BUCKHANNON — Local residents and healthcare providers attended Thursday’s Upshur-Buckhannon Health Department board of health meeting to discuss their opposition to and support for the implementation of the hypodermic needle exchange component of a harm reduction program that will begin Thursday in Upshur County.
The health department has partnered with Milan Puskar Health Right, a free healthcare clinic in Morgantown, to offer a harm reduction program to intravenous drug users on the second Thursday of every month in the health department parking lot and at the intersection of Route 4 and Route 119 in southern Upshur County.
The purpose of a harm reduction program is to curb the spread of blood-borne diseases, such as HIV and Hepatitis B and C that can result from the use of “dirty” needles. Sue McKisic, nurse director of the health department, has argued the harm reduction program offers a slew of other services in addition to the controversial needle exchange portion, including wound care, social services, mental health counseling services, referral to treatment and recovery resources and more.
Opponents: Could the program “trigger” rather than curb intravenous drug use? Will it adversely affect the general public?
But the idea isn’t sitting well with some residents, like Susan Foster, who signed up to speak during the health board’s public comment period Thursday.
The needle exchange is not a one-to-one exchange, as was previously reported. McKisic said Sunday the health department will provide users with as many needles as they need to make it through a month.
Based on data collected from multiple syringe exchange programs, McKisic said that distribution is most effective in halting the spread of disease.
Foster recommended strengthening those parameters by requiring users to bring back every needle they initially receive as a prerequisite to the clinic issuing any additional needles.
She also had more questions for the five-member health board.
“Do you have data on the cases of Hepatitis B and C to compare to see if
Foster also asked if users would be required to show identification confirming they are Upshur County residents.
“If not, what will stop people of areas from coming here just to take advantage of the free needle exchange program?” she asked. “How will the overall success or effectiveness of this program be evaluated? What parameters will be used? What level or percentage of needle return will be considered successful or acceptable?”
“What data is there to demonstrate the successful outcome of participants seeking help to overcome their addictions as a result of these needle exchange harm reduction programs?” Foster continued. “Why is mandatory attendance and participation in drug counseling, group or individual therapy, support groups or other treatment modalities not an essential or mandatory component of this program?”
The Rev. Ed McDaniels, who also attended Thursday’s meeting, raised other concerns about the program.
“If my understanding is right, you’re giving them the cooker, you’re going to give them a tourniquet, you’re going to give them some cotton balls, you’re going to give them the other paraphernalia? The only thing you’re not giving the drug user is the drug.”
McDaniels argued that distributing needles could potentially trigger a drug user to want to use in the same way that seeing a cigarette butt on the ground might trigger a former smoker to want to light up.
“If I see a needle, I’d like to use drugs, just like if I was recovering from smoking, and I see a cigarette butt, that would be a trigger for me,” McDaniels said. “You’re giving them everything they need to take the drug, but the drug. In my head, it just doesn’t seem right that public officials ought to do that.”
McDaniels also raised the question of how health department officials would feel should they find out a needle they had given to a user was the same one the user had used to overdose. How would department officials feel if that user ultimately died? Would they want to carry that burden?
Advocates: It’s about public health
Proponents of the harm reduction program — including the needle exchange — also attended Thursday’s meeting to share their viewpoints.
Matt Kerner, executive director of the Opportunity House and a person in long-term recovery himself, provided Foster with a lengthy report from the World Health Organization that was published in 2004 and is a distillation of about 200 research articles on the effectiveness of needle exchange programs in stopping the spread of disease. The title of the study is “Effectiveness of sterile needle and syringe programming in reducing HIV/AIDS among injecting drug users.”
“There were no contraindications, and there’s no reason why we should not move forward with this,” Kerner said. “This was done in 2004; this was done 13 years ago. It has clearly demonstrated that it does move some people into recovery.”
“We shouldn’t allow public health policy to be driven by fear, opinions, feelings, thoughts,” Kerner added. “It needs to be driven by science, and we have that … I would urge the health board to move forward with implementing this as planned.”
Dr. Lyndsi Cress, who is the daughter of health board member Larry Carpenter, also spoke in favor of the program, saying needle exchanges are intended to stop the spread of blood-borne diseases.
“This program is about public health,” Cress said. “It’s about preventing Hepatitis B, C
Cress said she often feels helpless when she sees clients who are addicted to opioids because there are so few
“As a health care provider, I feel extremely helpless in that situation, but if there’s something I can do to prevent Hepatitis and long-term illness, why wouldn’t I?” Cress said. “Hepatitis C leads to liver cancer and a whole host of other issues … so if there’s any small thing we can try to do to prevent that, why wouldn’t we?”
