Harm Reduction Story Archives - West Virginia Public Broadcasting

Advocates Celebrate First Year Of Narcan Vending Machine

Local harm reduction advocates celebrated the first anniversary of the installation of a Narcan vending machine in Charleston on Monday.

An unassuming former newspaper box sits unlocked at a church on Charleston’s west side. On Monday afternoon, the box wore a happy birthday hat with a balloon tied to its handle.

The box is filled with Narcan, an opioid reversal drug that can stop an overdose. Also available in this box are drug testing strips and plan B emergency contraceptives.

It was the box’s first birthday and advocates gathered to celebrate with a party.

The event is meant as a beacon of hope and celebration with music, food, dancing and chalk drawings and messages like, “We love you” and “You are valuable.”

Chelsea Steelhammer is a volunteer with SOAR, a Charleston-based community group that says it promotes the health, dignity and voices of individuals who are impacted by drug use.

Steelhammer said the box has helped distribute 300 Narcan kits, each containing two doses, in the year it’s been installed.

“People can come and get it and there’s no questions asked, there’s no real stigma about just coming into a church parking lot, walking around, coming back out, nobody knows what you’re doing,” Steelhammer said. “And you can get things that might save your life or a loved one’s life.”

Steelhammer said people have a misconception about Narcan. She says it should be treated like any first aid item.

“They’re like, ‘I don’t use drugs,’ but it’s not for you, because you can’t use it on yourself,” Steelhammer said. “So, it’s, it’s just something to have in your first aid box.”

Gail Michelson is a volunteer with SOAR and a lawyer who has watched the opioid epidemic unfold throughout the legal system and in her community.

“When it all began to come out about how these pills became available to people legitimately,” Michelson said. “I thought they had started a whole epidemic here and that we must do everything we can to stop it and keep people alive.”

Michelson said the vending machines are a more accessible and realistic way for people who suffer from substance use disorder to obtain harm reduction tools.

“Because people don’t want to go in to pay $60 or even if it was free and go to their local pharmacist and go ‘Oh, do you use drugs?’ It’s a very nice and anonymous way to get it done,” Michelson said.

The box was installed by SOAR, using grant money from the Women’s Health Center and AIDs United. The Women’s Health Center in Charleston also has a Narcan vending machine.

“If you can reach out to SOAR, we could probably get you some funding or hook up with partnerships so that you will be able to be a community lifesaver as well,” Steelhammer said. “And even if you’re not interested in a whole box, but you want training or your church or business or organization, we can provide that for free so that you’re able to better serve your community.”

SOAR is working with CareSource, a health insurance agency, and other partners to place more than 50 naloxone vending machines across the eastern states, including West Virginia this year.

Appalachia Health News is a project of West Virginia Public Broadcasting with support from Marshall Health.

Drug Testing Strips Are Legalized In W.Va.

A bill to legalize drug test strips was signed into law by Governor Jim Justice Friday.

A bill to legalize drug test strips was signed into law by Gov. Jim Justice Friday.

A drug test strip is a small strip of paper that can detect the presence of cutting agents, like fentanyl, in all different kinds of drugs.

Under previous state code, drug testing strips were considered drug paraphernalia. This means someone who was found in possession of drugs could have been additionally charged for possession of drug paraphernalia if they had drug testing strips.

Senate Bill 269 removes drug testing strips from the state’s list of drug paraphernalia.

Lawmakers passed a similar bill in 2022, exempting testing strips that detect fentanyl from that statute. House Bill 4373 went into effect in June of that year.

Illicit drug users can use test trips to verify their drugs aren’t contaminated with something else more lethal like fentanyl or xylazine.

Proponents of the bill like Iris Sidikman (they/them), harm reduction program director for the Women’s Health Center, say it could save lives.

They said while the fentanyl testing strips have been useful, the newest cutting agent, xylazine – or tranq – is the most requested test strip. Under current state law, it would be illegal for the clinic to distribute xylazine tests.

“The most immediate thing that this legislation would allow is for us to distribute xylazine test strips, which many people have asked me about here at the clinic as part of our Harm Reduction Program, people are interested in them.

Sen. Eric Tarr, a Putnam-R, was the only lawmaker to vote against Senate Bill 269. He said he wants West Virginia to be the last place someone would want to use or sell drugs.

“West Virginia ought to be the absolute worst place in the country to be involved in the drug industry, illicit drug industry,” Tarr said. “This should be the absolute last place in the world do you want to come to do drugs, sell drugs, be busted for drugs. And frankly, for rehab, because our rehab has been an abysmal failure.”

According to a June 2023 report from the Centers for Disease Control and Prevention, in 2021, the highest rate of drug overdose deaths involving xylazine occurred in Region 3, which includes West Virginia.

