The Mercer County Health Department voted Wednesday to close its needle exchange program due to strict requirements under a new state law, according to reporting from the Bluefield Daily Telegraph.
“Under the new law, we can’t comply,” Health Department Administrator Roger Topping told board members. He noted almost 50 requirements that had to be approved for a license to offer a harm reduction program that includes a needle exchange.
Mercer County health officials began the needle exchange in 2019.
The law in question, West Virginia Senate Bill 334, requires programs offering syringe exchanges to deny clean needles to those who don’t return used ones and only serve clients with state IDs.
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.
A new structure was unveiled at a ribbon-cutting ceremony Friday in Charleston. It wasn’t a school, business or hospital. Instead, local activists celebrated a humble disposal box, intended to collect used syringes.
A grassroots HIV and recovery group installed Charleston’s second sturdy sharp container amid ongoing concerns over the city’s growing HIV outbreak.
“Let this be the first action to get us united on a path to meeting this growing need for expanding harm-reduction in our community,” said Stacy Kay with Solutions Oriented Addiction Response, or SOAR.
Kay said SOAR will be responsible for clearing out the box on a regular basis.
This event comes just days after the Centers for Disease Control and Prevention released a report that says the capital city needs more clean needles to curb the spread of HIV, which has gotten worse in recent years.
The CDC’s recommendation didn’t come as a surprise to SOAR and those that study infectious diseases. But state and local laws passed this year do limit who can give out clean needles.
SOAR shut down its health fairs days before the city ordinance passed. The group continues to criticize the city’s move.
“We simply cannot punish those who are hurting the most, criminalize the helpers, and hope that this will all just go away,” Kay said.
The CDC’s findings also say the city could use more public sharp containers for IV drug users to properly dispose of used needles.
“It helps to do something,” Kay said.
State epidemiologist Shannon McBee told WVPB she thinks the city and state can get behind these recommendations.
“I think there’s options for us to minimize improper or unsafe disposal of used syringes within the current context of our laws,” McBee said.
The only other sturdy sharps container in Charleston is outside the local health department. McBee, activists and the CDC pointed out that there is a constant law enforcement presence near that container, which could deter folks from disposing of their syringes there.
The new box is located on Charleston’s East Side near a park commemorating those who have died of AIDS.
“The struggle to overcome AIDS started in an ocean of stigma,” said Carl Maxwell, the president of the Living AIDS Memorial Garden. “Too many people thought that the people who first acquired AIDS were unworthy or somehow deserved it. That wasn’t true then, and it’s certainly not true now. We’re excited to be a part of the solution.”
More than 300 nurses, doctors, social workers and pastors urged the governor to veto Senate Bill 334. The legislation would regulate syringe service programs for the first time in West Virginia.
In a letter written by the state chapter of the American Civil Liberties Union, signees said the bill could “eradicate” harm reduction programs that help curb the spread of HIV and other blood-borne illnesses. The bill doesn’t shut down programs, but it requires all operators to get approval from local city councils and county commissioners.
The letter argues that syringe distribution has been so controversial that elected officials would be reluctant to approve any operation. The bill also requires participants show state IDs and limit the number of needles that could be distributed. Both measures could shut out some participants, the signees explained.
West Virginia legislators that voted in favor of the bill have said regulations are needed for these services, just like any healthcare operation. They argued that harm reduction programs need to be accountable to the communities they operate in, not just their program participants.
At this point, the governor has no intention of vetoing the bill. He said it is a good compromise.
“It prevents the problems we were having with needles all over the place,” Gov. Justice said at a virtual press briefing Monday. “But it still aids in helping those folks that we need to reach out and try to help and keep them safe too.”
State Health Officer Dr. Ayne Amjad said she will support the governor’s decision. “Our job at the state level is to follow the legislative ruling at this time,” she said.
She said the state will continue to work with the Centers for Disease Control and Prevention and local health departments to come up with a plan to address West Virginia’s multiple HIV outbreaks.
“We’ll be coming up with our plan and putting it forward,” Amjad said. “We’ll have more to follow.”
U.S. Sen. Joe Manchin recently sent a Congressional inquiry to the CDC about its findings that Kanawha County has the “most concerning” HIV outbreak.
The CDC responded in a letter Friday. It stated that since 2019, more than 50 new HIV cases among those who inject drugs had been documented. That contrasts from previous years where fewer than five cases were reported annually.
CDC officials said they had been working with the West Virginia Bureau of Public Health and local partners to understand the outbreak. “CDC stands ready to provide more support at the invitation of the state,” wrote Dr. Jonathan Mermin with the CDC.
Programs that hand out clean syringes to IV drug users may soon be required to obtain a license.
