On Friday afternoons, the warm, buttery aroma of fresh grilled cheese makes its way through the front doors of the Canton City Public Health and out onto the sidewalk, letting those waiting outside know it’s time.
Since June 2017, Canton, in Stark County, has been fighting back against the opioid epidemic through instituting the SWAP program (Stark Wide Approach to Prevention). SWAP allows individuals to trade used needles for sterile ones — something the Licking County Board of Health has considered in years past, but rejected in a unanimous vote in 2019. Those sterile needles, though, could help reduce the spread of infectious diseases among people who use drugs.
Canton City Public Health — the home of SWAP — opens its doors between 2 and 4 p.m., transforming itself into a one-stop-shop for anything and everything harm reduction.
Upon entering, guests check in at the front desk, giving an abbreviated version of their name, their birthdate and their membership card. Upon joining the program, each guest is issued a card with a unique code that identifies them as a voluntary participant of the needle exchange. Core to the program’s mission is that every guest enjoys anonymity.
Following the check-in, guests dispose of their used syringes into a sharps container in the corner of the room. For each participant, there is a maximum exchange of 50 syringes per week.
Guests are then escorted to a back room where an abundance of harm reduction supplies are stationed. SWAP offers their guests more than 10 kinds of harm reduction tools, some of which include HIV/hepatitis C testing kits, safer sex supplies, naloxone medications as well as injection-related wound care.
Positioned at the back of the room are five storage containers filled to the brim with sterile, Easy Touch syringes.
Guests are given the choice between five different syringe sizes and volumes, all of which are displayed on a menu in front of them.
“Can I get one of the 100 shorts and four of the 50 longs please?” one guest asks.
According to members of the SWAP program and Ohio CAN — a nonprofit working to support people struggling with addiction — choice is a huge component of harm reduction.
“It respects individuals’ autonomy over their own lives and decisions,” said Trish Perry, the leader of the Licking County branch of Ohio CAN. “Choice is something our people are rarely able to enjoy and so we try hard to offer it whenever possible.”
From check-in to leaving, the whole exchange process takes guests no more than 10 minutes before they’re out the door.
“Our goal is to promote better health practices in those who choose to inject, while at the same time creating an environment that is welcoming and fosters a sense of community,” said Pam Gibbs, one of the original founders of SWAP.
Across the country, needle exchange programs are being implemented to support community health.
“They are proven to save lives, help those with substance use disorders get needed support, prevent overdose deaths, and reduce the impact of drug use on the community,” according to the Centers for Disease Control and Prevention.
These exchange programs “are associated with an estimated 50% reduction in HIV and [hepatitis C] infections,” according to the CDC — and those numbers are reflected in Stark County.
According to Gibbs, Stark County has seen a significant decrease in the number of HIV/AIDS and hepatitis C cases over recent years. In 2016, Stark County reported 344 new cases of hepatitis C, and 32 cases of HIV/AIDS. By 2023, those numbers were nearly halved, with 182 new cases reported of hepatitis C and 14 cases of HIV/AIDS.
“I like to think that we played some role in discovering that positive change,” Gibbs said.
Canton health department’s Early Intervention Specialist (EIS) Kristina Gantz said those results made the hard work of maintaining the SWAP program worth it.
“Maintaining a program like this is not easy, it takes a lot of effort and creativity, but it’s all worth it when all that positive change is happening right in front of you,” she said. “This is something that every county can and should be doing.”
The needle exchange in Stark County is one of many. More than a quarter of Ohio’s 88 counties — 24 as of this year — sponsor needle-exchange programs.
In 2019, Licking County decided not to allow any such programs.
“The decision was made due to a lack of broad public support for such a program,” the Health Department Board stated in a letter to The Reporting Project earlier this year.
When the decision was made in Feb. 2019, the Licking County Health Department Board of Trustees unanimously voted 8-0 in favor of banning syringe-exchange programs countywide. Discussion of the program was not on the meeting’s agenda, there was no public discussion of the issue in the meeting and two board members were absent during the meeting.
At the time of the vote, Harm Reduction Ohio’s President Dennis Cauchon told the Newark Advocate there was support for the program in Licking County. Then-Newark City Council members Jeremy Blake and Sean Fennell recommended the city council lobby the health board in support of the program.
Included in the same letter to TRP, which took the place of an interview, the board reasoned that the community mirrored their own opinions on the issue.
“While some requests for a Syringe Exchange Program were received, there were many more requests against the implementation of the program,” the board wrote. “This remains the case in 2024 and there are no plans to revisit this decision at this time.”
Supporters of the program have been protesting the ban since then, and Perry has been at the forefront of this battle.
“The reason me and so many others like me are so very passionate about creating this type of program is because there’s a need — a huge need,” Perry said. “Every year without fail, we hear about folks in our community getting sick because they don’t have access to clean needles and other harm reduction necessities.”
According to the Licking County Health Department, over the past three years (2021-2023) there have been 297 chronic hepatitis C cases reported, some of which were tied to poor injection practice associated with the injection of drugs.
“There is no denying what the statistics are saying,” Perry said. “This is a massive, terrible problem. The worst part is that as a community we’re sitting back and doing nothing.”
This story was updated at 11:25 a.m. on Tuesday, Sept. 3 to correct the names of Canton City Public Health and Pam Gibbs. The Reporting Project regrets the errors.
Jack Wolf writes for TheReportingProject.org, the nonprofit news organization of Denison University’s Journalism program, which is supported by generous donations from readers. Sign up for The Reporting Project newsletter here.