The Critical Dilemma: Struggles and Hopes of A Needle Exchange Program in Madison

It’s ten o’clock on a sunny Friday morning. In his office at AIDS Resource Center of Wisconsin, located one block away from the Capitol, James Reinke started to pack up boxes and bags of supplies and bring them down to his cobalt blue Dodge minivan waiting in front of the building. He piled up boxes of various sizes of syringes in the backseat, dropped bags of condoms on the ground, and put alcohol wipes, cottons, filters, tourniquets and bottle-cap cookers into an eight-drawer cabinet beside the seats.
“Basically everything you need to hit,” Reinke said, while sweeping his eyes over the mini heroin paraphernalia shop he just built in the interior. “Now I gotta wait for calls.”
It’s been the start of his regular workday for 12 years, as the operator of the LifePoint Needle Exchange. Then he spends most of the day driving around the city, in response to the calls, usually about 12, from injection drug users in Madison area asking for syringes and other supplies.
“I had friends who used got hepatitis C from sharing equipment with other friends, so you hate to see someone sick.” Reinke talked about why he chose this job. “She was lucky that they didn’t have HIV, you know, 20 years ago, many people got HIV from using needles, it used to be one out of three nationally.” According to the data of Centers of Disease Control and Prevention until 2009, injection drug use accounts for a quarter of HIV transmissions.
Reinke said a heroin user needs about three to four syringes to get through one day, and if he is using cocaine, it will be 20 to 50 every day. However, the problem is, one can be fined more than $1,000 because the possession of drug paraphernalia is illegal in Wisconsin; and on the other hand, even though the distribution of needles is not illegal, most pharmacies in Madison don’t sell them to people without prescription because of the underlying moral issue. Therefore injection drug users have to turn to Reinke and his program that serve as a mediator in this dilemma, or they would share dirty needles.
“I am being included into these things and told about stuff that nobody is allowed to talk about, it is special that they share stories with you, trust you, you can’t tell anyone that you are doing heroin today or cocaine,” Reinke said while driving to the east side of the city, as an exchanger just called. “It will be a lot safer if everybody knew, if we knew who was doing it, where they were doing, what they were doing. It’s simply prohibition is ninety percent of the problem.”
The call was a young white girl with dark lips and bruised arms who headed into the van parked outside an Open Pantry. She grabbed some boxes of syringes and some cotton while chatting with Reinke about what her mom told her to do if she has no place on her arm to hit.
“Her mom is a nurse working in hospital, she does not want her to wreck her vein,” Reinke said when writing down the age and phone number of the girl after she left. “When you know someone, it becomes harm reduction immediately.”
The needle exchange program is based on the harm reduction model, in which the goal is to reduce any negative consequences resulted from drug use. The CDC and the National Academy of Sciences had similar conclusions that NEPs can reduce HIV’s spread among IV drug users, their partners and children. In Wisconsin, According to the 2010 annual report of AIDS Resource Center of Wisconsin, Lifepoint reduced the annual HIV infection rate for drug users by 66 percent.
United States Surgeon General and Department of Health and Human Services have endorsed the finding that NEP does not increase drug use. Nevertheless, because it might symbolize an approval of drug use, since 1988 U.S. government did not allow any federal money to be spent in NEPs until President Obama signed a bill repealing the ban in 2009.
However, according to UW-Madison social work instructor and clinical social worker Amy Garvey, the federal government hasn’t given money to NEP and those in Wisconsin are still funded with mostly private grant and some state grant. “Our society is still conservative in terms of drug treatment, and the cultural emphasis on personal responsibility doesn’t support any governmental intervention.”
“My mom is concerned with my safety and doesn’t understand what I do,” said Reinke, parking the van in front of the house of another exchanger who just called. “Just those big scary words like heroin and cocaine can be really scary, especially to someone who doesn’t know about it.”
After 20 minutes, Reinke gave up waiting. “ It’s probably because he saw a new guy in the van,” Reinke said. “They are super sensitive.”
Instead of going back right away Reinke decided to stay outside, since he received a call telling him a police officer was waiting in his office to talk to him about the program. “ We talked once but she still wants to talk more,” Reinke explained, adding that. “ I don’t want to talk to the cops at all, just because I know too much about my people, I don’t want to disclose something that I shouldn’t for their safety.”
Furthermore, Reinke said, the police even tracked his cell phone. “It’s simply harassment, ” Reinke said. “The number of heroin overdoses is increasing in Madison, why are the wasting time on me instead of the dealers?”
“There’re a lot of individualities in both of those,” Garvey commented on the conflict. To the NEP workers it’s not important whether the people coming to him are criminals because they only care whether they are sick, but some of the police are more conservative and see it as criminal issue. “The drug enforcement people would be foolish to not look at who is coming to see James.”
Garvey believes it’s a means to an end to find out where the major supply is by following the NEPs. “They are not so concerned about people using drugs, but more about the people delivering to them.”
However, even for investigative purpose, if he gives police the information of his clients as they asked for, the users would be scared and stop coming to get clean needles, which could lead to more cases of HIV, Reinke insisted. “It shouldn’t be a crime, it’s health issue.”
Last year Lifepoint gave away about 200,000 syringes, this year by the end of September it’s 210,000 already, Reinke said. “Every year a couple of people I know die. It really sucks.”
“ Needle exchange is just one tool in the toolbox of harm reduction,” Garvey said, expecting harm reduction-based and cross-sectional collaboration in the future, even though the abstinence model is still on its continuum and criminalization is increasing. “We need all of the people in these field including enforcement and medical agencies and policy makers to work together to make it available for everybody.
“Always be careful, and find out how to stay safe. We encourage community input as it relates to injection drug use and any positive change,” says the first page of the annual zine One Shot that Reinke publishes to educate drug users about drug use safety and encourage them share personal experience.
“It’s not like it’s a monster, it’s still the person, going through something,” Reinke said about the users, when he drove back to the Capitol Square in the light of the setting sun, assuming the police officer had gone.