FAQs on Legal Syringe Exchange Programs in North Carolina
When did syringe exchange programs become legal in North Carolina?
Syringe exchange programs became legal in North Carolina on July 11 2016, the day Governor McCrory signed House Bill 972 into law (G.S. 90-113.27).
Why does H972 include statutes regulating law enforcement body camera footage?
H972 was originally written to regulate body camera footage. Later, a legislator added the language authorizing syringe exchange programs as a proposed committee substitute, or an amendment. The language was taken from another bill, Senate Bill 794, which was introduced into the Senate in April 2016.
Who can start a syringe exchange program in NC?
Any governmental or nongovernmental organization “that promotes scientifically proven ways of mitigating health risks associated with drug use and other high risk behaviors” can start a syringe exchange program. This includes, but is not limited to harm reduction organizations, health departments, AIDS Service Organizations and community based organizations (CBOs).
What legal protections are there for employees, volunteers, and participants of syringe exchange programs?
Under H972, no employee, volunteer or participant of the syringe exchange can be charged with possession of syringes or other injection supplies, or with residual amounts of controlled substances in them, obtained from or returned to a syringe exchange. To encourage people to feel comfortable using the exchange and to avoid any uncertainty should participants be stopped by law enforcement, exchange should offer participants a wallet card or other documentation that they are a participant in the exchange that they can show to police if they are stopped.
How will the syringe exchange programs be funded?
2016's H972 does not fund syringe exchange programs and it prohibits the use of public funds to purchase syringes and other injection supplies. The restriction on the use of public funds to purchase syringes and other injection supplies was a requirement for some House members to agree to vote for the bill. Public funds can still be used for all other expenses, including personnel, health care costs, HIV and hepatitis C testing, naloxone, wound care, treatment and social service referrals, etc. Organizations will have to secure funding for syringes and injection supplies through sources such as private grants, individual donors, corporate giving, fundraisers, donations from medical organizations, etc. This issue can be revisited in future sessions through the legislative process.
The Stop Act in 2017 allows local governments to fund syringe exchanges. It changed the state legal language to say no state funds can be used to fund syringes for syringe exchanges, not public funds, which was the previous language.
What services are syringe exchange programs required to provide?
Syringe exchange programs operating in North Carolina are required to provide the following:
(1) Disposal of used needles and hypodermic syringes
(2) Needles, hypodermic syringes, and other injection supplies at no cost and in quantities sufficient to ensure that needles, hypodermic syringes, and other injection supplies are not shared or reused
(3) Reasonable and adequate security of program sites, equipment, and personnel. (Written plans for security shall be provided to the police and sheriff's offices with jurisdiction in the program location and shall be updated annually)
(4) Educational materials on all of the following: Overdose prevention; the prevention of HIV, AIDS, and viral hepatitis transmission; drug abuse prevention; treatment for mental illness, including treatment referrals; treatment for substance abuse, including referrals for medication assisted treatment
(5) Access to naloxone kits or referrals to programs that provide access to naloxone
(6) For each individual requesting services, personal consultations from a program employee or volunteer concerning mental health or addiction treatment as appropriate
Programs should also provide written verification to all participants that they have received syringes and other injection supplies from the exchange. This can be in the form of a letter or laminated card.
What does “reasonable and adequate security of program sites, equipment, and personnel” mean?
This will depend on the size, location, and resources of the program, but the syringe exchange sites should at a minimum be kept securely locked. Syringes and other supplies should be locked up (especially used syringes in biohazard containers) and the exchange must take reasonable steps to protect the health and safety of employees, volunteers, and clients. This information must be sent to local law enforcement prior to implementing a program and updated every 12 months.
Is there a restriction on how many syringe we can hand out per person?
No. The law says that syringe exchange programs must provide “Needles, hypodermic syringes, and other injection supplies at no cost and in quantities sufficient to ensure that needles, hypodermic syringes, and other injection supplies are not shared or reused.” That means that restrictions such as “one-for-one” are prohibited.
Do people have to bring back syringes for disposal in order to get new ones?
No, as noted above the law requires that participants be provided with syringes in sufficient quantities to meet their needs. However, participants should be encouraged to do so, and reminded that under the new law they can not be charged or prosecuted for possession of needles that they received from or are returning to the exchange.
If we don’t distribute naloxone, where should we refer people to get it?
Participants who have medical insurance or Medicaid can obtain naloxone from any pharmacy in the state. As of June 20, 2016, North Carolina has a statewide standing order for naloxone that allows anyone who has insurance, Medicaid or the ability to self-pay to pick up naloxone in the pharmacy.
