Richard Cusolito believes he’s saving lives by distributing clean syringes and needles to drug users in Elko, a rural northeastern Nevada region — but he knows some residents disagree.
“I was hated in this town for that,” said Cusolito, 60. I was accused of “getting an addict,” which is pretty much the standard term. People are not affected by the whole thing. “
Medications, including heroin and other opioids, are readily available in Elko, and Cusolito said programs like his have long been needed. Cusolito is a Peer Recovery Support Specialist and trained through Trac-B Exchange, a Las Vegas-based organization that provides a range of harm reduction services throughout Nevada.
In a city the size of Elko of 20,000 residents, jobs in Cousolito are already within reach. He helped his daughter, who died of a drug overdose earlier this year, get rehabilitation services.
“I just keep hopeful for those I can help,” he said.
Cousolito has been running the exchange program since 2020, when Elko City Council approved a resolution allowing him to distribute needles and syringes to the homeless in the city’s refugee camps. The agreement was originally for one year, but the council recently extended it for three years.
Elko officials’ approval of the work in Cousolito comes at a time when leaders of small, often conservative cities are being asked to adopt policies set in more liberal big cities like New York and San Francisco. federal report People who use needle-exchange programs are shown to be five times more likely to start a drug treatment program and three times more likely to stop using them than non-users, but programs in Nevada and other states are already facing similar pushback.
Scott Wilkinson, Elko’s assistant city manager, said the city has limited capacity to provide resources for drug users. “We’ve done our best to help, but we don’t have a health department,” Wilkinson said.
The Trac-B Exchange, which funds Cusolito’s project, reports to the city how many syringes and needles he distributes and collects for disposal.
Needle swaps are part of an effort known as harm reduction, which focuses on minimizing the negative effects of drug use rather than shaming people. In recent years, harm reduction strategies have begun to spread to rural areas, said Brandon Marshall, associate professor of epidemiology at Brown University’s School of Public Health.
Marshall says 2015 HIV outbreak due to drug use in rural Austin, Indiana, which became a “canary in the coal mine,” showing how sharing needles can spread the virus.Syringe replacement program could have avoided outbreak or reduced the number of infections, according to reports A modeling study co-authored by Marshall in 2019.
Cusolito is trying to prevent this disaster from happening in Elko. His small office is unobtrusive from the outside in a gray building off the main street near the city center. A “Trac-B exchange” sign was posted outside, but it did not identify the space as a syringe and needle exchange. However, Cusolito estimates he sees 100 to 150 people a month, relying on word of mouth.
He also toured prisons to help people charged with drug use complete the assessments needed to receive treatment at a rehabilitation facility.
He insisted that participants turn in used syringes and needles before changing them. The old ones are put into a sharp container — a sturdy plastic box — which he sends to the Trac-B Exchange in Las Vegas, where they are sterilized and shredded for safe disposal.
Trac-B Exchange’s harm reduction efforts also extend to other parts of rural Nevada: A peer rehabilitation support specialist runs a needle exchange program in Winnemucca, 124 miles from Elko, home to 8,600 people. In Hawthorne, which has fewer than 3,500 residents, leaders approved the installation of a vending machine run by the group, stocked with clean syringes and needles, as well as condoms, tampons and body wash. In 2019, the group installed two sharps containers in Erie, a city with a population of less than 4,000.
Trac-B Exchange program director Rick Reich said the organization has been providing services in rural areas to help people there use drugs more safely or find resources that allow them to become sober and stay sober. These services include assistance with obtaining identification, housing, and jobs.
“You’re trying to get a carrot that someone will go after,” he said, referring to clean needles and syringes. “Then when they come to you, get that carrot and eat that carrot, they can see that you have other things available and that you are not the horrible person they think you are in the nightmare they live in .”
In 2020, Nevada’s overdose death rate was 26 per 100,000 people, the 27th highest among states. Centers for Disease Control and PreventionThat year, more than 800 Nevadans died of drug overdose as the spread of covid-19 spurred stay-at-home orders and business closures.
In the seven years since the 2015 HIV outbreak in Indiana, seven states reportedly still do not have any syringe exchange programs. KFF analysisIn some states, harm reduction workers may face criminal penalties for carrying clean syringes or test strips to detect the presence of the synthetic opioid fentanyl, which is 50 to 100 times stronger than morphine.
Passed by the Nevada State Legislature a law In 2013, the syringe and needle exchange program was legalized so peer rehabilitation support specialists like Cusolito could do their work.
But that doesn’t mean that such efforts are always accepted.
Cusolito said he could put the nasty comments aside because he believed in the work he was doing. He recalled a client who had one of the worst heroin addictions he had ever seen. “I don’t think he’s going to survive,” Cusolito said. After contacting Cusolito and receiving treatment, the client returned to work, bought a home and got married. He still keeps in touch with Cusolito every few months to tell him about his latest achievements.
Clients with similar stories helped Cusolito keep going when the other challenges of the job weighed on him. The hardest part is losing customers.
“Sometimes I feel like I’m strong, like I can beat the world,” he said, “and other times, I think when I knock on the door, you know? I want to lock the door and let no one in, because I don’t want to deal with anyone who might die.”
KHN (Kaiser Health News) is a national newsroom that provides in-depth news coverage on health issues.Along with policy analysis and polling, KHN is one of the top three operating programs in the U.S. KFC (Kaiser Family Foundation). KFF is a donating non-profit organization that provides information on health issues to the state.
Photo: Sezeryadigar, Getty Images