Senate Bill 334 passed the West Virginia Senate Tuesday, and as written, it would hold harm reduction programs to some basic standards. But opponents say it could shut down critical services that curb the spread of HIV.
West Virginia has long struggled with opioid use, and many are connected to the crisis in some way.
Democratic Sen. Richard Lindsay of Kanawha County talked on the floor Tuesday about his younger cousin who has a drug use disorder, but is now in recovery.
“And I’m so proud of him, but I guarantee you he would not be alive, he would not have children, he would not have a family and job, if he contracted HIV or Hep C in the process,” Lindsay said.
IV drug users face a serious risk of becoming infected with HIV and other blood-borne illnesses. And West Virginia has two of the most concerning HIV outbreaks in the nation — in Cabell and Kanawha counties.
To combat the crisis, several harm reduction programs have started handing out clean syringes to prevent users from sharing potentially infected needles.
These programs are unlicensed and are run by non-profits, local health departments and grassroots volunteers.
Republican Sen. Eric Tarr of Putnam County wants needle exchange programs to be regulated like most other public health programs.
“I can go out in the parking lot and start distributing needles. There’s no regulation that says I can’t,” Tarr said.
Senate Bill 334, sponsored by Tarr, calls on programs to obtain licenses through the state.
That involves plenty of paperwork, quarterly reports, and licensed health staff on hand. These programs would have to ensure they’re also providing other services like STD testing, birth control, overdose reversal supplies and education. Participants would also need to show a West Virginia ID.
The bill also instructs programs to keep a close watch of the number of needles they distribute. Programs would need to follow a 1:1 exchange, as much as possible. That means giving one needle for every needle a participant returns.
Dr. Michael Kilkenny, CEO and chief health officer at the Cabell-Huntington Health Department, says a 1:1 exchange doesn’t work well. He said it’s too restrictive, and can lead participants to opt out.
“1:1 says if you don’t bring me any, you don’t get any. It doesn’t mean you don’t need them,” Kilkenny told West Virginia Public Broadcasting. “For public health, it won’t change the statistics.”
His department started a syringe exchange program in 2015. In the past it was more restrictive, limiting the number of needles and who it served. He’s pivoted.
“Some of the things in SB 334 are mistakes I’ve already made or observed. We don’t have the luxury of making the same mistake over and over again,” Kilkenny said.
The bill would also require programs to mark each individual needle to better track them.
Tarr said all of this is in the name of public safety. He worries that needles supplied from these programs are ending up on sidewalks and other public outdoor spaces.
He also added language in the bill that local sheriffs could shut down these programs at any time.
“Should that needle exchange be significantly increasing the crime in that area, placing his deputies at risk, police and other law enforcement at risk, placing the community at risk… he can rescind the letter of support. And it produces a closure of that needle exchange,” Tarr said.
That’s on top of approval needed by county commissions.
The bill passed the Senate 22-11. It now heads to the House of Delegates.
A volunteer-run harm-reduction group in the city of Charleston called SOAR has come under fire from city officials for distributing syringes as part of its “mobile outreach” efforts.
A representative from SOAR (Solutions Oriented Addiction Response) says group members started distributing syringes some time after the 2018 shutdown of the Kanawha Charleston Health Department syringe program.
SOAR shut down its program three weeks ago after the city’s police chief claimed they were violating a municipal ordinance. However, the city’s ordinance may not actually prohibit anyone from distributing syringes.
Lauren Peace / Mountain State Spotlight
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Mountain State Spotlight
Volunteers with SOAR set up a tent in Charleston, WV.
Every two weeks, SOAR sets up tables in a church parking lot to provide free services to anyone that wants them. People come to get anything from rapid-HIV testing and wound treatment, to a cup of hot chocolate and a conversation. Volunteers pass out supplies like Naloxone, snacks, and condoms. Until three weeks ago, these supplies included sterile syringes for anyone who needed them. People, like Tommy, who lives in the streets.
Tommy spoke out about the problem on Thanksgiving, sitting under a bridge in Charleston. Tommy said now that SOAR has stopped giving out sterile syringes, he’s had to Macgyver his old needles in order to reuse them.
“I had to take a matchbook because you use the striker as your sandpaper to try to sharpen the end of that needle back.”
As he talked, Tommy took out two syringes — a clean one and an old one that he’s tried to sharpen back into shape. Despite his efforts, the old syringe looked a little crooked. To demonstrate how dull his old needle was, he jabbed it against a plastic bag he was holding in his other hand.
“Well, you see how it’s bent? I mean, it was a ‘Z’ the other day.” Holding up the old syringe, he said, “I had no choice, but to use this. It barely goes through the plastic.”
