It’s about 2 p.m. on a Friday, an hour before closing time, and soon a stream of clients will try to squeeze into the lobby of Trac-B Exchange, the first storefront syringe exchange in Southern Nevada.
Dan, a 46-year-old Las Vegan who declined to provide his last name for privacy reasons, knows other heroin users who’ve contracted hepatitis from sharing needles, so he tries to be careful.
He beats the rush to get fresh ones this day, along with naloxone, the opioid overdose reversal medication.
Though he’s only been visiting the location for two months, his story is an emphatic advertisement for Trac-B’s mission as the group expands its outreach efforts across the state.
Naloxone obtained from Trac-B has been administered to him in three instances, reversing potentially fatal overdoses.
“It’s saved my life at least three times,” he said. “I’ve never been to anything like this.”
Tucked away in a shopping center near Charleston and Jones boulevards, Trac-B Exchange offers HIV and Hepatitis C testing, naloxone, needles and syringes, vaccinations, meetings for sex workers and a host of other services and products.
The organization, which has a nonprofit arm, made a splash in the public spotlight in 2017, when it first partnered with the Southern Nevada Health District and NARES (the Nevada AIDS Research and Education Society) to place syringe vending machines in three locations around town. The machines distribute up to 30 syringes a week per person and items like safe sex kits to adults who register at the Trac-B office. They’ve since expanded to two additional spots around Southern Nevada.
Christina Parreira, a sex worker and UNLV doctoral student in sociology, coordinates sex work harm reduction services for Trac-B.
She said staff are proactive about discussing with clients their usage of naloxone, and from those conversations, they gather data on overdoses reportedly reversed by the packages they’ve distributed. They count 175 lives saved.
“It makes me feel great. Some of the community, they don’t see these as lives worth saving,” she said.
This year has been a busy one for Trac-B as the group raises funds to continue its work tackling drug abuse and unsafe injection practices across the state.
The U.S. Congress in December 2015 cleared the way for federal health money to fund certain aspects of syringe exchange programs. The Centers for Disease Control and Prevention requires jurisdictions to prove their areas are “experiencing or at-risk of significant increases in Hepatitis infection or an HIV outbreak due to injection drug use” in order to be eligible for those funds. Nevada is one of 38 states and several other jurisdictions to do so.
However, fundraising remains vital for places like Trac-B because while federal money can be used to support some expenses, it cannot be used to purchase the actual needles or syringes.
Though the core staff at Trac-B is no more than seven members, they’ve managed to distribute more than 1 million needles in the two-and-a-half years they’ve been open.
A GoFundMe page Parreira created in April to help with costs has raised more than $1,100.
Meanwhile, grants provided through the Center for the Application of Substance Abuse Technologies as well as the Nevada Division of Public and Behavioral Health have helped Trac-B kickstart its 2019 expansion of services. In January, Trac-B began shipping syringes and other harm reduction materials across Nevada while ensuring used ones can be shipped back in a legal manner.
A peer mentorship facility is also nearly open. The mentors have been working since July, but the facility designated for the program is expected to open this month adjacent to the main Trac-B office.
Marlo Tonge, communicable disease manager at the Southern Nevada Health District, praised the exchange for its approach to addiction. She said programs like peer mentorship are the future of addiction recovery.
“These individuals can help people navigate getting sober and what that looks like,” she said. “In the past we would give people tools and say, ‘Ok you’re good,’ and we’d cross our fingers and hope they’d get there.”
Trac-B staff are working closely with the Southern Nevada Health District and officials in rural Nevada to try to place two vending machines and return receptacles in rural towns.
Tonge said rural outreach will require patience and heavy dialogue with the communities to ensure some of the same fears syringe exchanges often elicit are allayed.
“Some of the same dialogue that you would hear here, ‘Oh, there’s going to be more needles, oh you’re going to encourage people to do drugs,’ you’re going to hear in the rurals,” she said.
But all of the services provided by Trac-B are based on the principles of harm reduction, a growing public health approach to drug use.
“We’re not going to eradicate drugs,” said Todd Edwards, program manager of the Community Involvement Center at WestCare Nevada. “We’ve been trying to since the ‘80s. We have to try something new. We have to try something different.”
That different path doesn’t mean turning a blind eye to drug use, said Edwards, whose Nevada behavioral and mental health organization also offers harm-reduction services.
He calls it a more practical approach to drug abuse that addresses a person’s overall well-being rather than focusing solely on drug abstinence. It also tackles related societal concerns like the spread of disease and crowding of criminal justice facilities connected to drug use.
“Even if you’re not in treatment, it gives you another day to start thinking about it,” Parreira said.
Of the nearly 9,200 Nevada inhabitants living with a diagnosed HIV infection in 2016, 15.5 percent of male cases and 21.8 percent of female ones reported injection drug use, according to the public health partnership AIDSVu.
Injection drug users who share needles are also at risk of contracting hepatitis.
Trac-B offers testing for HIV and Hepatitis C as well as vaccinations.
“They go out and connect with populations that a lot of people don’t go out and work with,” Tonge said. “To me, that’s the best public health work.”