The uneasy formation of a legal needle exchange

by Jonathan Michels

Photography by Justin Cook

Colin Miller doesn’t want to add to the list of names tattooed on his arm.

“Nathan” committed suicide in downtown Minneapolis after a five-year struggle with heroin.

“Jason” died of an overdose in a hotel room in Montana.

They found “Denver” in a ditch down in Archdale.

There are 12 names in all, and more that could be added. They are the inky memorials for Miller’s friends who died of overdoses or another type of drug-related death. Most of them involved opioids.

Nearly 30,000 Americans die from opioid overdoses each year as a nationwide drug epidemic continues to spread throughout the country, not only in areas traditionally associated with poverty like the inner city and the Appalachian holler but in upscale suburbia as well.

In North Carolina alone, heroin deaths increased 554 percent between 2010 and 2014 and the mortality figures are expected to have risen again in 2015. Prescription opioids — synthetic medications such as Oxycontin that mimic the pain-relieving properties of opiates — are believed to be a risk factor for heroin use, according to the National Institutes of Health. Of the top 25 worst cities for opioid abuse, four of them are in North Carolina, with Wilmington ranked at No. 1.


Not content with merely adding to the list, Miller recently co-founded a syringe exchange with Erika Mishoe near downtown Winston-Salem. A syringe exchange — trading dirty or used needles that have been used to inject heroin for clean ones — is part of a set of ideas and principles called “harm reduction,” designed to mitigate the damaging effects of drug addiction.

“A lot of drug users will never see the healthcare system,” Miller said. “They’re forgotten. Syringe exchange is a point of contact where we can at least start to give people some education and show them that there are people who care and to teach them ways to care for themselves.”

The Twin City Harm Reduction Collective began operating out of Green Street United Methodist Church in early December. The Winston-Salem site is one of 19 operations created since July, when then-Gov. Pat McCrory signed NC House Bill 972 legalizing syringe exchanges.

In addition to the usual coalition around humane substance-abuse policy, the campaign to legalize syringe exchange in North Carolina has found support among law enforcement officers who realize that they can’t simply arrest their way out of the drug war. In fact, these new policies were in part the result of a strategic campaign spearheaded by the North Carolina Harm Reduction Coalition to educate and lobby law enforcement and elected officials, many of them Republican, about the public health benefits of harm reduction. The campaign has become an organizing model for other proponents throughout the South.

“The country has moved towards harm reduction in a really big way in the past few years because of the scope of the opioid epidemic,” said Tessie Castillo, the communications and advocacy coordinator at the NC Harm Reduction Coalition.

“Legislators are just looking for answers,” she said. “We’ve had them all along but no one was listening.”

With a significant number of law enforcement officers now supporting syringe exchange and Naloxone distribution, many wonder if the drug war has turned a corner by becoming more just and humane. Harm-reduction advocates remain doubtful about this optimistic perspective and believe the collateral damage of the drug war will take decades to overcome, but they view the recent wave of laws legalizing syringe exchange as a step in the right direction.

“The legalization of syringe exchange,” Miller said, “symbolizes the shift from, ‘We’re going to punish you’ to, ‘Let us help you.’”

The creation of Winston-Salem’s first legal syringe exchange is a story of pain and redemption and of a community, cautiously but optimistically, navigating the ruins of a public health epidemic.

The face of addiction

Though often regarded with the same grimy, deviant imagery stereotypically ascribed to the heroin epidemic of the 1960s which plagued mainly African Americans living in inner cities, young white men and women of all socioeconomic groups are the main abusers of heroin today, and the drug has thoroughly inundated bucolic, rural America.

A 2014 study in the Journal of the American Medical Association Psychiatry titled “The Changing Face of Heroin Use in the United States” reported that 90 percent of respondents who began using opioids in the last decade were white.

Some see discrepancies in the harsh treatment of drug addicts who used crack cocaine –- commonly associated with African Americans — during the 1980s and today’s public health resources being unleashed for white communities suffering from opiate addiction.

“Such public-health responses were not necessarily unthinkable during the crack-cocaine wave of the 1980s or the heroin epidemic of the 1960s.,” wrote Andrew Cohen in The Atlantic. “But the limited public-health measures adopted during those eras were overshadowed by more punitive responses to those crises.”

While Miller wears the scars of chaotic drug addiction on his body, Erika Mishoe’s personal experience with the drug epidemic is less apparent but still painful: Close family members died from drug overdoses only two years apart . She hesitated to give more details about drug abuse in her family because of the discomfort that it might cause among the rest of them due to the stigma of addiction.


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