In newly released letters, eight harm reduction experts and program administrators from around the country disagree with the West Virginia review of the Kanawha-Charleston Health Department’s now-closed needle exchange program that ultimately led to the program losing state accreditation.
The experts take issue with the notion in the Bureau for Public Health audit that the program should have first connected patients to primary care and offered substance-abuse treatment before distributing syringes, that it distribute needles only to patients who come to the program in person and that incomplete data was a reason to close the program.
In a two-page letter dated June 11, Peter Davidson, a professor at the division of infectious disease and global public health at the University of California, wrote that the auditors appear to see the purposes of needle exchange programs as data collection and linking patients to medical care, so much so that disease prevention is an afterthought.
“As a consequence of this framing, almost all of the recommendations in the audit represent severe and in some cases unconscionable barriers to effective, evidence-based, primary prevention of blood-borne virus transmission,” Davidson wrote.
He wrote that the “gold standard” approach to achieving primary prevention is having a low threshold to access.
“By this I mean that decades of research have demonstrated that [needle exchange programs] are most effective at preventing the spread of HIV and other blood-borne viruses when they concentrate on providing enough syringes to people who use drugs for them to use a new syringe for every injection, and avoid anything that impedes that goal in any way,” he wrote.
The health department’s needle exchange program has been suspended since March, and a health board official has said there are no plans to restart it.
Mayor Danny Jones, who had called for the needle exchange program to be closed, asked Public Health to do the audit, which was released in May.
Matthew LaRocco, a community liaison at the Louisville Metro Syringe Exchange Program, wrote that he shares the state’s concern about KCHD’s data collection. But data collection can be a barrier that prevents a person from participating in a syringe exchange, he said.
“For that reason, data collected face-to-face from participants should be limited to data essential for the provision of services,” he wrote. “Other data, such as someone’s use of contraception, past history of treatment for [a substance use disorder], syringe sharing practices, etc., should be collected through the use of anonymous surveys. Collecting this data anonymously provides a space for the participant to share data of a sensitive nature without feeling uncomfortable.”
Tessie Costillo, advocacy and communications coordinator at the North Carolina Harm Reduction Coalition, wrote that it’s common at harm reduction clinics that participants take needles to distribute to other drug users who didn’t come to the clinic.
“This enables programs to reach far more people,” Costillo wrote. “One could argue, as this report does, that this practice enables proxy patients to avoid contact with services such as treatment referrals and medical care. But consider that the KCHD operates only during work hours in the middle of the week.”
Many proxy patients might be working, have children or have transportation problems that keep them from getting to the exchange, she wrote.
Costillo also wrote that the report appears to be one-sided — quoting first responders and city leaders but no KCHD staff or program participants.
Brenda Isaac, chairwoman of the Kanawha-Charleston Board of Health, has previously said the health board has no intention of restarting the needle exchange program.
The letters of support, which the health board solicited, also came from Dan Ciccarone, professor of family and community medicine at the University of California, San Francisco; Corey Davis, a teaching professor at the Brody School of Medicine at East Carolina University; Leo Beletsky, an associate professor of law and health science at Northeastern University; Laura Pegram, manager of the drug-user health program at NASTAD, an association of public health officials who administer HIV and hepatitis programs; and Robin Pollini, an associate director at the West Virginia University School of Public Health.
Isaac told the Gazette-Mail earlier this month that the letters vindicate the health department from accusations it mismanaged the needle exchange program.
“Did we make some mistakes? Yes, of course we did,” Isaac said. “One of which was we didn’t anticipate how quickly we would grow ... And the audit ... just about every conclusion in it was wrong, because they have looked over the audit thoroughly.”
Isaac previously said the board did not plan to release the reviews. After the Gazette-Mail and another news outlet requested them under the Freedom of Information Act, the department released the letters to the newspaper Thursday morning. Copies also were distributed at the health board’s regular meeting Thursday afternoon.
Isaac said releasing the reports “shows that we were following the correct guidelines and standards in our program and trying to do it on a shoestring budget.
“The findings from the audit were really auditing the program as if we were a clinical program, and harm reduction/syringe exchange is not clinical, it’s a public health program,” she said. “You can’t audit it on clinical guidelines, which I am sure the state department knows that. At least I would have assumed they would know that.”
A spokeswoman for the Department of Health and Human Resources did not respond to an email requesting comment from Dr. Rahul Gupta, commissioner of the Bureau for Public Health. Gupta announced his resignation earlier this week, effective in November.