Needle exchange project inspired by urban efforts aims to save lives in rural Nevada

Richard Cusolito believes he is saving lives by distributing clean syringes and needles to people who use drugs in this rural area of ​​northeastern Nevada, but he knows some locals disagree.

“I’m hated in this town because of it,” Cusolito, 60, said. “I’m being accused of ‘allowing the junkies’ is pretty much the standard term. People don’t feel the impact of any of this.”

Drugs, including heroin and other opioids, are readily available at Elko, and Cusolito said a program like his is long overdue. Cusolito is a Peer Recovery Support Specialist and received training from Trac-B Exchange, a Las Vegas-based organization that provides a range of harm reduction services throughout Nevada.

In a city the size of Elko, with 20,000 people, Cusolito’s work has touched close to home. He helped his daughter access rehabilitation services, and earlier this year she died of an overdose.

“I just hold out hope for those I can help,” he said.

Cusolito has run the exchange program since 2020, when Elko City Council approved a resolution that gave him permission to distribute needles and syringes at the town’s camp for the homeless. The agreement was originally for one year, but the board recently renewed it for three years.

Elko officials’ endorsement of Cusolito’s work comes as often conservative small-town leaders have been urged to adopt policies forged in more liberal big cities, such as New York and San Francisco. Federal reports show that people who use needle exchange programs are five times more likely to start drug treatment programs and three times more likely to quit drug use than people who don’t. not, but programs in Nevada and other states have faced a similar setback.

Scott Wilkinson, deputy city manager of Elko, said the city’s ability to provide resources to people who use drugs is limited. “We did what we could to try to help, but we don’t have a health service,” Wilkinson said.

Trac-B Exchange funds Cusolito’s project, and it provides reports to the city on the number of syringes and needles it distributes and collects for disposal.

Needle exchanges are part of efforts known as harm reduction, which aim to minimize the negative effects of drug use rather than shaming people. In recent years, harm reduction tactics have begun to spread to rural areas, said Brandon Marshall, associate professor of epidemiology at Brown University School of Public Health.

Marshall said a 2015 HIV epidemic fueled by drug use in rural Austin, Indiana became a “canary in the coal mine”, showing how shared needles could spread the virus . A needle exchange program could have averted the outbreak or reduced the number of people infected, according to a modeling study co-authored by Marshall in 2019.

Cusolito tries to prevent this kind of disaster in Elko. His tiny office, in a gray building just off the main street near the city center, isn’t eye-catching from the outside. A “Trac-B Exchange” sign is displayed outside, but it does not identify the space as a needle and syringe exchange. Still, Cusolito estimates he sees 100 to 150 people a month, relying on word of mouth.

He also tours the prison, helping those charged with drugs complete the assessments required to receive treatment at rehabilitation centers.

He is adamant that participants return their used syringes and needles before getting replacements. The old ones go in a sharps container – a sturdy plastic box – which he sends to Trac-B Exchange in Las Vegas, where they are sterilized and sprayed for safe disposal.

Trac-B Exchange’s harm reduction efforts also reach other rural parts of Nevada: A peer recovery support specialist runs a needle exchange program in Winnemucca, 200 miles from Elko and home to 8,600 people. In Hawthorne, which has a population of less than 3,500, leaders approved the installation of a vending machine run by the organization and containing clean syringes and needles, as well as condoms, tampons and body soap. In 2019, the organization installed two sharps containers in Ely, a town of less than 4,000 people.

Trac-B Exchange program director Rick Reich said the organization provides services in rural areas to help people use drugs more safely or find resources to get and stay sober. Services include assistance with obtaining identity, housing and employment documents.

“You’re trying to get a carrot that someone will go after,” he said, referring to clean needles and syringes. “Then when they come to you, to get that carrot and eat that carrot, they can see that you have other things available and you’re not the scary person they thought you were in the nightmare that you were. they lived.”

In 2020, Nevada’s overdose death rate was 26 per 100,000 population, the 27th highest among states, according to the Centers for Disease Control and Prevention. That year, as the spread of covid-19 spurred stay-at-home orders and shuttered businesses, more than 800 Nevada residents died of drug overdoses.

Seven years after the 2015 HIV epidemic in Indiana, seven states still do not have needle exchange programs, according to a KFF analysis. In some states, harm reduction workers could face criminal penalties for carrying clean syringes or strips that detect the presence of the synthetic opioid fentanyl, which is 50 to 100 times more potent than morphine.

The Nevada Legislature passed a law in 2013 that legalized needle and syringe exchange programs so peer recovery support specialists like Cusolito could do their jobs.

But that does not mean that such efforts are always accepted.

Cusolito said he could put aside the nasty comments because he believed in the job he was doing. He remembers a client who had one of the worst heroin addictions he had ever seen. “I didn’t think he would survive,” Cusolito said. After contacting Cusolito and undergoing treatment, the client returned to work, bought a house and got married. He still checks in with Cusolito every two months to tell him about his latest accomplishments.

Clients with stories like these help Cusolito move forward when other work challenges weigh on him. The hardest part is losing customers.

“Sometimes I feel really strong and I can beat the world,” he said, “and other times I think about the moment I knocked on the door, you know? I want to lock the door. door and not let anyone in because I don’t want to deal with anybody else who might die.”

This article was reprinted from with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health policy research organization not affiliated with Kaiser Permanente.

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