In New Jersey, workers serving on the front lines of one deadly public health crisis — the opioid epidemic — now find themselves unable to safely serve their clients as another health crisis has hammered the state. As coronavirus cases surge, four of the state’s seven syringe exchanges have had to close for nearly a month because of a shortage of personal protective equipment.

Two are expected to re-open with limited hours next week. But advocates say that in a state already short off syringe exchange programs, any cutbacks can harm people addicted to injection drugs, who rely on the exchanges for clean needles that can prevent infection and disease, as well as naloxone to prevent overdoses.

Syringe exchanges have long been controversial, even though they’ve been operating for decades in the United States and are considered essential businesses under state stay-at-home orders. The programs are still technically illegal in Pennsylvania, though a handful operate throughout the state at the discretion of local governments. In New Jersey, syringe exchanges are legal, but are bound by strict laws. Research shows that allowing drug users to exchange dirty needles for clean ones prevents needle sharing and reusing — and, in turn, the spread of blood-borne illnesses like HIV and hepatitis C.

A 2019 study on Prevention Point Philadelphia, the public health organization that runs the city’s only brick-and-mortar needle exchange, estimated that the exchange prevented 10,592 HIV diagnoses in its first 10 years of operation.

Now, amid another pandemic, needle exchanges on both sides of the Delaware River are struggling to protect staff as they serve their clients. Prevention Point is still handing out needles, but a lack of PPE for staff has forced it to limit its regular food handouts to those living on the streets; now, grab-and-go meals for clients are prepared only when there’s enough PPE for the staff to pack lunches.

And in New Jersey, PPE shortages have shut down several needle exchanges. Kathy Ahearn-O’Brien, executive director of Hyacinth AIDS Foundation, which runs exchanges in Jersey City, Paterson, and Trenton, closed the organization’s offices on March 16, hoping it would only be for a short while.

Some of her staff volunteered to work without PPE, she said. But she couldn’t risk their health.

“I’ve got 100 employees,” she said. “I’ve got staff who are living with HIV, staff with heart conditions, staff with asthma. I can’t risk exposing staff to the virus.”

Staffers at Hyacinth typically wear gloves when working at the syringe exchange; now, they’ll need gowns and face masks to keep themselves safe. On Friday, Ahearn-O’Brien said she was expecting the arrival of N95 masks that she ordered on Amazon a month ago. She’s also ordered 4,000 more masks that the organization hopes to share with the other exchanges in the state, and is looking into ordering gowns as well. The Jersey City and Trenton exchanges are expected to reopen next week, handing out syringes for just a few hours, one day a week.

“It was heartbreaking" to close, Ahearn-O’Brien said. The programs tried to give clients as many syringes as they needed, not knowing when they might be open again. Most of the other services Hyacinth offers for people with HIV and AIDS are using telemedicine to connect with clients. But by design, the needle exchange is an anonymous service, and it’s been difficult to stay in touch with people in addiction who may still need help.

“In all fairness, we might have closed the needle exchange for a week or two just to see if the initial curve flattened,” she said. “But we would have reopened by now had we had the PPE."

Even syringe exchanges that managed to stay open say they’re worried about their clients’ health. Last month, as the first cases of coronavirus cases began to emerge in New Jersey, a potential case of COVID-19 exposure required Asbury Park’s syringe exchange program to close for a few days.

Once it was deemed safe to reopen, Bobby Lowry, the program’s harm reduction coordinator, went back to the office. His bosses had figured out a workaround: They could save PPE by handing out syringes to people who inject drugs from behind a drive-up window.

One of his clients told Lowry that he was grateful the program was open again. He had been using the same syringe to inject drugs for the last two weeks.

“I think some people might look at my services and say, ‘Why are they still open — people can just stop using,’” Lowry said. “That’s not really the case. By not providing these services, we would see an increase of hep C and HIV and overdose in the community. By providing syringes and [naloxone], we are going to reduce that — which also gives more time for EMTs to work on the current COVID-19 pandemic."

Lowry said the state Department of Health has helped the exchange secure PPE for staff. In addition to Asbury Park’s exchange, programs in Newark and Camden are still operating, albeit with limited hours.

“The department is exploring options to increase availability to these services during the COVID-19 outbreak in the state,” Dawn Thomas, a spokesperson for the department, wrote in an email, adding that the department had restocked exchanges with naloxone.

People whose needle exchanges have closed or are operating on limited hours can also get up to 10 syringes apiece at pharmacies, if they’re able to afford them.

Harm-reduction advocates in the state say they’re doing what they can to get services to people who most need them during the pandemic. The New Jersey Harm Reduction Coalition increased its naloxone mail program, sending 500 doses to state residents who reached out over a hotline since March 13, said Caitlin O’Neill, the program’s harm-reduction coordinator.

O’Neill said that the coronavirus pandemic has only highlighted the need for more syringe exchanges and harm-reduction services in New Jersey.

“If New Jersey actually treated the harm reduction centers and syringe service programs as essential, there would be one in every county, and we wouldn’t have only seven at completely max capacity,” she said. “Just because we don’t have syringe exchanges doesn’t mean that drug use isn’t happening. The reality is that the risks of HIV, hep C, skin infections, and overdose don’t stop with COVID. They probably get greater.”