Health department stresses benefits of needle program amid questions

BUCKHANNON — Representatives on one side of the issue said they’re trying to stop the spread of blood-borne diseases.

People on the other side of the debate said they were upset a syringe access program has spread to their community.

And by the time the more than two-hour-long public forum concluded on Tuesday, June 19, in the Public Safety Complex, individuals with differing viewpoints on the syringe access component of the harm reduction program —commonly referred to as a needle exchange — had yet to reconcile their differences.

How did we get here?

In May, the Upshur County Health Department partnered with Milan Puskar Health Right in Morgantown, a free healthcare clinic that has implemented a harm reduction program in Monongalia and Preston counties, to start up a similar program in Upshur County. On the second Thursday of each month, the harm reduction program is held in the health department’s parking lot and at the intersection of Routes 4 and 119 to reach rural Lewis and Upshur County residents.

The harm reduction program offers a slew of services to intravenous drug users in the midst of West Virginia’s opioid and heroin epidemic, including counseling, social services, help accessing primary care doctors, wound care, connections to drug treatment programs, access to Naloxone, which reverses opioid overdoses and more. But it also offers a syringe access program that provides clean syringes — or needles — and equipment used to inject heroin or other drugs in an effort to stop the spread of blood-borne diseases like Hepatitis B, Hepatitis C and HIV.

That portion of the program has proved controversial with some Upshur County residents and government officials, who either don’t like the idea of distributing syringes in Buckhannon or wish health department officials had held public hearings prior to implementing it. On Friday, April 13, health department nurse director Sue McKisic held an invite-only educational session on harm reduction for public health and safety personnel, as well as city and county officials.

The event was sparsely attended, and in its wake the health department scheduled the June 19 meeting, opened it to the general public and invited MPHR executive director Laura Jones and Caitlin Sussman — the social worker who helps administer the program in Upshur County — to deliver a presentation.

The argument for syringe access

At the outset of the forum, McKisic said she wanted to make it clear that neither the health department nor MPHR are encouraging or condoning the use of illegal drugs.

“We, Upshur-Buckhannon Health Department, and our partner, Milan Puskar Health Right, are in no way encouraging, I repeat, are in no way encouraging the use of illegal drugs or improper use of prescription drugs,” McKisic said. “We are trying to reduce infectious disease that is bombarding our state right now.”

Jones, the MPHR executive director, then provided an overview of the harm reduction program, known as L.I.G.H.T., which is an acronym for Living in Good Health Together.

She said the program isn’t just about distributing syringes, “but actually working with them to improve their health and eventually, and hopefully, get them into treatment.”

The program is not a one-to-one needle exchange; participants, who must carry a membership card and provide information to health officials, are given as many syringes as they need for the duration of the month.

Jones said the program is about rekindling hope where it’s largely died out.

“We are trying to shine a light into the darkness of addiction and opioid use,” Jones said. “Most of the people we’ve been seeing over the last three years, that we’ve gotten to know, have gotten to a point where they don’t see a lot of hope for the future,” Jones said. “They can’t imagine their life without using heroin or other drugs, but our job is really to help them find hope that recovery is possible.”

Jones also discussed the need for harm reduction, calling it “immense.”

Not only has the number of West Virginians who inject drugs doubled over the last five years, overdose rates have also skyrocketed. Users who share needles put themselves at a very high risk for contracting Hepatitis B, Hepatitis C, HIV and other conditions, including cellulitis and endorcarditis, Jones said. West Virginia’s rate of neo-natal abstinence syndrome — babies being born dependent on opioids — is one of the highest in the country, she added.

“Things are a little unique in West Virginia, though, because we currently have the highest rate of Hepatitis B in the country,” Jones said. “We also have the second highest rate of Hepatitis C in the country, and both of these rapid increases are related to people who are injecting drugs, and typically the transmission occurs because there are not enough syringes in the community and people don’t have access to them, so they’re sharing them.”

Jones pointed to what happened in Scott County, Indiana in 2014 as a cautionary tale.

“In 2014, they had one person injecting drugs who had HIV and they now have over 200 people in Scott County, Indiana who are positive for HIV because there was no syringe exchange and people were sharing syringes,” she said. “Scott County, Indiana is a small, rural county, and that’s part of the reason West Virginia has to move so quickly is because we’re a state full of small, rural counties where these kinds of things could happen.”

Harm reduction can keep people alive and as health as possible while they’re engaging in risky behavior.

“The people that are using heroin or injecting other opioids know that this is risky,” Jones said. “They know it, but they’re addicted, and that addiction is stronger than logical, rational thought, so what we try to do is put plans in place so they have syringes so they do not need to share them with someone.”

Jones corrected one misconception, saying harm reduction programs don’t spur people who don’t already use controlled substances to begin using.