Tommy said when access to clean syringes dries up, people often resort to buying used ones. “You’ve got this black market out here where you’re buying a used needle. Now, yeah, you’re trying to bleach it. You’re trying to — but where’d it come from?”
Experts say limiting access to needles doesn’t impact addictions.
“In 20 years of doing this work, I’ve never met a person who said: If I didn’t have access to sterile syringes, I would stop injecting,” said Robin Pollini, a researcher at WVU, who holds a Ph.D. in public health from Johns Hopkins. “It just doesn’t work that way.”
Pollini says this isn’t the first time the City of Charleston has shut down a harm reduction program. In 2018, the Kanawha- Charleston Health Department’s sterile syringe program closed its doors after the city put restrictions on it — restrictions, she says, that prevented the program from operating according to best practices as outlined by the CDC.
“They were serving a very large number of people, which is what you want these programs to do, because you need to have enough people having access to sterile syringes, to reduce the transmission of disease.”
The WV Center on Budget & Policy recently released a report that confirms Pollini’s point. The study looked at HIV transmission from people reusing needles in Kanawha County. It found the rate of HIV transmission started going up 2018, the same year the KCHD’s syringe program shut down. As of October 2020, the transmission rate had increased by more than five times since the shutdown of the city’s program.
The report also showed that statewide the number of fatal overdoses from all drugs was down 15 percent over the past three years, in contrast to Kanawha County where the number has been rising steadily.
“Here’s a perfect case study of when you restrict these programs, and reduce the number of people who can use them, you are not effective in preventing disease in the community,” Pollini said.
According to Pollini, SOAR was picking up the city’s slack. But in recent interviews Mayor Amy Goodwin and Police Chief James Hunt have said SOAR’s syringe program was violating a municipal ordinance. The ordinance says that any person distributing syringes in Charleston has to first get “any and all licenses required under state law.” Hoyt Glazer, an attorney in Huntington, says there’s just one problem with the ordinance.
“At this point, I don’t see there’s any statute that requires licensure,” Glazer said of the W.Va. State Code.
Glazer says there is no license required by the state for people to distribute syringes. In fact, the state guidelines for syringe programs don’t even use the word “license.”
“It uses the word certification. A certification is different than licensing. And, I’m not aware of any statute that requires an entity to have actual licensing in order to go forward with the distribution of the syringes.”
He adds that anyone being told they can’t distribute syringes by city officials could have grounds to sue.
“If they’re going to challenge the person or program that’s providing the syringes, a person could possibly challenge that and make arguments that it was a violation of their rights to distribute materials that are not otherwise prohibited by the criminal code.”
The city’s attorney responded to West Virginia Public Broadcasting by saying that the city council may move to amend the ordinance in the future. The WV-ACLU, which represents SOAR, says it doesn’t currently plan to sue the city. In fact, a representative from SOAR says his organization is “eager to work hand in hand with the city to address public health and safety for our whole community.”
Under a bridge in downtown Charleston, Tommy said that “whole community” includes people like him—people who are suffering from addiction. In the weeks since SOAR stopped giving out syringes, Tommy says he’s seen someone pay $6 for another person’s used syringe. In recent weeks, he’s even had to use a set of pliers he carries with him, to remove a broken needle from a friend’s arm — a common occurrence when using old syringes, he said.
“They’ve got no choice but to use something that should have been retired last week.” According to Tommy, the problem of drug addiction isn’t going to be solved by taking resources away from people who inject drugs.
“Yes, there’s a problem. But, closing [syringe programs] down or turning your back to is not going to change the problem. Problem’s still here.”
Until sterile syringes are made accessible again, Tommy says a lot of his friends will still be here, too — on the streets of Charleston.
Health officials in Huntington, West Virginia, say a cluster of HIV infections has grown to 71 confirmed cases. That’s in a city that usually sees about eight HIV infections in a year. As with an earlier such cluster in northern Kentucky, officials say the primary cause of infection is needle drug use.
Health officials say a harm reduction program is an effective tool against HIV infection. The programs usually offer a syringe exchange, access to addiction counseling, and health screening services such as HIV testing.
Credit Alexandra Kanik / Ohio Valley ReSource
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Ohio Valley ReSource
The programs have expanded rapidly in the Ohio Valley, a region hit hard by the opioid crisis and at highest risk in the nation of infectious disease outbreaks due to needle drug use.
But many people remain wary of syringe exchanges, and health officials are concerned that a backlash means some programs will close just when they’re most needed. The Huntington cluster of HIV cases appears to be correlated with the controversial closure of a nearby harm reduction program.
“The boomerang effect, the recoil, is going to be if these programs start closing, you’re going to see explosions of blood-borne pathogens, specifically HIV,” said Dr. Michael Brumage, director of the Preventive Medicine Residency Program in the West Virginia University School of Public Health.
