Needle and syringe programs are a major public health success story in Australia. By contrast, in the United States there is a ban on federal funding for NSP programs and some state laws continue to criminalise possession of syringes.
The Rev James Sizemore is senior pastor at Catalyst Community Church in Fayetteville, North Carolina. By operating a clandestine NSP outreach service from the back of his truck, this man of the church risks imprisonment.
“I could go to jail for practicing medicine without a license. Needles are considered suitable cause for arrest under suspicion of drug use or supply,” he told the Bulletin.
The Reverend’s guiding principle is also his call to action: to save a soul, a community needs first to save a life. In the last six years, Pastor Sizemore has distributed over 1500 syringes to people who inject drugs in his community.
North Carolina law allows pharmacies to sell syringes and people to buy them, but it is a criminal offence to possess or distribute syringes or other equipment that may be used for injecting illegal substances. This means that people who use drugs and outreach workers face criminal prosecution.
“They recently passed legislation that decriminalises syringes themselves, as in if I was walking down the street with some needles, I couldn’t be arrested for having them, but it doesn’t apply [to NSPs] and the distribution of needles.”
The Reverend is generally called out at night to deliver equipment. Meetings are brief, with a hand-over of supplies and a health check for anyone who wants one. He feels that the outreach with needles and syringes is important because more people are shifting to injecting drugs.
“As of 2012, the rate of new HIV infections in our state was 41% higher than the national rate. Nearly one-quarter of AIDS cases diagnosed in adolescents are due to injecting drug use – one of the highest rates in the country.”
Rev Sizemore told the Bulletin that those statistics should force the community into expanding NSP access, but opposition is entrenched. The federal budget does not allow programs to be funded under disease prevention, and, he said, even if the government did become involved, it would not follow that society would accept NSPs.
“For a church-based society, such as the one I live in, the issue would not evolve on any level unless the faith community sanctioned it.
“Technically, there is one legal needle exchange program in our state, but they will not allow any others. We need that to change before more lives are lost, before more lives are destroyed from a ravaging incurable disease and before we lose a generation of young people who do not have access to the simplest of resources,” he said.
In addition to the issue of blood borne viruses, North Carolina has been seeing a wave of overdose-related deaths that is also higher than the national average.
In 2009, there were approximately 1000 fatal drug overdoses in the state, which has a population of 9.7 million. By way of comparison, overdose deaths in Australia, with a population of 22.9 million, were 1383 in 2011 (according to the Australian Bureau of Statistics).
The region, which is also home to the Fort Bragg military facility, has experienced a surge in painkiller prescriptions after soldiers began returning home wounded from the first Gulf War, the second Iraq war and Afghanistan. Fort Bragg leads the state in the sale of oxycodone and has had to cope with increasing overdoses, crime and addiction.
A small ray of hope has been provided by the North Carolina State Senate this year passing an overdose prevention bill which would allow medical practitioners to prescribe naloxone to individuals who may be at risk of opiate-related overdose, and/or to their families and friends. The law also offers “Good Samaritan” protection for witnesses to overdose who call an ambulance.
While I manage my pain and my narcotics extremely well, I still have naloxone on me at all times.
Reverend James Sizemore
“But that is not enough, and it cannot be the end to all that we do, as a community, for those who so desperately need help,” Rev Sizemore said.
“It’s a horrible situation in this town, horrible, trying to help people that have a drug problem,” he said. “It just doesn’t happen.”
Rev Sizemore says he understands how people have issues with prescription medicines because he is on pain medications himself. Consequently he also carries naloxone – for himself.
“The naloxone issue is a bit personal. Three years ago, I had surgery to fuse my spine at the L5/S1 junction [and] the surgeons damaged the nerve bundles in the process, which caused me to be in significant pain, more so than I was prior to the surgery. So, for the past three years, I have been on narcotic pain meds to help manage the pain.
“So, each month I go see my pain management doctor to deal with this process. North Carolina has a state narcotic database that I am on which lists (or is supposed to list) everyone that is on a narcotic medication to prevent doctor shopping. I am drug tested and my pills are counted when I go to the doctor.
“So, while I manage my pain and my narcotics extremely well, I still have naloxone on me at all times.”