Richard Cuzzolitto believes he’s saving lives by handing out clean syringes and needles to people who use drugs in Elko, a rural area of northeastern Nevada, but he knows some residents disagree.
“I get hated in this town for that,” said Cuzzolito, 60. “They accuse me of ‘enabling junkies,’ is pretty much the standard term. People don’t understand the impact of this whole thing.”
Drugs, including heroin and other opioids, are readily available in Elko, and Cuzzolito said a program like his is long overdue. Cuzzolitto is a Peer Recovery Support Specialist and has received training through Trac-B Exchange, a Las Vegas-based organization that provides a range of harm reduction services throughout Nevada.
In a town the size of Elko, with 20,000 residents, Cuzzolito’s work hit close to home. He helped his daughter get rehab services, and earlier this year she died of an overdose.
“I just keep hope alive for those I can help,” he said.
Cuzzolito has run the exchange program since 2020, when the Elko City Council approved a resolution giving him permission to distribute needles and syringes at the city’s homeless encampment. The agreement was originally for one year, but the council recently renewed it for three.
Elko officials’ endorsement of Cuzzolitto’s work comes as leaders in small, often conservative cities have been asked to adopt policies forged in 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 enter drug treatment programs and three times more likely to stop using drugs than people who do not, but programs in Nevada and other states have faced similar repulsion.
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.
Trac-B Exchange funds Cuzzolitto’s project, and it provides reports to the city on how many syringes and needles it distributes and collects for disposal.
Needle exchanges 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 tactics have begun to spread to rural areas, said Brandon Marshall, an associate professor of epidemiology at Brown University’s School of Public Health.
Marshall said a 2015 HIV outbreak fueled by drug use in rural Austin, Indiana, became a “canary in the coal mine” showing how shared needles can spread the virus. A syringe exchange program could have prevented the outbreak or reduced the number of people infected, according to a modeling study that Marshall co-authored in 2019.
Cuzzolito is trying to prevent a similar disaster in Elko. His small office, in a gray building just off the main street near downtown, doesn’t attract attention from the outside. A Trac-B Exchange poster is posted outside, but it does not identify the location as a syringe and needle exchange. Still, Cuzzolito estimates he sees 100 to 150 people a month, relying on word of mouth.
He also visits prisons, helping people with drug charges complete the necessary evaluations to receive treatment at rehabilitation centers.
He is adamant that participants hand in their used syringes and needles before receiving new ones. The old ones go into a sharps container — a sturdy plastic box — that he ships to Trac-B Exchange in Las Vegas, where they are sterilized and pulverized for safe disposal.
Trac-B Exchange’s harm reduction efforts reach 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 operated by the organization that carries clean syringes and needles, as well as condoms, tampons and body soap. In 2019, the organization installed two sharps containers in Ely, a town of less than 4,000 residents.
Trac-B Exchange Program Director Rick Reich said the organization offers services in rural areas to help people there use drugs more safely or find resources so they can get and stay sober. Services include assistance in obtaining identity documents, housing and employment.
“You’re trying to get a carrot that someone will go after,” he said, referring to the clean needles and syringes. “Then when they come to you to get that carrot and eat that carrot, they can see that you have other things available and that you’re not the scary person they thought you were in the nightmare that they live.”
In 2020, Nevada’s overdose death rate was 26 per 100,000 people, 27th highest among states, according to Centers for Disease Control and Prevention. That year, as the spread of covid-19 spurred stay-at-home orders and business closures, more than 800 Nevadans died of overdoses.
Seven years after the 2015 HIV outbreak in Indiana, seven states still do not have any syringe exchange programs, according to analysis of KFF. 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.
The Nevada Legislature passed law in 2013, which legalized syringe and needle exchange programs so peer recovery support professionals like Cuzzolito can do their jobs.
But this does not mean that such efforts are always accepted.
Cuzzolito said he can put aside the nasty comments because he believes in the work he does. He recalled a client who had one of the worst heroin addictions he had ever seen. “I didn’t think he was going to survive,” Cuzzolito said. After contacting Cuzzolito and undergoing treatment, the client returned to work, bought a house and got married. He still contacts Cuzzolito every few months to tell him about his latest achievements.
Clients with stories like these help Cuzzolito move forward when other job challenges weigh on him. The hardest part is losing customers.
“Sometimes I feel really strong and like I can take on the world,” he said, “and other times I think about when they knocked on my door, you know? I want to lock the door and not let anyone in because I don’t want to deal with anyone else who might die.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polling, KHN is one of three major operational programs in the KFF (Kaiser Family Foundation). KFF is a charitable, non-profit organization providing information on health issues to the nation.
Photo: Sezeryadigar, Getty Images