High-Risk Region
In 2016 the Centers for Disease Control and Prevention spotlighted the counties in the U.S. at the highest risk of an HIV outbreak. Of the 220 high-risk counties, about a quarter were in Kentucky, West Virginia, and Ohio. The ten counties CDC found at highest risk were all in Kentucky and West Virginia.
Public health officials in the region have been working to implement syringe exchange harm reduction programs, which are widely supported as the most effective tool in combating HIV and other infectious diseases associated with needle drug use.
“It takes a while for them to build that level of trust up to come in,” he said. “That’s their one bridge, where they can be respected, and be given nothing but help to stay healthy.”
Corby-Lee said HIV prevention is the primary focus.
“That’s what they were designed for. But there are a lot of other benefits that come with it,” he said, such as peer counseling and screening for other diseases, such as Hepatitis C.
Credit Mary Meehan / Ohio Valley ReSource
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Ohio Valley ReSource
HIV/AIDS educator Greg Corby-Lee talking about harm reduction.
Corby-Lee said prevention and testing for HIV are becoming more widely available in the area, and stigma – which can thwart outreach, testing and treatment – is gradually diminishing.
But he and other health officials also worry about a backlash brewing in many communities, threatening the harm reduction programs. They fear that misconceptions about the programs may threaten the very communities at greatest risk of an outbreak.
Daniel Raymond is Deputy Director of Planning and Policy for the National Harm Reduction Coalition. He said that while harm reduction programs are generally expanding, some are closing in the communities where they are needed most. The programs can become the focal point for other problems associated with the addiction crisis, he said, such as litter from used needles, homelessness, and petty crime.
“A lot of these programs have been starting in communities that don’t have a long history with harm reduction,” Raymond said. “So the programs that end up being at risk of closure are often the ones that are getting scapegoated for a community’s drug problem.”
Closure, then a Cluster
Dr. Brumage says that’s part of the problem he encountered when leading a harm reduction program in Charleston, West Virginia. The program ended most of its services last year amid local political pressure and complaints about discarded needles.
“I think it’s a simplistic view to look at and blame one program for all of the city’s woes, with homelessness, with use, with all these other things,” Brumage said. “And I think that’s a trick that many politicians use very well, is to find a culprit scapegoat and to blame it rather than really looking at deeper issues.”
Credit Courtesy of West Virginia University
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Dr. Michael Brumage.
The deeper issue, he says, is that the HIV threat is real and not going away. Less prevention equals more sick people. In Huntington, one person in the HIV cluster has died. However, Brumage is concerned that some Huntington residents are now viewing the cluster of infections as evidence to close its harm reduction program as well.
“Currently, some people in that community are saying, ‘Well, look, we have the syringe program, and we still got HIV, maybe we just need to close the program,’” he said. “The fact that you have a fire doesn’t mean you should close the fire department. You know, you bring more trucks on the scene.”
Brumage worries that the closure of the Charleston program may have contributed to the rise in HIV infections Huntington is now experiencing. The two cities are less than an hour’s drive apart along Interstate 64. And Brumage argues that Huntington’s cluster of infections could be much worse without a syringe exchange in place.
“My guess is had Huntington not had a syringe program, this problem would have exploded far worse.”
Other health officials say the growing HIV cluster in Huntington is a cautionary tale.
“It’s the looming disaster that we were all afraid of,” West Virginia University School of Medicine Professor Dr. Judith Feinberg told Mother Jones magazine.
Signs of Hope
Still, harm reduction proponents remain optimistic. The National Harm Reduction Coalition says that for every program closing, 20 more open. Kentucky has witnessed rapid growth in such programs.
Van Ingram, who leads Kentucky’s Office of Drug Control Policy, said that has only been possible with a fundamental shift in thinking about drug use as a health problem instead of a problem for law enforcement. He admits he was skeptical that the programs could take root in Kentucky. But it’s happening.
Credit Kentucky Drug Control Policy Office
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Kentucky Drug Control Policy Director Van Ingram.
“I never dreamed we’d have 56 programs,” he said. “I did not think as many communities would have said, ‘Yes, we have a problem, and yes, we’re addressing big issues.’ Those communities are much, much quicker in recognizing the problem than I thought they would. I’m glad to say, I was wrong.”
Bourbon County, Kentucky, is an example of the phenomenon Ingram is describing. After several failed votes the county approved a syringe exchange program last year. Judge Executive Mike Williams said he braced for the complaints and backlash.
“I got gas yesterday afternoon and had three conversations at the gas pump about three different things,” he said, but the syringe program was not one of the things people had concerns about.
Since the syringe program opened, helping about 100 people, he said he’s only heard concerns from three people.