Dr. Gregory Peters, a local family medicine practitioner, said needle exchange programs are often the “first step” in convincing addicts to seek treatment. Intravenous drug users are a population that doesn’t often seek out medical services because they’re wary of being judged, Peters said.
“You chip away feelings and people’s gut reactions about what a needle exchange program is, and you just look at the math, the math supports [the intention],” Peters said, adding that West Virginia leads the nation in the number of newly diagnosed Hepatitis B cases.
Joy Messenger is the associate director for Appalachian Community Health Center, which has an office in Upshur County on Kanawha Street. She argued the community should look at the bigger picture and not zero in on the needle exchange aspect.
“Certainly, needle exchange is certainly part of it, but it’s a much bigger thing,” Messenger said. “There’s so much to a harm reduction program, and if we could look at it as a harm reduction program versus a needle exchange program, maybe we could all sleep better at night because we’re going to try to offer other services, whether that’s evaluation or whether that’s offering counseling, or whatever that is that we can give people in our community to make them want to come for other services.”
Foster said she still felt the health department wasn’t considering the well-being of the general public who are non-users and first responders.
“What about the responsibility to the rest of the public and the community?” Foster asked. “I’ve heard no one address what happens to our first responders, our police officers, the public who may encounter a dirty needle and get stuck? You have an obligation to protect the entire public health, not just people who are putting themselves at risk through their IV drug use.”
The health department’s take: It’s about protecting the community on a tight budget
At that point, Carpenter, a health board member, said he’d like to make a brief statement.
“Every voting member that you see on this board is a volunteer,” Carpenter pointed out. “Every year, we’re getting cuts. We have to take what money we can get and we have to use it in a very smart, intelligent manner. This harm reduction program, we are not trying to be a recovery program. We don’t have the funds. We don’t have the expertise to do that. But the people we have turned this harm reduction over to [Milan Puskar Health Right], they do that. We can go out and try to protect community with the least amount of dollars we have and protect those people.”
Carpenter stressed that the health department itself is not the entity that will be distributing needles.
He said other health departments in larger areas were handing out needles.
“We are not going to do that,” Carpenter said. “That’s why the program was stopped [in larger areas, such as Charleston]. That’s why they’re going with a different program, one that’s similar to what we’re doing.”
An ideal result or an ordeal?
Laura Jones, executive director of Milan Puskar Health Right, fielded a few questions from McDaniels and Foster.
McDaniels observed that it was difficult to “wrap your head around” the fact that the health department, or a clinic it’s partnering with, will be passing out paraphernalia associated with an activity that’s illegal.
Jones said MPHR is trying to lobby for the state to focus on larger sellers of drugs, rather than their addicted customers.
“So we’re trying to focus on not putting the drug users in jail, but to focus on the people who are selling drugs in our communities, to focus on the pharmaceutical companies that pumped thousands of pills into our communities that eventually caused the heroin problem that we have,” Jones said. “It does seem like the opposite thing to do to give a syringe to a drug user, but when you understand how desperate people with heroin addiction can be, and you understand they will use any syringe they can find in order to get the drug that their body now tells them that they desperately need, [you can understand the rationale for an exchange program].”
Jones said there’s a lot of misinformation — particularly about the situation in Charleston — floating around.
“The idea that there are 200,000 syringes out on the streets in Charleston that nobody knows where they are, that’s just not true,” she said.
Jones said MPHR uses several mechanisms to attempt to ensure proper disposal of “dirty” needles. First, biohazard containers are given to users, which they are instructed to fill with used needles and return to the clinic; in addition, information about how to safely and legally dispose of used needles
McDaniels countered, “That’s the ideal, but most of the time we get an ordeal and most people are looking for a new deal.”
Jones defended the program, saying the majority of the people who participate are no longer getting high from heroin.
“They just use it to feel normal,” she said. “These are people who have jobs, who are grandparents. We have seen every person from every socioeconomic background you can imagine in our Morgantown facility.”
Jones further argued that people who attend syringe access programs are five times more likely to enter treatment because they finally have someone to talk to about their addiction.
“A lot of people are keeping their disease a secret,” Jones said. “They don’t tell their family or friends … so they don’t have somebody to talk through, ‘How do I get out from under this?’ And that’s part of the conversation we have with people, and as we develop a relationship over time, then we can help people move to the next step in recovery. That’s what we hope happens.”