Participants who are uninsured can be referred to the NC Harm Reduction Coalition for free naloxone kits by contacting Robert Childs at firstname.lastname@example.org
What kind of personal consultation on mental health or addiction treatment are we required to provide?
This could range from a minimum of providing written information on mental health and addiction treatment programs in the area to offering one-on-one private consultations with a substance use counselor, social worker, nurse or medical professional on site.
Are there any reporting requirements before starting a syringe exchange program?
Yes. Each syringe exchange program must report the following information to the North Carolina Division of Public Health before starting operations:
(1) The legal name of the organization or agency operating the program.
(2) The areas and populations to be served by the program.
(3) The methods by which the program will meet the requirements for starting an exchange (i.e. how will your program provide syringes, dispose of syringes, and provide adequate security, treatment referrals, education on HIV/hepatitis C/overdose prevention, naloxone, personal consultation, etc)
The exchange must also provide local law enforcement with a copy of the site’s security plan on a yearly basis.
Are there any reporting requirements after the syringe exchange becomes operational?
Yes. Each syringe exchange program must provide an annual report to the North Carolina Division of Public Health containing the following information:
(1) The number of individuals served by the program.
(2) The number of needles, hypodermic syringes, and needle injection supplies dispensed by the program and returned to the program.
(3) The number of naloxone kits distributed by the program.
(4) The number and type of treatment referrals provided to individuals served by the program, including a separate report of the number of individuals referred to programs that provide access to naloxone.
To whom we should submit the reports at the Division of Public Health?
The person to submit reports to is TBD. NCHRC will send out a separate email when we get this information.
How can I start a syringe exchange program in my area?
The first step to starting an exchange is to gather your stakeholders and create a plan for how to organize, staff, fund, and run the exchange. Stakeholders could include local health entities, HIV prevention organizations, drug treatment centers and recovery communities, local user unions, and people impacted by drug use. It may also be helpful to reach out to local law enforcement organizations.
Once you have created a plan with stakeholders, decided on a model for the exchange (see examples below), and secured funding, you need to submit the report mentioned above to the Division of Public Health before you can begin operations.
What kind of syringe exchange models are there?
Fixed Site Exchanges – The exchange is located in a building. This could be a storefront, an office, or other similar space.
♦Shelter from street-based activities/safe space.
♦Room for other services such as medical care, referrals, psychosocial.
♦Out of view of local residents, businesses
♦Privacy for exchange participants
♦Participants have to come to you.
♦Limited hours of operation.
♦Higher overhead and upkeep.
Mobile/Street Based Vehicle based exchange – The exchange is conducted via a van or RV that drives to exchange sites and neighborhoods.
♦Flexibility if the drug scene or neighborhood changes.
♦Easier negotiations with larger community if they know you are not a permanent fixture.
♦Informal and low threshold if actually on the sidewalk or in a park.
♦Reaches harder to reach IDUs who may not have transportation or feel comfortable walking into a fixed site exchange
♦Harder to deliver ancillary services than with a fixed site.
♦Van involves higher overhead because of insurance, upkeep, driver, etc.
Home Delivery or Peer-Based Exchange - Participants call a phone number to arrange delivery of services, which can be done in their home or at another agreed upon site. Can happen on a regular schedule, or by appointment via cell phone.
♦Safer for participants.
♦Peer knowledge of drugs, drug use, and the local drug scene.
♦Increases access to new syringes for socially isolated injectors who do not access services such as syringe exchange.
♦Can involve a lot of driving, resulting in high overhead.
♦ Harder to offer wrap around services such as HIV testing, wound care, referrals, etc
Integrated syringe exchange - An organization adds syringe exchange into their on-going services.
♦Pre-existing organizational infrastructure and client base.
♦Multiple ways of getting syringes to participants, depending on the type of services provided by the agency.
♦May offset operational and human resource costs
♦Staff may be resistant to new programs & new ideas, especially if the agency follows a traditional abstinence approach.
♦Cost of training and supervision of peers.
♦Possible conflicting identities as peer worker and IDU community member.
Where can I get more information and technical assistance on how to start a syringe exchange program?
For more information or to request technical assistance, please contact Jesse Bennett at the North Carolina Harm Reduction Coalition.
Sample syringe exchange operation manuals:
- Community based organization example:
- Washington Heights Corner Project
- Peer based distribution manual
- Syringe Access Manual
- Guide to Developing and Managing Syringe Access Programs is a comprehensive, step-by-step manual for starting and managing syringe access programs. This pragmatic and straightforward guide can serve as a valuable tool for new and established programs alike, offering practice suggestions and guidance in several areas including: Planning and Design, Operational Issues, Organizational Issues, External Issues and Population-Specific Considerations.