A needle exchange project modeled on urban efforts aims to save rural lives

Elko, Nev. — Richard Cusolito believes he’s saving lives by distributing clean syringes and needles to people who use drugs in this rural area of ​​northeastern Nevada — but he knows some residents disagree.

“I hate this town,” said Cusolito, 60. “I’ve been accused of ‘enabling junkies’, that’s almost a common term. People don’t get the effect of this whole thing.”

Drugs, including heroin and other opioids, are readily available in Elko, and Cusolito said a program like his has been needed for a long time. Cusolito is a Peer Recovery Support Specialist and trained through Track-B Exchange, a Las Vegas-based organization that provides a range of harm reduction services throughout Nevada.

In a city the size of Elko, with 20,000 residents, Cusolito’s work hits close to home. She helped her daughter access rehab services, and earlier this year, she died of an overdose.

“I just hope for the people I can help,” he said.

Cusolito has been running the exchange program since 2020, when the Elko City Council approved a resolution allowing him to give needles and syringes to city camps for homeless people. The contract was originally for one year, but the council recently renewed it for three years.

Elko officials’ approval of Cusolito’s work comes as leaders in smaller, often conservative cities are asked to adopt policies that mimic larger, more liberal cities like New York and San Francisco. Federal reports show that people who use needle exchange programs are five times more likely to start a drug treatment program and three times more likely to stop using drugs than those who don’t, but programs in Nevada and other states have faced similar pushback.

Scott Wilkinson, Elko’s assistant city manager, said the city’s ability to provide resources to people who use drugs is limited. “We’ve done what we can to try to help, but we don’t have a health department,” Wilkinson said.

Track-B Exchange funds Cusolito’s project, and he provides reports to the city about how many syringes and needles he distributes and collects for disposal.

Needle exchanges are part of an effort known as harm reduction, which focuses on reducing 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 School of Public Health.

Marshall said the 2015 HIV outbreak fueled by drug use in rural Austin, Indiana, has become a “canary in the coal mine,” showing how shared needles can spread the virus. A syringe exchange program could avoid outbreaks or reduce the number of people infected, according to a modeling study Marshall co-authored in 2019.

Cusolito is trying to prevent that kind of disaster in Elko. His small office, in a gray building just off the main street near downtown, is unremarkable from the outside. A “Track-B Exchange” placard is posted outside, but it does not identify the location as a syringe and needle exchange. Yet Cusolito estimates he sees 100 to 150 people a month, depending on word of mouth.

He visits jails, helping people indicted on drug charges complete evaluations needed for treatment at rehabilitation facilities.

A photo shows a needle disposal box and a waste bin  The waste bin, on the left, has a sign that reads, "No bags please!  Containers or bottles only."
Used syringes and needles are returned to Richard Cusolito, who places them in a secure disposal box.(Jazmin Orozco Rodriguez/KHN)

He is adamant that participants turn in their used syringes and needles before receiving a transplant. The old ones go into a sharps container — a sturdy plastic box — that he ships to the Track-B Exchange in Las Vegas, where they’re sterilized and pulverized for safe disposal.

Track-B Exchange’s harm reduction efforts have reached other areas of rural Nevada: A peer recovery support specialist runs a needle exchange program in Winnemucca, 124 miles from Elko and home to 8,600 people. In Hawthorne, which has fewer than 3,500 residents, leaders approved the installation of a vending machine that is operated by the agency and carries clean syringes and needles, as well as condoms, tampons and body soap. In 2019, the company installed two sharps in Ely, a town of less than 4,000 inhabitants.

Track-B Exchange Program Director Rick Reich said the organization is offering services to help people in rural areas use drugs more safely or find resources so they can get and stay sober. Services include assistance with obtaining identification documents, housing and employment.

“You’re going after someone who’s trying to get a carrot,” he said, referring to clean needles and syringes. “Then when they come to you, to get that carrot and eat that carrot, they see you have other things available and you’re not the scary person they thought you were in the nightmare they’re living.”

In 2020, the overdose death rate in Nevada was 26 per 100,000 people, the 27th-highest among states, according to the Centers for Disease Control and Prevention. That year, more than 800 Nevadans died of overdoses, as stay-at-home orders and businesses closed as a result of the spread of Covid-19.

Seven years after the 2015 HIV outbreak in Indiana, seven states still have no syringe exchange programs, according to a KFF analysis. In some states, harm reduction workers can face criminal penalties for carrying clean syringes or strips that detect the presence of the synthetic opioid fentanyl, which is 50 to 100 times stronger than morphine.

Nevada’s legislature passed a law in 2013 that legalized syringe and needle exchange programs so peer recovery support specialists like Cusolito could do their jobs.

But this does not mean that such efforts are always accepted.

Cusolito said he can keep the nasty comments at bay because he believes in the work he’s doing. He recalled a client with the worst heroin addiction he had ever seen. “I didn’t think he would survive,” Cusolito said. After connecting with Cusolito and undergoing treatment, the client went back to work, bought a house, and got married. He still checks in with Cusolito every two months to update him on his latest accomplishments.

One photo shows Richard Cusolito posing for a portrait while at his desk.
Richard Cusolito has run a syringe and needle exchange program in Elko, Nevada since 2020.(Jazmin Orozco Rodriguez/KHN)

Clients with stories like these keep Cusolito going when other challenges at work weigh on him. The hardest part is losing clients.

“Sometimes I feel really strong and feel like I can beat the world,” she said, “and other times I worry about when I get a knock on the door, you know? I want to lock the door and not let anyone in because I’m someone else’s.” Don’t want to deal with someone who might die.”

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