In Louisville, KY there's a needle exchange. Complete with your choice of 20-30 needles, tubes of clean water, cotton balls, alcohol wipes, and a container for your old needles, and as long as you have your needle exchange ID you won't get a paraphernalia charge of caught with any of these items.
However, I've been on suboxone for a year and a half and tapering. I've had zero trouble besides running into old friends with the common temptations. Some days I forget to dose completely and am perfectly fine.
About the pill presses though, it's a true problem. At least with pills you knew what you were getting, but a few months back I caved on some xanex bars, and took a whole one, and trust me, I know my bars this was legit by looks and with the taste, but I've never in my life had a bar mess me up this bad. Passed out the whole night standing straight up, woke up on the cabinet in the kitchen. Plus some other side affects. In my day I've dropped ten bars in one day and still not had this outcome. Now that people are pressing their own, no telling what's in it! I'll stick to my sub taper and stay alive from here on out, I've come too far to be KOed by a homemade xanex!