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.
