The Louisville Metro Syringe Exchange is set to open at 3 p.m. Not 2:58. Not 2:59. Open the door, peek your head in, beg for service early because of work or a flight out of town — no luck. On this bright and steamy June afternoon, doors open when the clock stiffens its posture into a perfect 90-degree angle. Such rigidity can spark tempers. Matthew La Rocco, who runs the exchange, endures occasional rants. “That’s just wrong, man!” one flustered visitor argued. But La Rocco has his reasons — enforcing boundaries, clients working through frustration and reconciling anger. “It’s teaching them good recovery principles and they don’t know they’re being taught,” he says in a rare moment between clients.
Let’s take a step back, though. The exchange, which marked its one-year anniversary in June, isn’t a recovery or treatment center. Its intent is to take in used needles, pass out clean ones, prevent the spread of blood-borne diseases and educate folks about how to sober up if they’re ready. (The exchange also offers hepatitis C and HIV testing. In the first year, it tested close to 700 people for the diseases and referred 203 for hepatitis C treatment, 10 for HIV treatment.)
While La Rocco is strict about certain rules, once inside the large white van stationed outside the Metro health department’s downtown office, he has the gentle, outgoing demeanor of a pastor (which he is) and the patience of a substance-abuse counselor (which he is). It’s rare that any arm of the government is prone to hugs. But La Rocco’s known to offer an embrace to those who really seem to need it. Like when a young, tired woman’s round and sunken eyes tear up as she talks about an accidental overdose that led to a miscarriage. “I feel so guilty,” she says. “I want to get clean.” La Rocco hands over his business card. “Call me anytime. We’ll talk.” Then: “Can I give you a hug before you leave?”
From the outside, the former mobile dental van is clinical, with its pictures of smiling mothers, nurses and children plastered on the sides. From TV news cameras, it can look suspicious. “Taxpayer-funded syringes!” cried a WAVE-3 news investigation last fall. From the inside, it’s wholly un-sinister, almost disarmingly so. There’s a snug lobby area with blue waiting chairs and brochures advertising treatment. La Rocco’s fellow health department employee checks folks in, joking with the regulars and offering a friendly, formal introduction about the program for newcomers. La Rocco has engaged with many of the 3,679 participants who have visited, nearly half returning regularly. With his curly mohawk, tattoos and boyish charm, the 34-year-old is easily relatable. Some clients form schoolgirl crushes. Some form schoolboy crushes. Watch him work. It’s in the casual moments between passing out needles and alcohol swabs and red needle-disposal bins that he leans on the counter, crosses his left leg over his right and tries to make a connection, talking about family or the weather or the right way to inject (e.g.: “If you’re going to ‘run’ the same vein, give yourself one-third to three-quarters of an inch between spots,” he’ll say, showing four small pen marks on his biceps spaced out accordingly.) Or, hey, when you’re ready, there are lots of options out there: inpatient, outpatient, medical detox, Suboxone and methadone to help relieve opioid dependency. (Seventy-six percent of the needle exchange’s clients use heroin, an opioid pain killer.)
“Drug treatment that works really well is drug treatment that’s kind and loving and caring and compassionate and honest and straightforward and has boundaries,” says La Rocco, referring in the last word to the strict hours of operation (which vary day to day) and the rule that no one can acquire needles if obviously high. “But you can’t do this and not love people. Because if you do this and you don’t love people, all you’re doing is handing out needles. So that’s going to help stop HIV and hepatitis C from spreading, but (the clients) are not going to trust you and talk. And we’re not going to see all the other positive stuff happening.” He says folks who visit syringe exchanges are five times more likely to seek treatment than those who do not.
First-timers often enter with knees bouncing, on edge, perhaps expecting a lecture or shame, not an open, neutral conversation about their addiction. Usually the whole process takes less than 15 minutes. By the time they leave with their brown bag of supplies in addition to needles, they’re at ease, perhaps compelled to sing the exchange’s praises.
“This is a really helpful program. I hope it doesn’t stop,” says a petite brunette.
“I don’t think it will,” La Rocco replies.
“It’s a huge deal,” she says. “I’ve been doing this for years. Getting clean needles — that’s a weight off.”
