How We Legalized Needle Exchange in a Southern Red State

Jul 19 2016

How We Legalized Needle Exchange in a Southern Red State

July 19th, 2016

On July 11th, 2016, North Carolina lawmakers made history by becoming the first veto-proof Republican supermajority to legalize syringe exchange programs. Who’d have expected the same state that earned the ire of the nation for passing the infamous transgender “bathroom bill” would legalize progressive disease prevention programs for people who use drugs?

It wasn’t easy. It took several years of targeted outreach, coalition building and strategic partnerships—plus two months of legislative shenanigans that could rival a high school prom for drama. But in the end the new law, which allows groups to launch programs to collect and distribute syringes to drug users, was passed.

Syringe exchange legalization efforts were spearheaded by the North Carolina Harm Reduction Coalition (NCHRC), a small nonprofit dedicated to improving the health and dignity of people affected by drug use. I started working for NCHRC in December 2010, just a month after midterm elections had swept a Republican supermajority into the legislature for the first time in decades. NCHRC’s Executive Director, Robert Childs, and myself made up the entirety of our full-time staff at this tiny nonprofit spouting controversial ideas about naloxone access, 911 Good Samaritan laws and providing people who use drugs with clean needles. Mostly, our message met with slammed doors and sudden dial tones.

Nevertheless in the spring of 2011 we tracked down a local progressive legislator and asked her to introduce a bill that would decriminalize syringes, thus legalizing syringe exchange programs.  She did, but the bill was quickly killed due to opposition from law enforcement associations.

In 2013 we got smarter. If law enforcement was our greatest opponent on syringe exchange, then we needed to get cops on our side too. We found the perfect ally in a conservative representative who was also a retired police chief. He agreed to sponsor a bill that would decriminalize syringes, but during the legislative process the law enforcement associations once again opposed it, forcing the bill to be watered down to a needle-stick prevention law that decriminalized syringes only when declared to law enforcement prior to a search. It wasn’t our ideal bill, but it was a start.

In 2015 we came back, again pushing for full legalization of syringe exchange programs. What we got was a law that allowed us to collect syringes, but did not legalize distribution. We were halfway there.

In mid-2015, I met with a conservative senator whom we had worked with on a 911 Good Samaritan law in 2013 and asked him if he would help us legalize syringe exchange—no watering it down this time. To my surprise, he agreed.

I’ll admit that at this time I entered a slight panic (I hadn’t actually expected him to say yes). We had less than a year before the next legislative session and we were nowhere near ready. The law enforcement associations still staunchly opposed syringe exchange and the majority of legislators recoiled at the idea of handing needles to drug users. How to get over 100 legislators plus the most powerful lobby groups in the state to change their minds in only a few months?

We started with our lessons learned from years earlier: win over law enforcement and you win over legislators. Since we had already established positive relationships with many law enforcement departments through our overdose prevention programs and needle-stick prevention trainings, we contacted those departments and asked to sit down with the chief or sheriff to discuss syringe exchange, and how it was proven to reduce crime, connect people who use drugs to treatment, and lower needle-stick injury to law enforcement.

We were amazed at the results. During these meetings, law enforcement confessed that they were tired of arresting low-level drug offenders only to see them back on the streets doing the same things days later. They recognized that jail wasn’t the answer and listened intently to the idea of syringe exchange. Some hesitated to lend their support. A couple balked completely. But most (upwards of 90 percent) said they would support such a measure, especially if it meant offering drug users a portal into treatment programs. We started collecting a list of quotes from chiefs and sheriffs about why they supported syringe exchange programs. That quote sheet was advocacy gold.

Sheriff John Ingram of Brunswick County was one of the law enforcement officials who changed his mind about syringe exchange. “At one time in my career I probably would have thought [syringe exchange] was enabling people to use illicit drugs, but we realize now that the old approach of arresting everyone and letting the judicial system sort it out doesn’t accomplish much,” he says. “People in our state have no place to get clean needles or dispose of them. We are finding needles discarded in roadways, parks, and cemeteries. This is a public safety issue.”

