchanges that health care providers warned would “all but eradicate syringe service programs.”

In New Jersey, lawmakers and harm-reduction advocates fear that Atlantic City’s effort to evict Oasis — the state’s first needle program — could embolden some of the six other cities that offer exchanges to pull out of the voluntary public health initiative.

The 7-2 vote by the council came in defiance of Gov. Philip D. Murphy, a Democrat, whose administration had lobbied members to try to block the move. City and state officials said discussions were ongoing that could result in an 11th-hour deal to relocate Oasis to another building outside the tourist district.

“We should have more of these, not fewer,” Mr. Murphy told a caller on WNYC’s “Ask Governor Murphy” show.

“This is life and death,” he added.

Programs like Oasis have been proven to slash H.I.V. infection rates by limiting the reuse of contaminated needles and prevent overdose deaths by training drug users to recognize and reverse opioid overdoses.

New participants are five times as likely to enter drug treatment as addicts without access to needle exchanges, according to the C.D.C. The sites often offer nursing care and testing for infectious diseases and pregnancy.

At Oasis, condoms stuffed into grab-and-go packets sit in a bin near the door. Each day, staff members hand out 35 to 40 two-packs of Narcan nasal mist that can quickly reverse an opioid overdose, said Carol Harney, chief executive of the South Jersey AIDS Alliance, which runs Oasis.

Only the needle exchange is required to leave, but the council’s decision has the potential to gut the ancillary health care programming as well, Ms. Harney said.

“People come in for the syringes,” she said, “and we talk them into the other services.”

A virtual meeting of Atlantic City’s council included dozens of impassioned pleas to spare the program. A city so dependent on round-the-clock gambling, alcohol sales and nightlife must also care for the vulnerable residents who work in its shadows, several speakers said.

Oasis officials say 95 percent of the 50,000 needles distributed monthly are returned. Still, the council president held up a jar of syringes he said were collected from sidewalks and alleys — evidence, he said, that the center is a scourge.

In interviews, other elected officials said they did not doubt Oasis’ benefits. Instead, their objections center mainly on regional equity and what they see as a saturation of social services in the resort city where 37 percent of residents live in poverty.

“This whole outdated model that exploits Atlantic City and the six other towns that carry the burden of the rest of the state is silly,” said Jesse O. Kurtz, the sole Republican on the council, who voted to rescind Oasis’ permission to operate.

New Jersey’s needle-exchange law, adopted in 2006, gives localities veto power over syringe sites; programs similar to Oasis operate in Asbury Park, Camden, Jersey City, Newark, Paterson and Trenton.

Legislation pending in Trenton could change the rules. One bill would empower state health officials to establish needle programs in areas they deem to be high risk.

Dr. Shereef Elnahal, a former New Jersey health commissioner who now runs the state’s only public hospital, in Newark, said the issue should transcend local politics and decision-making.

“We’re backtracking on addressing the stigma,” Dr. Elnahal said. “Unless officials are willing to make courageous moves that sometimes defy their local politics, it’s going to get worse.”

It is not a red-state, blue-state issue. Kentucky, represented by the Republican Senate minority leader, Mitch McConnell, is home to 54 of the 220 counties identified nationwide as most vulnerable to H.I.V. infections among I.V. drug users. It has more than 70 needle exchanges.

New Jersey, dominated by Democrats, has lagged far behind other states on initiatives that make it easier to access sterile needles.

Lawmakers authorized needle exchanges two decades after Tacoma, Wash., opened the country’s first legal syringe program, and only after activists who ran renegade needle swaps helped overcome the argument that the programs would encourage drug use.

Loretta Dutton spent 25 years working at a drug-treatment center before joining the state’s health department, where she was responsible for H.I.V. prevention for 16 years. Closing Oasis, she said, would be disastrous.

“People are going to die from overdoses,” Ms. Dutton said. “They’re going to share needles. And they’re going to get diseases.”

Joseph Lombardi, a father of two and a heroin user, goes to Oasis every two weeks to exchange needles.

“If they were to take this away, I don’t know what we would do,” said Mr. Lombardi, 42, who said he relocated to Atlantic City to be closer to the city’s ready supply of drugs.

“I can guarantee,” he added, “it’s not going to make these addicts leave.”

In 2016, citing runaway expenses and poor management, New Jersey took over most decision-making from Atlantic City. While the takeover gives the state power to veto ordinances approved by the council involving the city’s financial health, state officials believe decisions about the needle exchange are outside their purview.

Still, critics have said that Mr. Murphy could have used the considerable leverage the state wields over the city’s purse strings to block the vote to evict Oasis.

“Murphy could have done more — and sooner,” Ms. Dutton said.

Georgett Watson has worked for the South Jersey AIDS Alliance for almost 29 years and handed out the first legal needles in Atlantic City on Nov. 27, 2007.

Her definition of a win, she said, may seem modest: people who ask for fewer needles one week to the next; a newcomer who agrees to get tested for H.I.V. and hepatitis C; an expectant mother who attends a prenatal care appointment and earns a $10 gift card to Walgreens or McDonald’s.

The gold standard is a decision to start drug treatment.

“That’s a do-backflips-down-the-foyer win,” she said.