Appalachia Health News is a project of West Virginia Public Broadcasting with support from Charleston Area Medical Center and Marshall Health.

Lawmakers Legalize Drug Testing Strips

A bill to legalize drug test strips passed both chambers last week.

A drug test strip is a small strip of paper that can detect the presence of cutting agents, like fentanyl, in all different kinds of drugs.

Under the current state code, drug testing strips are considered drug paraphernalia. This means someone who is found in possession of drugs can be additionally charged for possession of drug paraphernalia if they have drug testing strips.

Senate Bill 269 removes drug testing strips from the state’s list of drug paraphernalia. It passed the Senate on Tuesday and the House of Delegates on Friday. The bill has gone to Gov. Jim Justice’s desk for his signature.

Lawmakers passed a similar bill in 2022, exempting testing strips that detect fentanyl from that statute. House Bill 4373 went into effect in June of that year.

Proponents of the bill like Iris Sidikman (they/them), harm reduction program director for the Women’s Health Center in Charleston, say it could save lives.

They said while the fentanyl testing strips have been useful, the newest cutting agent, xylazine is the most requested test strip. Under current state law, it would be illegal for the clinic to distribute xylazine tests.

According to the Bureau for Public Health’s Drug Overdose Mortality report, in 2021 fentanyl and fentanyl analogs were involved in 76 percent of all drug overdose deaths occurring in West Virginia, up from 58 percent in 2017.

According to a June 2023 report from the Centers for Disease Control and Prevention (CDC) brief, in 2021, the highest rate of drug overdose deaths involving xylazine occurred in Region 3, which includes Delaware, the District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia.

Fentanyl was the most frequently co-occurring drug mentioned on xylazine death records between 2018 and 2021.

Sidikman said people knowing what is in their drugs allows them to use more safely and better respond to overdoses around them.

“I think that they allow people to make better, more informed decisions about their health and what they do with their bodies and I think that that’s a good thing,” Sidikman said.

Sidikman said the harm reduction program aims to provide people with the tools necessary to stay healthy and safe while they navigate their lives.

“Whether or not they choose to end their substance use, reduce their substance use whatever they choose,” Sidikman said. “In order for people to be able to make positive changes in their life, they have to be alive.”

Sen. Eric Tarr, R-Putnam, was the only legislator to vote against Senate Bill 269.

“So in spite of all the efforts that we’ve made on these enablement measures, and that’s what I see, this is just, it’s another enablement feel-good measure,” Tarr said. “We are seeing still an escalation of our population that is using drugs and being significantly harmed by them.”

Tarr said he wants West Virginia to be the last place someone would want to use or sell drugs.

“West Virginia ought to be the absolute worst place in the country to be involved in the drug industry, illicit drug industry,” Tarr said. “This should be the absolute last place in the world you want to come to do drugs, sell drugs, be busted for drugs, and frankly, for rehab, because our rehab has been an abysmal failure.”

Sidikman said the legalization of all drug testing strips would allow them and their team to stay ahead and the newest cutting agents.

“If there is a new drug that enters the supply that we that testing strips are developed for, we would automatically be able to give those out and we wouldn’t have to wait and go back to the legislature and get those legalized before being able to give them out,” Sidikman said.

Appalachia Health News is a project of West Virginia Public Broadcasting with support from Charleston Area Medical Center and Marshall Health.

Decoding The Drug Epidemic

When it comes to decoding the language of the drug epidemic, advocates say compassionate language plays a crucial part in discussing the drug epidemic.

When it comes to decoding the language of the drug epidemic, advocates say using compassionate language is vital when speaking with the people behind the numbers.

This language is also medically accurate, as clinicians’ diagnostic manuals have changed.

“In behavioral health disorders there is, for the past several decades, there has been something called the DSM,” said Michael Haney, director of addiction treatment center PROACT, based in Huntington. “It’s the Diagnostic and Statistical Manual of psychiatric disorders, and there used to be a delineation between abuse and dependence which I think is where the whole idea of addiction dependence got confused because abuse is someone that was a problem user, but it hadn’t gotten to the point where they were truly considered as having a disease or sick.”

In 2013, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM 5 was released, removing terms like substance abuse for a more simple term.

“It’s simply use disorder,” Haney said. “And it’s like alcohol use disorder, mild alcohol use disorder, moderate or alcohol use disorder severe. And that really just depends on how much of an impact it’s having on you.”

Laura Lander has lived in West Virginia for nearly 20 years and watched the trajectory of the drug epidemic from a social work perspective as an associate professor at West Virginia University’s (WVU) Department of Behavioral Medicine and Psychiatry.

“And now, it’s really a kind of on a continuum,” Lander said. “So people have mild, moderate, or severe substance use disorder. So that’s the diagnosis. So addiction is really an umbrella term, which is not a diagnostic term, is really more of a descriptive colloquial term that we use.”