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The list of supportive quotes from law enforcement—and the fact that many of them were willing to call and visit their legislators to urge them to support syringe exchange—was the primary vehicle that we used to gain support from lawmakers. It wasn’t statistics like the fact that syringe exchange programs can drastically lower the rates of hepatitis C and HIV transmission or even information on how participants of syringe exchanges are five times more likely to enter drug treatment than nonparticipants.

We also enlisted the support of Health Directors, such as Colleen Bridger, President of the NC Association of Local Health Directors. “As health directors, we worry about communicable disease like hepatitis C that spread through people sharing dirty needles,” she explains. “We asked our association members to reach out to elected officials to help them understand why syringe exchange is an important public health effort.”

With help from local law enforcement, health departments, treatment centers, people impacted by drug use, and members of the faith community, we began traveling across the state to meet with legislators. Since we couldn’t meet with all of them, we created a target list based on particular lawmakers’ influence on health or judiciary legislation. We set up meetings where our target legislators were invited to the police department or sheriff’s office to meet with a variety of stakeholders. It took weeks and sometimes months to set up these meetings. But when successful, we knew the outcome of the meeting before the legislator had even walked through the door.

By the time the 2016 legislative session rolled around, we had strong support from twenty police chiefs and sheriffs, which we felt would be enough to neutralize any opposition from the law enforcement associations. We had a resolution signed by dozens of local health departments, treatment centers, HIV prevention organizations and churches in support of syringe exchange. We had the support of a growing number of influential legislators. We had published several op-eds in local newspapers in support of syringe exchange programs.

The first day of session I marched into our senate sponsor’s office feeling confident about our chances. All we needed was for him to introduce the bill into the legislature, which he had continued to assure us he would do. From there it would go into committees where legislators would debate and vote on the bill, then to floor votes where the House and Senate would vote as a complete body. After passing both the House and Senate committees and floor votes, the bill would be sent to the governor for signature. It could be over in a matter of weeks.

I walked into the senator’s office and asked him to introduce the bill.

He said no.

Okay. So he didn’t quite say ‘no.’ He explained that in the last weeks before session he had met with the lobbyists for the law enforcement associations and they were threatening to oppose the bill. Other senators were asking him not to introduce it because they didn’t want to vote on anything controversial during an election year.

By the time I left his office I could barely contain my disappointment. All that hard work traveling the state, meeting with law enforcement, health directors, legislators, the faith community, reporters—for nothing! But no. We weren’t done yet. I went straight home and typed up an action alert, which we blasted to our NCHRC list serv of over 7,500 people: Call the senator and ask him to introduce the bill.

Lots of people called. He introduced the bill the next day.

I had thought that was the end of our troubles, but no sooner had we begun to celebrate when we received word that one of the law enforcement associations had voted to formally oppose the bill (meaning they would send their lobbyist around to urge legislators to vote against it and would speak up against it during committees). So we reached out to our law enforcement allies and asked them to make calls to the police association members urging them to change their votes. Within 24 hours, after we had agreed to make a few changes to the bill, the association formally withdrew their opposition. Not only that, but several of their committee members joined our list of chiefs on record in support of syringe exchange programs.

Unfortunately, also within hours of that victory, we learned that our bill had been referred to the Rules and Operations Committee of the Senate. Even the mention of this committee brings shudders to even the most seasoned lobbyist. It is a graveyard for bills, the place they are sent when someone very high up the chain of command wants them to die. Discouraged once again, I stopped by the senator’s office to talk strategy. Immediately, I sensed something was wrong.

“Some members of the leadership are…nervous about this bill because of the controversy,” he said, without making eye contact. “I need to ask you to stop talking about the bill. Don’t meet with legislators. Don’t go to the media. Just stop what you are doing.”

I stared at him, gape-mouthed. “Stop?”

“Just keep it quiet,” he said. “We will find another way to get this through.”

“What other way?”

He hesitated. “Just another way.”

