On a below-freezing night in Cedar Rapids, three med school students meet in a parking lot and start unloading boxes from a crammed car trunk.
They sort through condoms, housing paperwork, fentanyl test strips, and vials filled with a drug that reverses opioid overdoses. There are booklets about safe injection practices, test kits for HIV and hepatitis C, and needles, syringes and cookers.
The first person to stop by is Dennis Brown, a former drug user who tries to help people who are still struggling with addiction.
“I try to give them clean needles and things, and I don’t encourage them to do it, but if they’re gonna do it, they’re gonna do it,” Brown says. “So I just try to give them a clean way of doing it.”
That’s the idea behind this illegal needle exchange, which is trying to prevent diseases among injection drug users while Iowa lawmakers consider a bill to legalize that kind of program.
Staff from the nonprofit Iowa Harm Reduction Coalition meet clients wherever they are to provide several services, including on-site blood tests for HIV and hepatitis C. Volunteers from a collective called Prairie Works sometimes join the nonprofit and give out clean needles and syringes to prevent the spread of those diseases. That’s the illegal part.
“I think handing out bags of them is a little too excessive,” says Tabitha, a client who joins the group in the parking lot. IPR is only using her first name because her meth use is illegal.
Tabitha is a bit skeptical of the syringe exchange for the same reason a lot of policymakers are—it can look like it’s facilitating, or even encouraging, drug use.
“But I mean at least we’re getting something out there that might be able to stop the hep C going around, the AIDS, the diseases that are being contracted from it,” Tabitha says.
She tells volunteers and clients gathered in the parking lot that she got hepatitis C at the age of 17, when someone forcibly injected her. She is one of many young Iowans who have contracted the disease from dirty needles in recent years.
Randy Mayer at the Iowa Department of Public Health says hepatitis C diagnoses among Iowans under 30 increased from 73 in 2009 to 347 in 2016.
“And when we see hepatitis being diagnosed among people who are under the age of 40 or in some states under the age of 30, it’s an indication there’s active needle sharing going on,” he says.
Mayer says that is a direct result of increasing opioid use in the state, as well as ongoing meth use.
Because of these trends, Iowa recently got permission from the Centers for Disease Control and Prevention to use federal funding to support a syringe exchange. It is now up to the Iowa Legislature to decide whether to allow such a program. More than 30 states have legalized distribution of needles within approved exchange programs.
Mayer says he encourages Iowans to wait for a law change before they start illegally handing out clean needles. He says legal syringe exchange programs have been successful in many other states.
“We actually do have good data about that,” Mayer says. “So you don’t see increases in drug use. What you generally see are decreases in disease transmission.”
Back in Cedar Rapids, the volunteers leave the parking lot and stop by a homeless shelter.
Iowa Harm Reduction Coalition Executive Director Sarah Ziegenhorn pricks a client’s finger, drawing blood.
“I got tested for HIV and hep C which came back negative, which I knew they would,” says Buzz, who also picked up an overdose reversal kit and some clean needles. “It cuts down on diseases. Educates people. A lot of people don’t know, hey just use them once then throw them away. Don’t sharpen them on a matchbook.”
Another client, who was accidentally stuck with a used needle at the shelter, excitedly pumped his fists in the air when his blood test came back negative for hepatitis C.
By the end of the day, Ziegenhorn had stopped at a motel to help a couple with housing paperwork, stood in a freezing parking lot to hand out harm reduction supplies, and spent time at a shelter to test people for infectious diseases.
“And we had conversations with folks around ways to prevent and reduce the risk of overdose with naloxone, aka Narcan,” Ziegenhorn says.
On the drive back to Iowa City, Ziegenhorn says syringe exchange programs can provide all of these services, with the ultimate goal of getting clients into drug treatment.
“Rather than being an opportunity to encourage or celebrate drug use in any way, they just accept the nature of what drug use can be and can look like for individual people and try to take a holistic perspective of people’s health,” she says.
Ziegenhorn has been lobbying government officials to legalize distribution of needles and syringes for programs approved by the public health department.
“They’ll be able to run a program that has greater reach, but that also is able to offer people services that are more professional and legitimate than those that are offered out of the back of a car,” Ziegenhorn says.
Mayer says legal syringe exchanges might operate out of local public health departments, which already have staff who provide services to people with substance use disorders.
Legalization would also open up avenues for funding. Prairie Works, the collective that gives out syringes, currently relies on donations from syringe exchange groups in other states and from an online fundraising page.
As long as Prairie Works’ distribution of needles remains illegal, the group depends on how local police respond to them in individual cities. Law enforcement agencies in other states have supported syringe exchanges because they help keep dirty needles off the street.
A bill in an Iowa Senate subcommittee would decriminalize distribution of needles and syringes for approved needle exchange programs.
Dale Woolery, interim director of the Governor’s Office of Drug Control Policy, says he was not aware of illegal needle exchanges in the state. He says his office will wait to offer an opinion on these programs.
“We’re kind of in a listen and learn mode, ourselves,” Woolery says.
Meanwhile, the network of volunteers distributing syringes and other services continues to grow across the state. Groups currently operate in Cedar Rapids, Des Moines and Iowa City, with plans to expand into northern and western Iowa.