Louisville’s syringe exchange was the first of its kind in Kentucky, made possible by last year’s Senate Bill 192, the so-called “Heroin Bill” that green-lighted a number of efforts to curb the state’s heroin epidemic. Kentucky, along with the rest of the country, has experienced heroin resurgence. A recent Kentucky Health Issues Poll showed 13 percent of adults have a relative or friend who’s experienced heroin-related issues. That’s up from 9 percent in 2013. Kentucky ranks second in the nation along with New Mexico for the most drug overdose deaths per capita. While La Rocco knew the community needed a needle exchange long before state legislators acted, last year’s HIV and hepatitis C outbreak in nearby Scott County, Indiana — where some 180 people contracted HIV in a community of 4,200 — brought urgency.
Since opening, the needle exchange has stayed busy, providing nearly 416,000 needles to participants and taking in more than 245,000, a respectable rate for needle exchanges. (Rules encourage people to bring back needles. If they show up empty-handed, they can only leave with 10 “rigs.” Turn some in, and you get double the number you return up to a week’s worth, which for most addicts totals about 40 to 70 needles.) In its first year, the exchange has expanded, now hosting sites in Lake Dreamland and South Louisville with the help of Volunteers of America workers. Those satellite sites are each open only one day a week. La Rocco thinks the city could probably sustain another site like the one downtown that’s open six days a week. While most clients come from Jefferson County, 360 have arrived from Floyd and Clark counties in Indiana, with dozens hailing from Oldham, Hardin and Bullitt counties. Ninety-two percent of the exchange participants are white. Sixty-three percent are male. Sixty-five percent are unemployed.
But participants run the socioeconomic spectrum, from sweet-voiced, short-shorts-wearing college-aged kids to homeless men and women to bartenders to one well-dressed businessman who opens up to La Rocco. He’s scared — his business, his kids. “No one knows I’m fucking doing this,” he says, repeatedly. There’s been loss in his life, divorce. La Rocco offers him options, hands him his card. “Pain shared is pain lessened, man,” La Rocco says. Then, the hug.
La Rocco’s job demands listening. Investigating too. “Can I see your arms?” he says to a young girl who has already been to the hospital for an infection. She picks at a ladybug-sized scar. “If you’re developing tracks, you’re going to build up scar tissue. If you develop scar tissue, you’re going to bend the needle. If you use that needle, you’re going to end up blowing out a vein,” he begins, reciting a tutorial on proper ways to shoot up. Some might watch and scoff: Enabling! To which La Rocco would say: “She’s going to get high anyway. Her arms were horrible.”
Reacting, that’s a big part of his work. Last Friday a regular tore into the van: “Narcan! Please tell me you have Narcan!” (Narcan — aka naloxone — is a drug that helps reverse overdoses.) La Rocco grabbed his naloxone kit and ran about a block down the street toward a well-known dope house. He helped save the guy who had stopped breathing, right there on the sidewalk. La Rocco is still a bit shaken. As much compassion as he has, sometimes he just wants to scream — all your problems would disappear if you stopped using drugs! But addiction is messy. It’s brain chemistry gone awry. It’s compulsive behavior despite awful outcomes.
In the last several months, overdoses have increased. La Rocco says users are often buying heroin that’s been cut with fentanyl, a synthetic opioid similar to morphine. In the first half of 2016, LMPD investigated 121 accidental overdose deaths and administered 404 doses of Narcan to 275 individuals. That’s up from 67 overdose investigations and one LMPD-administered Narcan dose in the first half of 2015. La Rocco advises clients to mash up their drug and take a small test hit before shooting up. When clients walk in today, a whiteboard advertising a free naloxone class greets them.
It’s now 6 p.m. Closing time. Three people wait to be seen, having slid in before the cutoff. Today’s total: 54 clients, 40 of whom are return visitors. It’s a busy but typical Thursday. At 6:02, a sweaty man with a mustache and dark eyes opens the door. “Closed, man,” La Rocco says. The man begs. Nope.
“I’m going out of town,” he says.
“You can come tomorrow at 11 in the morning,” La Rocco responds. The man storms off, slamming the van door. Later, he’ll apologize for “being such an ass.”
“He wasn’t rude,” La Rocco says. “Just desperate.”
Illustration by Rachael Sinclair
This originally appeared in the August 2016 issue of Louisville Magazine. To subscribe to Louisville Magazine, click here. To find your very own copy of Louisville Magazine click here
