Thoughts on Harm Reduction Needle Exchange Programs

Harm Reduction Series

June 15, 2026

Michael Cline, Author

Tom O'Connor, Publisher

There was a dark time in my life when I was addicted to heroin. Fortunately, after a long battle with several false starts, I was able to get that monkey off my back, but it wasn't easy. I'm quite proud to say that at the time of this writing, I haven't stuck a needle in my arm for 26 years. I was a member of a needle exchange program for a few years while living in NYC's East Village, way back in the 90s, when the neighborhood was very different from what it is today.

Like most heroin users, I started out sniffing. I firmly believe that the very second the powder entered my nasal cavity, I was hooked. With a childhood packed with trauma, I foolishly believed that I had found the cure for all that I had been suppressing since I was a kid. The other addicts I had met all claimed that sniffing was a waste of time. Within three months of using heroin, I graduated to the needle and understood what these guys were talking about.

I was soon to lose my job, stop paying my rent, and every penny I had, either from my dwindling bank account or cash I could easily hustle up on the streets, went towards buying dope. There used to be a section of Avenue B where junkies would sell "works," the street term for needles. They didn't hide what they were doing and would sit on doorsteps while casually saying "works, works" to everyone who walked by. This is where I'd get my needles, but with money always being an issue, spending a dollar for a hopefully clean one became an expense I couldn't afford.

The Lower East Side Harm Reduction Center

After a long legal battle, the Lower East Side Needle Exchange opened its doors to IV drug users in May 1992, at 39 Avenue C, between East 3rd and 4th Streets. Its location couldn't have been any better, since Alphabet City, the neighborhood's moniker, was jam-packed with dope spots and their customers.

It was operated out of a storefront and was my first introduction to harm reduction for drug addicts. The program was anonymous, but members would be given an ID card containing their initials, date of birth, and membership number. Supposedly, this card allowed people with an addiction to possess hypodermic needles without a doctor's prescription. For people with an addiction, this document could mean the difference between being arrested for possession of a needle, even if they weren't holding any drugs, and walking away without incident.

I had learned about the needle exchange through other IV drug users that I had met at different drug locations. For street addicts, spending a buck for a clean needle on the street was sometimes a price too high to pay, so the thought of being able to get them for free with the bonus of being able to possess them legally was a good deal. I remember walking into the storefront to sign up, and while it wasn't the nicest of environments, the volunteers there were all quite helpful. Some of them appeared to be harm reduction specialists, while others looked to be IV drug users like myself.

I sat down at a small card table with a rough-looking guy of maybe thirty years old. After we exchanged niceties, he asked me about my drug use. Although I was self-taught on how to inject drugs, it was a requirement of the program to be educated about safe injecting, and more importantly, how to clean needles properly with bleach and water. I was then given my membership card, five brand-new needles, a small package of clean, balled-up cotton, a small bottle of bleach, and a cooker (a small metal container resembling a bottle cap). These were all the necessary components for safe injection.

Although I don't recall their exact hours of operation, I do remember they weren't open 24/7 and were open only a few days a week. People with an addiction could return their used needles and be given double the amount in return. I guess that this is how the needle sellers on Avenue B got them. The Harm Reduction Center also distributed free condoms and had plenty of literature available on 12 Step Programs and Rehab Centers. However, they never pushed for people with an addiction to seek help. Its main goal was to help prevent the spread of HIV, as studies in 1994 suggested that 30 to 40% of IV drug users in NYC were HIV positive.

Another advantage of the Lower East Side Harm Reduction Center was the information they shared about brands causing issues for users in the neighborhood. On a large blackboard on the wall were the names of dope brands that were to be avoided. These were usually the ones that were adding things like rat poison to their dope, although dealers that did this didn't last long, since the junkie grapevine worked faster than today's high-speed internet.

READ: What Is Harm Reduction For People Who Use Drugs?

Are Needle Exchange Programs Helpful or Harmful?

One of the biggest complaints about needle exchange programs is that they encourage drug use. In my opinion, they don't encourage drug use, at least not for first-time users. There's no way that you can convince me that a perfectly normal person who never used hard drugs thinks to themselves, "Oh, cool, a needle exchange program has opened up in my neighborhood. Maybe I'll swing by there this weekend, pick up some needles, buy some narcotics, and see what all the fuss is about." However, for existing users, it may not encourage them to stop, but it is helpful to slow down the spread of HIV and Hepatitis C.

As someone who was at one time a member of a needle exchange program, my thoughts on their value are more nuanced. Personally, it most definitely helped me avoid contracting HIV, since the sharing of needles during my days as an active IV drug user was incredibly common. I also learned how to clean them properly by flushing them with bleach and water, which likely prevented me from developing unwanted, potentially deadly infections.

While there was ample information there about rehabs, methadone clinics, and Narcotics Anonymous meetings, I had little interest in getting clean. For me, it was a way to get clean needles and other drug paraphernalia for free and not much else. The "Get Out of Jail Free" card that came with membership was the icing on the cake.

At sixty years old, I'm not too sure how I'd feel if a needle exchange program were to open up in my neighborhood. While a lot of IV drug users are non-violent and of a somewhat sound mind, many are not. In the depths of addiction, some will acquire the much-needed cash to buy their drugs by any means necessary, and that includes strong-arm robberies, home invasions, and street muggings. Mental illness is common amongst people with an addiction and can lead to uncomfortable and sometimes dangerous encounters with residents.

There's a fine line between being pro-harm reduction and having a "not in my backyard" mentality. If a needle exchange center were proposed to open in my neighborhood, I think I'd be more apt to support it if it pushed a bit harder on getting people with an addiction into recovery rather than merely offering free needles to slow down the spread of disease.

Drugs are, unfortunately, a part of our society. Ultimately, I believe it's the government's responsibility to help people with an addiction find a path out of addiction instead of locking them away in jails and prisons solely for the possession of syringes and narcotics. However, not everyone will agree with me.

If this article resonated with you, you may be interested in my recovery-focused books, which explore addiction, trauma, and healing beyond abstinence.

New York City Junky Days is a raw, firsthand account of how an ordinary person can quickly become engulfed in addiction, told with brutal honesty and a hard-earned path toward recovery.

New York Recovery Days examines the difference between abstinence and true recovery, focusing on the long-term healing of childhood trauma and the emotional work required to build a fulfilling life.

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Read Michael's bio by clicking his icon at the start of this article.

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