Harm reduction in North Carolina

In North Carolina syringe exchanges are currently illegal and several people have been arrested because of it. Robert Childs is the Executive Director of the North Carolina Harm Reduction Coalition (NCHRC). The NCHRC advocates a change in law in North Carolina believing that the use of harm reduction is the way forward. Currently the only form of harm reduction done by the state of North Carolina is condom distribution.

Robert Childs, MPH, who was recently named by "The Body" as one of five people who made a difference in HIV in the USA, has worked in harm reduction for 10 years in Oregon, New Hampshire, New York and North Carolina.  Most recently Robert has served as the Executive Director of the North Carolina Harm Reduction Coalition and as the Program Director of Positive Health Project in New York City. 

Robert speaks frequently at national conferences, city councils, state legislatures, the United Nations, NGOs and to the media about Syringe Exchange, Syringe Decriminalization, Safe Injection Sites, HIV, Viral Hepatitis, the Negative Effects of the Drug War, Drug Use in the American South, and Sex Worker Issues in the American South.

Robert has also led research teams that investigated injection drug use in public venues and how injection drug user relations with law enforcement effects their HIV/hepatitis/overdose related risk behaviors. Robert lives with his wife Paige, their baby Abraham and dog Baylah in Chapel Hill, NC.

Which states currently have a similar policy to North Carolina?

The American South (the Southeastern Quadrant of the US) features a lot of laws on syringe possession similar to North Carolina’s (NC).  These laws ban or make syringe exchange near impossible, hence there are no legal syringe exchange programs in the American South.  There are multiple underground programs in the American South in North Carolina (5), Tennessee (1), Georgia (1), Florida (1) and Louisiana (1) and a couple advocates are looking at starting some in Mississippi and Arkansas.  

North Carolina has a long history resisting the law and doing underground syringe exchange, but this has lead to 5 people being arrested for syringe exchange in the last 2 years.  The lack of syringe access has led to the American South having the most new HIV infections out of any area in the United States.  Unfortunately, it also has the least resources and hence its people struggle mightily once they gain HIV infection. 

For reference, North Carolina’s law is structured as follows:

90-113.22. Possession of drug paraphernalia.

(a) It is unlawful for any person to knowingly use, or to possess with intent to use, drug paraphernalia to plant, propagate, cultivate, grow, harvest, manufacture, compound, convert, produce, process, prepare, test, analyze, package, repackage, store, contain, or conceal a controlled substance which it would be unlawful to possess, or to inject, ingest, inhale, or otherwise introduce into the body a controlled substance which it would be unlawful to possess.
(b) Violation of this section is a Class 1 misdemeanor.

90-113.23. Manufacture or delivery of drug paraphernalia.

(a) It is unlawful for any person to deliver, possess with intent to deliver, or manufacture with intent to deliver, drug paraphernalia knowing that it will be used to plant, propagate, cultivate, grow, harvest, manufacture, compound, convert, produce, process, prepare, test, analyze, package, repackage, store, contain, or conceal a controlled substance which it would be unlawful to possess, or that it will be used to inject, ingest, inhale, or otherwise introduce into the body a controlled substance which it would be unlawful to possess.
(b) Delivery, possession with intent to deliver, or manufacture with intent to deliver, of each separate and distinct item of drug paraphernalia is a separate offense.
(c) Violation of this section is a Class 1 misdemeanor. However, delivery of drug paraphernalia by a person over 18 years of age to someone under 18 years of age who is at least three years younger than the defendant shall be punishable as a Class I felony.

The federal government after two decades started funding needle exchanges in 2009 has that had any impact on North Carolina’s policy?

None, NC does not allow syringe exchange and thus we can not take federal funds.

Do you believe that the political environment in North Carolina makes it possible for syringe exchange programs to be legal in the future?

I think this is extremely unlikely that a syringe exchange specific bill would pass without a large infusion of resources to a campaign.  There is a lot of stigma in the American South associated with Syringe Exchange.  People believe it encourages drug use, even though it is proven to not do so.

In North Carolina we have had multiple bills that went nowhere trying to legalize them. Thus we decided to focus on something more progressive, which is to decriminalize all syringes from an angle of law enforcement safety. 

In the US, 1 out of 3 officers get needlesticks and 28% get multiple sticks when syringes are criminalized.  We know if you decriminalize syringes or partially decriminalize syringes we can decrease needlesticks by 66%.  Thus we are pushing for a law enforcement safety act and have successfully advocated to get legislation for it introduced (NC House Bill 601).  

