When I was 19, living in New Jersey and injecting drugs, I found out that I had hepatitis C. All of my friends learned that they had it too, after one of them got tested in jail. We had been sharing needles. It was devastating news to me, as I knew nothing about the disease. I thought it was a death sentence.

    I was also impacted by stigma. I was scared to tell my girlfriend and embarrassed in front of my family. The guilt and shame I experienced from having hep C greatly contributed to my using drugs addictively for several more years, and made coping with emotions in early recovery nearly impossible.  

    Finally, in 2014, after 10 years of living with hep C and three years recovered from addiction, I obtained health insurance that paid for the then-new drug Harvoni. I took one pill a day for 90 days and it saved my life.  

    My treatment cost somewhere in the ballpark of $100,000. A sterile syringe could have cost about 10 cents.

    When I was using drugs, the only way to get a syringe that I knew of was to buy it on the street from the same people selling the drugs. They sold them for $5 each. But either we wouldn’t have the extra money or there wouldn’t be any for sale, in which case my friends and I would share. It’s maddening to think now of how much damage hepatitis C caused in our lives, and how it could have been prevented with a few pennies.


    Overcoming Cultural Obstacles

    About three years ago, having long been in recovery and having worked in the addiction field, I started looking at the situation where I currently live, in Greenville, South Carolina.  

    I found out that pharmacies here rarely sell syringes without a prescription, and that there were no formal syringe exchange programs in the entire state. South Carolina is one of the leading states for new cases of hep C. It was then that I decided to start my own syringe program.

    South Carolina is a Red state with a church on every corner, and some consider Greenville, located in its northwest corner, to be the center of the Bible Belt. This is a place where sex education is still controversial. Greenville is home to Bob Jones University, a well-known evangelical and conservative institution, with a history of racism.  

    As well as anticipated community pushback, I had to consider the possibility of legal action. South Carolina’s relevant laws are somewhat ambiguous (syringe distribution is allowed for “legitimate medical purposes,” but there is no specific reference to exchange programs).

    Many people have been kind. A local pharmacy donated a few hundred syringes. A doctor gave me a box of sharps containers.

    With all this in mind, I set out to learn, research, network and discover ways to accomplish my mission. I asked the advice of my mentor, who works for a program in Asheville, North Carolina, about an hour north of here. He had been operating a syringe exchange there for almost 20 years before it became legal. His advice was to prioritize gaining community support. So far, his suggestion has been fruitful.  

    Many people have been kind. A local pharmacy donated a few hundred syringes. A doctor gave me a box of sharps containers. The local AIDS organization donated condoms, cookers and educational materials. Thanks to all of the donations I received then and since, it probably cost me only about $300 to get the program started.

    A look of appreciation came over their faces. It was a magical experience.

    It started in 2017 with just me, handing out these donated supplies from the trunk of my car in a gas station parking lot, in a Greenville neighborhood where I knew many people were injecting drugs. Initially, people were hesitant to engage with me, especially out in public, but a few of them actually took what I was giving out.  

    It was interesting to watch their reactions when they realized what I was doing. They had never seen or heard of a syringe exchange before. When they saw that I wasn’t judging them for taking the syringes and was simply offering them help for free, a look of appreciation came over their faces. It was a magical experience and is still my favorite part of the job.

    I continued showing up on Fridays for several weeks to give out my services, and it grew from there. The nonprofit program, which I named Challenges, Inc, now operates daily and has a team of volunteers that distribute to that area on a daily basis. I also have peer distributors in different towns who help out. It’s great to have so much help, although running the operation now takes more administrative time and organizational skills than I imagined.

    Today, Challenges, Inc is mostly a mobile service. People contact us and we decide on a place to meet. I make deliveries all over the area, usually meeting in business parking lots. For people who are too far away to drive, I mail the supplies to them instead (another area in which laws can be ambiguous).


    An Inspiring Response

    A few months after opening, I was featured in South Carolina’s largest newspaper, the Post and Courier. The story brought lots of attention and to my surprise, it was mostly positive. Many people posted about it on social media, and for every person who attacked the idea, there would be two more who showed their support. Local news has continued to be supportive, and with each story, Challenges, Inc gets a little more funding for supplies and harm reduction awareness spreads.

    I was amazed at the community response.  It seemed like people were so tired of hearing about the “opioid epidemic” that they were willing to try something that might have seemed to them outlandish (although evidence for the efficacy of syringe exchange is long established).

    I hear stories of people using the same syringe for over four weeks or more.  

    Ever since, I have continued operating South Carolina’s one and only formal syringe services program. We offer clean syringes and other drug-using supplies, along with naloxone and treatment resources. We have partnered with several treatment providers in the local area who are willing to work with my participants. We have also made connections with ancillary services to provide food, clothing, HIV and hep C testing, medical care and more.

    The people we serve come from all demographics. What they have in common is a lack of access to clean syringes, which forces them to share needles and use old ones repeatedly. I hear stories of people using the same syringe for over four weeks or more.  

    We have 24 overdose reversals reported to date. That’s 24 families who still have their child, parent, or loved one in their lives. As a person who has experienced the loss of a loved one, this is all the feedback I need to continue doing this work.

    I set up a website and a Google listing for people to find Challenges, Inc. The NASEN syringe exchange directory has also been extremely helpful.  It turns out, a lot of people do Google searches for “syringes near me.” Most people either find Challenges that way or by word of mouth. Once we got some attention online, other harm reduction coalitions started sending me naloxone and other supplies. The support from the harm reduction community has been unbelievable.

    When you show people how to take care of themselves, they start to believe that they are worth taking care of.

    Strangely enough, the people who have given me the most pushback have been my closest friends. At first, they were confused as to why I was doing this work and seemed uncomfortable with the thought of me handing out syringes on the street. IV drug use, blood-borne disease and overdose are not easy topics for most people to talk about. Slowly though, they have become more accepting.

    My biggest fear has been the police. Since the laws are unclear, I am never quite sure what will happen. Will I get arrested one day while handing out supplies? Will the cops see me on the news and come find me? I picture them breaking down my door and confiscating my supply of naloxone. Luckily, I have an attorney who supports the cause and is willing to represent me pro bono if I have a problem. So far, I have not had to use his services.

    The people I serve are what keep me going. This work helps to empower a population that often thinks very low of itself. It’s like they think that since they are using drugs, they are supposed to feel like shit. The stigma caused by drug prohibition is responsible for this—but harm reduction can reverse it.

    When you show people how to take care of themselves, they start to believe that they are worth taking care of. It’s a process that I went through myself.

    Photo via Wikimedia Commons

    • Marc Burrows, MSW, LMSW, CPSS, is a former IV drug user; founder of the first syringe service program in South Carolina, Challenges Inc; and currently the chair of the South Carolina Harm Reduction Coalition. In his work, Marc advocates for drug policy reform and expanded access and reduced thresholds for evidence-based interventions including syringe services and medications for opioid use disorder. He lives in Greenville, South Carolina.

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