Lyn O’Connell, associate director for the Division of Addiction Sciences at Marshall University’s Joan C. Edwards School of Medicine, said avoiding derogatory terms and judgemental labels and instead employing person-first language can increase empathy and reinforce the idea that people are experiencing a health issue rather than a moral failing.

“One of the other reasons it matters is because, and we don’t use this term, but if we refer to someone as an addict, we don’t want to use that term, because it’s not person-centered, and it really dehumanizes the individual,” O’Connell said. “So we want to talk about a person with a substance use disorder because they are still a person. And so we want to refer to that person-centered language. The reason for doing that is also to try and reduce stigma to remind people that there is a person in the conversation.”

O’Connell said that with the understanding that language shapes perception and attitudes, adopting an empathetic approach can pave the way for more effective support systems and treatments.

“And although people might say, ‘well, that’s not going to change how someone enters treatment,’ it absolutely does. How we refer to programs, how we refer to people, how we talk about issues definitely impact our willingness to have treatment,” O’Connell said. “There’s no better example other than probably a needle exchange versus a harm reduction program.”

According to O’Connell, compassionate language not only benefits those directly affected by substance use disorder but also promotes a more inclusive dialogue among policymakers, health care professionals and the general public.

“Unfortunately, we haven’t done enough to combat that first piece of language, but we really want to make sure that, that terminology has impacted our willingness to treat people or provide funding or to legislate this overall,” O’Connell said.

Lander said using compassionate language doesn’t minimize the severity of the drug epidemic but rather acknowledges the humanity and inherent worth of every individual impacted by it. And it has practical applications as well.

“Previously, we had found there was a stigma around patients receiving Narcan,” Lander said. “Even though there was a state order in place that people did not need a prescription to receive it. It was hard for them to get it from the pharmacies. And now we have distributed so much free Narcan and it’s almost become like a household item, which on the one hand, you can think of as sad. On the other hand, you can think of as what an amazing thing we have done to really de-stigmatize a rescue medication, which allows people to live long enough to hopefully get into treatment and into recovery.”

Appalachia Health News is a project of West Virginia Public Broadcasting with support from Charleston Area Medical Center and Marshall Health.

Cabell County Commission Approves Audit of Harm Reduction Program

The Cabell County Commission approved a resolution seeking an evaluation and audit of the Cabell-Huntington Health Department’s syringe exchange program.

Syringe exchanges are widely seen by public health experts as a key measure in preventing the spread of infectious diseases like HIV and hepatitis C among people who inject drugs.

“We feel that our effort has been successful while we search for people who are afflicted with this illness and get them the help they need,” said Dr. Michael E. Kilkenny, executive director of the Cabell-Huntington Health Department. “So these restrictions have had some impact on our ability to prevent disease.”

The audit of Cabell-Huntington’s program comes over a year after a new state law went into effect, Senate Bill 334, which requires programs offering syringe exchanges to host a number of other harm reduction services, force them to deny clean needles to those who don’t return with their used needles and require them to only serve clients with state IDs in order to operate.

“As a licensed entity we are fully aware that we are subject to review by not only Office of Health Facility Licensure and Certification (OHFLAC), who issues our license but also by our main granting organizations through the Department of Health and Human Resources (DHHR) so we are certainly open and willing,” Dr. Kilkenny said. “We are actually even eager to have an inspection and make sure that we are complying with all aspects of the law. We are hopeful that the audit will provide clarity to the county commission.”

Kilkenny noted that the Cabell-Huntington Health Department’s syringe exchange program informed national harm reduction strategies and said he sees the audit as an opportunity to show success within the program and inform local citizens about the program’s benefits.

“I think we have established the basic understanding of Appalachian injection drug use and that has been used to inform the national strategy and we have been informed by the national strategy as we work toward that 2030 goal,” Dr. Kilkenny said. “I think that is what they are looking for and I think they will better understand what it is we do and how effective it is.”

One By One, Local Leaders Give Blessing To Harm Reduction Programs

Under a new state law, needle exchange programs must now get local buy-in from county and city leaders. Without it, these programs can’t legally operate.

One by one, local elected officials are signing off in support of their local harm reduction programs.

This month, West Virginia’s three largest communities weighed in. Morgantown City Council signed a letter in unanimous support of the Milan Puskar Health Right. The Kanawha County Commission did the same thing for Charleston’s Health Right and Covenant House. Huntington City Council signed a resolution this week in a 7-3 vote.

“It’s a no brainer,” Huntington Mayor Steve Williams told council members. “We need to support this program, because we’re in the middle of the war still and we cannot take our arsenal away from those that are on the front lines.”