Southerners love their law enforcement, so we are pushing for a law enforcement safety initiative, which will save officer lives, and indirectly will also help drug users and diabetics access and carry syringes without legal consequence. This angle would allow all users to carry syringes without of fear of legal consequence.  So users could get syringes anywhere (pharmacies, friends, etc.) and use them as necessary without consequence.   It is important to go via the law enforcement angle though because legislators are more likely to meet with you and support legislation that is pro-law enforcement.

Syringe Decriminalization is an important thing to do because most states just partially decriminalize syringes by having a syringe exchange exception and to have the exception you had to have a syringe exchange card or you could be arrested for carrying syringes.  If law enforcement were below their quota for arrests they commonly will line up people in front or near a syringe exchange and arrest them all for syringe possession with drug residue and “misplace” people’s cards.  It was a big problem when I worked at a Syringe Exchange in NYC.  Thus we are looking to avoid this with flat out syringe decriminalization.

What are the obstacles facing a change in the law? (E.g. is there a lack of public

Our major obstacles are a lack of knowledge about the benefits of syringe decriminalization, drug user stigma, law enforcement fear, legislative buy in and a lack of coverage over: how big an issue officer needlesticks are, drug user risk reduction, HIV in NC and viral hepatitis in NC.

What impact is the law having on HIV and Hepatitis C rates in North Carolina?

We are seeing more HIV and HCV infections.  The law leads individuals to share the syringes that are in circulation, which leads to the spread of HIV and viral hepatitis.  We are also seeing a lot of people with abscesses and collapsed veins due to the sharing of used and damaged syringes, leading them to frequent Emergency Room visits (where tax payers need to pick up the tab).

How do the authorities enforce the ban on needle exchanges?

They threaten arrest and taking ones funding away.  There have been 5 arrests in the last 2 years for people doing Syringe Exchange in North Carolina. 

Do you believe that the fact syringe exchanges are illegal makes drug users less likely to use underground syringe exchange programs?

Absolutely, especially since 4 of the 5 underground programs here don’t advertise their services, so if you don’t the underground exchangers, you won’t be able to get a needle.  Also, a lot of people who access the underground won’t take as many syringes as they need due to the fear of arrest.

What harm reduction policies (if any) does the North Carolina state current employ? If so what is the state reasoning for allowing these policies yet not allowing cost effective syringe exchanges?

The only state sponsored harm reduction program is condom distribution.  The state will only fund legal initiatives.

What are you as an organization doing in terms of advocacy and harm reduction in North Carolina?

North Carolina Harm Reduction Coalition has done the following advocacy to get syringe decriminalization legislation passed in North Carolina:


  • We have met with 200 legislators over the last 2 years discussing our issues
  • Successfully advocated for House Bill 601 to decriminalize syringes in the NC Legislature.
  • Successfully gotten bi-partisan support on our issues
  • Trained members of 17 law enforcement departments across North Carolina on the benefits of syringe decriminalization, how to advocate for syringe decriminalization and drug user and sex worker sensitivity.
  • Successfully gotten law enforcement to advocate for our issues at the legislature
  • Got human rights violations of drug users and sex workers in North Carolina documented by human rights watch and issued a policy brief.
  • Successfully worked with AMFAR to feature southern law enforcement voices in its law enforcement syringe exchange fact sheets so they were practical in the US South
  • Got 37 news sources to cover our issues over 2011
  • Held 111 public trainings on the importance of syringe decriminalization across North Carolina
  • Engaged in over 400 legislative advocacy events (legislative visits, legislative teach–ins, etc)
  • Held a drug policy summit on syringe decriminalization and other drug policy issues for the South, which was attended by southern drug users, law enforcement, public health officials and legislators
  • Built an effective social media campaign
  • Started online petition to change the law

North Carolina Harm Reduction Coalition provides the following harm reduction programs and services:


  • Syringe decriminalization, syringe exchange and overdose prevention advocacy
  • Overdose Prevention Programming
  • Transgender, drug user and Hepatitis C support/advocacy groups
  • HIV and Hepatitis C counseling, rapid testing and referral services
  • Law enforcement needlestick reduction advocacy
  • Neighborhood biohazard cleanup
  • Free workshops and training on: Protecting Police and Public Servants from Needlesticks, Harm Reduction, Drug Use Risk Reduction, Hepatitis, HIV, Overdose Prevention, SEPs, Working with People of Transgender Experience, Working with Migrant/Farm Workers, Biohazard Collection and Working with Sex Workers
  • Harm Reduction outreach and services
  • Prison and Jail based harm reduction services (educational and support groups on safer use)
  • Support Groups
  • Safer sex education, including utilization of the reality condom (aka the female condom)
  • Referrals to drug treatment, health services, mental health services, sexual assault support agencies, domestic violence support services and AIDS service agencies

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