I suspected he was talking about adding language legalizing syringe exchange to the budget, where it would become law once the budget was signed. Legislators often add policy items to the budget when they don’t want to vote on them directly.

I didn’t quite know how to take the senator’s request. Do nothing? That was like asking me not to breathe. NC Harm Reduction Coalition and all our allies were so pumped about this, so ready to go. Plus there was the added fear that the senator was lying or that someone was lying to him. What if we stopped all advocacy efforts for weeks and then syringe exchange wasn’t in the budget after all?

It seemed risky, but we really didn’t have a choice. Continuing to push loudly for syringe exchange would upset our sponsor and potentially alienate other legislators we wanted to work with in the future. We had no choice but to do what was asked. So we put out the word to our allies: Stop. Wait. Hope.

A month later the preliminary budget came out. There was no language on syringe exchange.

At that point we had only three weeks left in the legislative session, so we went back to our original strategy of meeting with legislators and urging them to pass the bill. Each day became an endless game of bouncing between the House and Senate. Every senator I met with blamed the House members for refusing to put policy language in the budget. Every House member chided the Senate for not moving the bill through the regular committee process. Some days there would be a glimpse of hope, a legislator who appeared willing to help push the bill out of the insufferable Rules committee and into a committee where it could be heard and voted on. Other days I felt like a hamster on a wheel, running, running, but getting nowhere.

We entered the last week of session (before they all go home for a seven month break) still not knowing what was going to happen. We knew we had enough votes to pass the bill, if only it would budge. Five days left, four days left, three days, two …

Finally, I got a call from a representative’s office.

“Tessie?” said the sweet legislative assistant on the other line. “The representative wants to know if you will be in the judiciary committee at 10am.”


“Uh…because your bill is being heard.”

It was 9:40am and I was miles away from the legislature. I probably broke every traffic law getting there.

I arrived at committee to discover that our bill had been added as an amendment to another bill regulating the release of footage from police body cameras. The irony of this was not lost on me. The body camera bill (though opposed by many progressive organizations) was strongly supported by the law enforcement associations. That meant they had signed off on the syringe exchange language being added as an amendment. In just a few weeks they had gone from opposing syringe exchange to wrapping it in their own bill. Things do change.

Within 36 hours that bill sailed through committee, Senate vote, House vote, and onto the Governor’s desk with nary a whimper of protest. Governor McCrory signed it on June 11th 2016, stating as he did that he wouldn’t have expected to sign a law legalizing syringe exchange just a few years ago.

“It’s not the politically correct thing to do…but it’s the right thing to do,” he said to a crowd of law enforcement and reporters.

I am often asked why syringe exchange was legalized in North Carolina this year. We know how it was accomplished—years of grassroots education efforts, coalition building, strategic partnerships, plus a hefty dose of stalking lawmakers—but why now? Why after all these years of opposition did the right people finally listen?

We at NCHRC think it’s because people in power are starting to recognize the expense—both human and monetary—of the status quo approach to drug use.  Drug addiction is affecting them in a way it never has before. In meeting with legislators and law enforcement, I learned that many of them had children addicted to drugs and friends or family members who had died of an overdose. Cops are tired of arresting the same person three dozen times for the same crime. Legislators are tired of the criminal justice system sucking up so many resources with so little result. Slowly, the stigma against people who use drugs is breaking down and addiction is being seen not as a sign of weakness or criminality, but as a public health issue that can and should be addressed through education and strategic outreach. Legalizing syringe exchange in North Carolina certainly won’t solve the problem of drug use, eliminate HIV or eradicate the terrible stigma that causes people who use drugs to be treated as second class citizens, but it does prove one thing—change is possible even where you would least expect it.

Tessie Castillo is a writer and Advocacy and Communication Coordinator for North Carolina Harm Reduction Coalition. 


  • James S. Campbell, MD.

    Great work! This accomplishment will improve the health of thousands of North Carolinians directly, and everyone in the state indirectly.
    Jim Campbell MD
    Doctor of MEDesign