How A Palm Beach County Needle Exchange Program Is Addressing Rise In Drug Overdose Deaths
TW: Mentions of drug use, addiction, suicide
There is a nationwide spike in drug overdose deaths. The Centers for Disease Control and Prevention says that, as of May 2020, the number is the highest amount of overdose deaths ever recorded in a 12-month span.
A nonprofit syringe needle exchange program, approved unanimously by Palm Beach County commissioners last year, says “the pandemic has played a role in the spike.”
“People had established certain routines that helped them maintain positive wellness,” said Justin Kunzelman, who co-founded Rebel Recovery Florida with Nancy McConnell. “A lot of places weren't ready to provide digital services.”
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The CDC says synthetic opioids like fentanyl drove the nationwide increase in drug overdose deaths during the early months of the pandemic — followed by psychostimulants like cocaine. According to preliminary data from 2020, overdose deaths could exceed 90,000, compared to more than 70,000 people who died in 2019.
Kunzelman — who was once homeless himself — says unemployment, social distancing, and isolation make life more difficult for many drug users but “people use drugs for all sorts of reasons. Constantly.”
The context behind the spike in drug use is a little more complicated. Needle syringe-exchange programs are one of many ways to reduce overdose deaths, provide human services, and de-stigmatize getting help and Kunzelman says participation in syringe programs for some populations reduces overall drug use.
"It's more about providing services that recognize complex personhood and recognize personal autonomy and shows up for people as people," he said. "I founded Rebel [Recovery Florida], and most of our programs, because at one time I needed those programs and they didn't exist."
Jobs and business closures exacerbated the spike in opioid overdoses, which began before the pandemic. John Hulick leads the opioid response strategies for the county's Office on Substance Use Disorders.
“In sum, there was a 26% increase in first quarter opioid overdose deaths from 112 in 2019 to 141 in 2020,” Hulick said. “And, a staggering 79% increase in the second quarter from 91 in ‘19 to 163 in ‘20.”
He cited the county’s overdose response trend analysis, through March 2021, and said the analysis uses data provided by Palm Beach Fire Rescue and the county's Medical Examiner's Office.
The data don't show the full picture but, in Palm Beach County, “overall, there was a 27% increase in deaths from 446 in  to 565 in .”
“On a good note, suicides were reported down year over year by 32% according to the [medical examiner],” Hulick said.
Kunzelman, a husband and father of two who was raised in the Glades area, says one public health approach should include hiring people who use drugs as consultants for overdose prevention strategies — alongside funding more essential services.
The Benefits Of Needle Exchanges
Kunzelman says aside from potentially saving hospitals millions of dollars, there are several unspoken societal and health benefits to syringe exchange programs.
“A benefit to a syringe exchange program is often the reduction of infectious diseases like HIV and viral hepatitis,” Kunzelman said.
Currently the program only runs through a mobile unit, a 25-foot passenger bus that features certified recovery peer support.
Their service area throughout the county is based on an overview of reported overdose incidents — area codes with the highest per capita rate of new HIV infections based on the county’s latest data.
Currently, Rebel serves the downtown Lake Worth area, Delray Beach, Riviera Beach, West Palm Beach, the Glades area, and other western parts of Palm Beach County.
Kunzelman said the nonprofit is in the middle of implementing medical services in partnership with the University of Miami, Florida Atlantic University, and the Palm Beach County Medical Society.
He also noted that people in needle exchange programs “are more likely to enter into some type of personal program of recovery or to seek out recovery support or treatment services.”
To reduce opioid overdose deaths, the 2020 annual report from the statewide Drug Policy Advisory Council recommends the expansion of drug interventions like access to Naloxone, Medication-Assisted Treatment (MAT), prescription drug disposal programs, syringe exchange programs, and reducing prescribing opioids for acute pain.
Kunzelman also raised some alarm about changes he's seen in community usage. He points to a demographic shift from white, middle-income and lower-income communities to BIPOC communities.
“Society is unprepared for the rise in stimulants used in BIPOC communities,” Kunzelman said.
Building trust with people in all of the communities, especially the homeless, requires a level of trust that is only present through genuine rapport and lived experiences.
Kunzelman says Rebel is very aware of not "imposing their will” on the people they serve.
“We were them,” he said, speaking about his own experiences. "I don't wear a badge and a suit to work. I wear the same thing I wore when I was a homeless punk kid on the street, you know what I mean?”
“Just a little cleaner now.”