Syringe service programs in smaller towns are getting the same response. Programs in Lewis and Fayette counties have already submitted their license applications to the state’s Office of Health Facility Licensure and Certification.

Mingo County Health Department Director Keith Blankenship had to go the extra mile to garner community support. Since Mingo County is such a rural part of the state, Blankenship had to get five towns to sign off on the new program along with the county, which voted in favor unanimously.

“Everyone of them has basically said … ‘What we’re doing is not working right now. So why not try something different?” said Blankenship.

Senate Bill 334

State lawmakers passed SB 334 this year. It’s the first law to regulate syringe service programs in West Virginia.

Any operator that hands out clean needles must meet certain guidelines and apply for a state license. Health departments and clinics are used to wading through red tape, said Dr. Michael Kilkenny, the the CEO of the Cabell Huntington Health Department. It began a harm reduction program in 2015.

“Licensure is a modest bureaucratic barrier …we’ve done harder things than to get licensed for syringe service,” Kilkenny said.

At least two programs, in Mercer and Marion Counties, have shut down due to the new stipulations.

The law also requires local political officials to sign off on these programs. Harm reduction is supported by evidence that shows offering clean needles curbs the spread of HIV. It also builds a relationship between health providers and people actively using illegal drugs, leading more people to eventually enter treatment. Still, it can be controversial.

“I think some of the distrust out there was driving this law,” Kilkenny said.

SB 334 doesn’t ban needle exchange programs altogether. Proponents of the bill said it would weed out bad operators.

Kanawha County Commission President Kent Carper didn’t write or vote on the state law, but now he’s an essential voice in whether a syringe service program can operate in the state’s largest county.

“I know this much, people in my county did not appreciate it when folks were passing out needles with no program,” Carper said.

Carper said he is a “longtime supporter” of a true comprehensive harm reduction program, and he would never sign off on anything that doesn’t meet his definition of that. He did voice his support for Health Right’s program, which has been around for 10 years.

“I’ve got absolute confidence in Health Right,” Carper said.

Standard Versus Best Practices

Health Right CEO Dr. Angie Settle has been holding public hearings on her program to meet both state and city requirements. Charleston passed its own regulations on syringe service programs right when state lawmakers were considering SB 334.

She spoke to a small group of mostly Charleston City Council members at a community center gym a block away from her East End clinic this month.

No one questioned if her program was enabling people to use drugs or creating more needle litter in the streets. (These are the types of concerns echoed by lawmakers surrounding SB 334).

Instead, two women chimed in to ask if Settle’s program was reaching enough people.

Settle said Health Right serves about 400 harm reduction participants a month, though not all need syringes. A third eventually go into treatment, and the clinic’s never had trouble getting help for someone that’s willing.

The program requires participants to return their needles to get new ones, called a 1:1 model.

“As long as they bring them back, we don’t limit the number they can have,” she said.

State law requires programs adhere to this model, even though the Centers for Disease Control and Prevention says it’s less effective than giving people syringes regardless if they return them.

“This law actually holds us back from moving towards best practices,” said Kilkenny. Instead, programs must settle on following “standard” practices.

It also requires participants to show a state I.D., again limiting who can access syringes.

“It is not best practice. But it is viable in our current community political environment,” Kilkenny said.

Even before SB 334, these programs have been at odds with the public’s favor at times. The programs that are still around, like Kilkenny’s and Settle’s, have been able to walk a tightrope of providing evidence-based services with some restrictions that ease the minds of political and community leaders.

“We will follow state and city ordinances to the letter of the law,” Settle said. “You have to be able to live within your community.”

A Brand New Program

SB 334 has frustrated program operators, causing some to quit entirely. But for some communities, it’s been a chance to build a brand new service.

“I really started getting very interested in maybe becoming a member of that first group to become certified health harm reduction centers,” said Blankenship with Mingo County’s health department.

Mingo County has been hit hard by prescription opioid abuse. One local solution has been a quick response team that engages with people shortly after they’ve overdosed. Blankenship says it usually leads to treatment, and he believes the harm reduction program will hopefully further success rates.

“We’ve got various aspects of the program in the county, but we don’t have that one major umbrella who kind of covers the whole perspective,” Blankenship said.

Not only does he hope to help more people, but he thinks the program will help this community collect data and understand the extent to which people are using IV drugs or are at risk of contracting HIV.

He’s ready to follow state guidelines, and work with the local leaders that signed off on this program in the coming year.

“We’re going to experience speed bumps, but by working together we can solve it instead of just getting frustrated and closing the program down and then everybody loses,” Blankenship said.

Appalachia Health News is a project of West Virginia Public Broadcasting with support from Charleston Area Medical Center and Marshall Health.

Recovery from addiction is possible. For help, please call the free and confidential treatment referral hotline (1-800-662-HELP) or visit findtreatment.gov.