New Hampshire has invested millions of dollars into curbing its opioid epidemic. But progress has been slow. That’s pushed some state policymakers and others to get creative.
This week, in a three-part series called “Alternatives,” NHPR’s Paige Sutherland reports on some less traditional approaches.
In the first piece in the series, we hear about a controversial new law that’s been in the works for decades, and is finally being implemented.
[Editor's note: We recommend listening to this story]
The Claremont Soup Kitchen has been around for more than 34 years, serving hot meals four days a week.
But as of a few months ago – it’s been offering something new.
“Hi, were you looking for the needle exchange," Louisa Chen asks one of the people entering the soup kitchen.
"Yes, awesome, we are actually working in there today if you could just go in there, that would be great,” said Chen, who's one of five Dartmouth Medical students who help run the exchange.
This syringe program runs out of the soup kitchen twice a month. Organizers collect used needles from drug users and swap them for clean ones.
This kind of program is common in many other states but it’s the first of its kind in the state since legislation was signed in June.
Prior to that, injection drug users could only buy their needles at a pharmacy. Many chose instead to reuse and share needles, which can lead to the spread of diseases including HIV and Hepatitis C.
Even after just a few weeks, the Claremont exchange has drawn people from all over the region.
“This is it," said Nasim Azizgolshani who also helps run the exchange. "Otherwise people have to go all the way out to White River Junction, which is a thirty minute drive from here and God knows how long if you’re inland and this summer we actually had someone come in from Maine.”
The day I was there, Azizgolshani helped ten people; a mom looking for the overdose reversal drug Narcan for her daughter, a veteran seeking clean needles, a married couple with their two small children looking for alcohol wipes and a box for their used syringes and a longtime user named Dusty.
“For every single one you give back to us we will give you an extra one – so I will give you two today but next time you come I will give you more," Azizgolshani told Dusty supplies in hand.
"Do you need more Narcan?,” Azizgolshani asked. “I would take more Narcan because I used the last one on a friend,” Dusty replied, who been using heroin since he was fifteen.
Dusty didn’t want to give his last name because he’s still using drugs. He’s been coming to the exchange since it opened two months ago.
He says there’s a real need for this in the area.
“It’s the easiest thing possible – you walk in, you eat a meal, you go get your needles and then you leave – good deal," Dusty said. "So I’m all for it, I don’t want people sharing needles or anything like that. I don’t care what you do but do it smart.”
The group behind the exchange relies on grants and donations. They use the space at the soup kitchen free of charge.
It took a long time to get to this point in New Hampshire. Critics were worried needle exchanges would enable more drug use. And once the legislation passed, the state didn’t put any money behind it.
Beth Daly of the state’s infectious disease department said that’s made it hard for the department to help out.
“Because there was no funding attached to this, our role at the health department is going to be very limited," Daly said. "There's no resources to fund these agencies or to oversee them in any way.”
With the state not really in the picture, local groups have had to step in.
In Dover, the New Hampshire Harm Reduction Coalition has been meeting for months. It’s made up of doctors, nurses, those in recovery and those working in recovery.
The coalition has now launched its own syringe exchange program. But it’s different than Claremont. Instead, volunteers approach drug users right on the street and offer them clean needles.
Kevin Irwin leads the group and has worked on needle exchanges worldwide. He says this approach is best suited to the rural parts of the state, where privacy may be a concern for drug users.
“Networks of small towns don’t lend themselves to any kind of bricks and mortar or even mobile health van types of services because they are just too visible so we don’t ever want to create disincentives for folks," Irwin said.
Irwin will lead a training session later this month to help organizations interested in running their own exchange services in the state.
But advocates still see a lot of challenges ahead.
“There is one thing when there is the law on the books and then there’s the how it really looks on the ground," said Laura Byrne, who runs an HIV resource center in Lebanon and two exchange programs across the border in Vermont.
Under the new law, a person found with drugs on a used syringe only faces a misdemeanor. If they’re heading to a needle exchange program, police have to let them go.
But Byrne says many of her New Hampshire clients still worry.
“I think it takes a couple of years for law enforcement to fully comply with the intention of the law and I think New Hampshire residents are wary – they fear arrest,” Byrne said.
As Dartmouth Medical student Louisa Chen packs up her supplies for the day at the soup kitchen in Claremont, she knows next time she’ll likely see the same clients but that doesn’t bother her.
“We want to be here not to solve this crisis because we are incapable of doing that," Chen said. "For us, our main goal is to just mitigate the issues as they come up. We want to make sure people are safe when they are using, we want to make sure nobody dies because they’re using and we want to make sure that anybody that wants to go into recovery has an easy path to it.”
It’s these reoccurring visits, that advocates hope will lead people into recovery…when they’re finally ready.