“A lot people believe that harm reduction causes people or encourages people to use drugs. There has never been a situation where someone has walked into our clinic and said, ‘I’m here because I heard I could get free syringes. I really want to try heroin,’” Jones said. “The people that we see are already addicted, have already been using and they will use whether we have a program or not. They also will use whatever syringe they find.”

Jones argued harm reduction is a realistic approach to nudging people toward recovery, saying heroin users can’t stop “cold turkey,” but rather, must often undergo a lengthy detox process prior to treatment.

Ultimately, harm reduction works to prevent or stop the spread of blood-borne diseases, Jones claimed.

“Evidence-based data shows using a clean syringe every time stops transmission of blood-borne diseases,” she said.

Harm reduction involves a “low-demand,” empathetic and client-centered approach that doesn’t shame, blame or judge people who are addicted and treats addiction as a medical disease rather than a moral failure.

Sussman, the social worker, said the program allows medical professionals to start a conversation with people they likely wouldn’t otherwise encounter.

“We are trying to reach people when they’re not ready for change and help move them along,” Sussman said. “Without the harm reduction program, this population is not being accessed.”

Program pushback

The majority of people who attended the June 19 forum expressed concerns about it, including Buckhannon resident Ron Pugh.

“The idea that needle exchange helps prevent the outbreak of this, that and everything else, AIDs and HIV, but you’re doing nothing to actually prevent the use of drugs [is troubling],” Pugh said.

Jones said prevention isn’t possible with a population already addicted.

In addition, councilman Robbie Skinner said he wished the health department had vetted the idea with the public prior to starting it.

“Although I appreciate this evening, where was this three months ago?” Skinner wanted to know. McKisic referenced the April 13 forum, saying she’d sent out 100 invitations, including one to city hall. Skinner said he never received one.

“I think the invitation route didn’t work because a lot of us didn’t know about it,  and I try to have my finger on the pulse of everything that happens in the community as a member of the city council, as an elected official,” he said. “I didn’t know this was going on until the week of the exchange, and that really troubles me because I believe there should have been a lot more transparency about this leading up to it.”

Skinner questioned whether Hepatitis B and C and HIV are problems in Buckhannon.

“It’s purpose, so sayeth, is to reduce Hepatitis B, C and HIV. Do we have a big problem with that in this community?” he asked. “To me, it seems like we have more of an issue with overdoses.”

Jones said although she wasn’t able to find statistics regarding either form of hepatitis, there are currently 42 cases of HIV combined in Lewis, Upshur and Randolph counties.

“You only need one person with HIV to be sharing syringes with someone else in order to have an outbreak,” she said.

Skinner also said the community is concerned syringe access will downgrade Buckhannon’s quality of life.

“We are very proud of our quality of life here, and we are very, very concerned that this is going to change that,” he said. “We have really worked hard here to have a good community, and we are known statewide, regionally for being one of the best places to live, work and play. We want to keep that.”

Another resident, Roger Davis, said he feared the syringe access program would lead to needles being disposed of in public places, such as on sidewalks and streets and in parks.

“We’re not against helping people,” Davis said. “Our problem is the health department going in and going to pass these needles out. We’re going to have them in our city parks, lying in our streets and everywhere else.”

“If someone’s irresponsible enough to do drugs, do you think they’re going to be responsible enough to use these needles properly?” he asked.

At that point, Tyler Gordon, a deputy with the Upshur County Sheriff’s Department, brought a bag full of used syringes up to the front of the room. He said used or “dirty” needles are already being found in people’s vehicles and other places.

“I want to show everybody something,” he said. “This is what just me, personally, what I find on people, in cars, things like that. These people don’t care whether there’s a needle exchange program or not. These ladies are 100 percent right (about the syringe access program). I hate drugs as much as anybody in this room. I deal it every night of my life and I’m sick of it, but these people use no matter what.

“The quality of life here, I think that’s more reason to do these kind of programs,” Gordon added.

The Rev. Ed McDaniels said he’s upset the program could potentially distribute needles to minors since it has a policy of not asking for identification.

“It just seems so wrong for you or any county official to give [someone addicted] a needle,” McDaniels said. “The thing that really bothers me the most, that there’s no age requirement for this.”

Sussman said that to her knowledge, no one under 18 has signed up for the L.I.G.H.T. program, adding that protocol is different for dealing with minors.

“I’m a social worker. I’m a mandatory reporter,” Sussman said, “so if I see someone who’s under the age of 18 who doesn’t have their basic needs being met and lives in a household that allows them to inject drugs, I’m required to call CPS.”

Pastor Jerry Murrell said he thought the program was conveying a message of resignation to the opioid epidemic.

“I don’t want to say, ‘It’s done and all over, and everybody’s going to do drugs, let’s just equip them,’ and that’s the perception we’re receiving,” Murrell said. “We’re not questioning your intention … We don’t disagree with that, we just disagree with the methods and how you’re trying to achieve the goals we’re trying to achieve.”


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