On Tuesday evening, as Logan County commissioners voted 2-1 to draft an ordinance banning needle exchange programs from operating in their county, researchers from Johns Hopkins University were preparing to release a study documenting how the closure of the Kanawha-Charleston Health Department’s needle exchange program was a detriment to the community at large and put some of the most vulnerable in the region at higher risk of infection and, potentially, death.
There is not currently a needle exchange program in Logan County, nor has there ever been a real effort to open one, said Steve Browning, administrator for the Logan County Health Department. Danny Godby, Logan County Commission president, said Chris Trent, the victims advocate at the Logan County Sheriff’s Department, brought the idea for the ordinance to the commission’s desk.
If passed, it would be the first of its kind in the state, and Trent said individuals from other areas have already reached out to him expressing interest in introducing similar ordinances.
Trent cited the closure of the KCHD program last spring and a WSAZ-TV series entitled “Needles Everywhere” as part of his inspiration for the ordinance.
Godby shared those sentiments when explaining why he thought it was something the county needed.
“Along the terms of what we were thinking, why we’re doing this, like on the news, you see a little kid getting stuck by a needle and we can’t have that here,” Godby said. “When you’re in this position, you have to make a decision for your people, a moral decision of what’s best for them, and this is it, I think.
“We don’t need an abundance of needles being handed out.”
Both Trent and Godby said they’d be open to a needle exchange program with a 100 percent return rate, but neither said they think it will be possible any time soon.
Instead, Godby said, it’s better to close off the risk of people contracting diseases from stray needles “like you saw in Charleston,” and keeping first responders and police officers safe.
There is no solid documentation of individuals having contracted diseases from needle-sticks in Charleston, before or after the shutdown of the KCHD needle exchange program.
According to data released by the city of Charleston through a Freedom of Information Act request filed by the Gazette-Mail last year, five city workers sustained needle-stick injuries while on the job in 2017. There were six in 2016, four in 2015, one in 2014, one in 2013 and two in 2012. The city would not provide whether any of those injuries resulted in the worker contracting a disease.
According to the Centers for Disease Control and Prevention, needle exchange programs reduce drug use, needle-stick injuries among first responders, overdose deaths, and new HIV and hepatitis infections. They also save health care dollars.
The National Institute of Health estimates it can cost more than $90,000 to treat each uninsured person infected with hepatitis, while, when it was open, it only cost $250,000 annually for materials to operate the KCHD needle exchange program, according to an audit of the program performed by West Virginia Department of Health and Human Resources last May.
The CDC notes that such programs link people with addictions to treatment programs, provide a way to properly dispose of needles, decrease needle sharing, prevent infections and teach participants how to use naloxone, a drug that reverses overdoses and is regularly used to save lives.
‘Right on the cusp’
While Logan County is different than Kanawha, being that there has never been a needle exchange program in its borders, those who work in the recovery and health community are most concerned with public health risks.
“We are right on the cusp of being in the situation Huntington is in right now, of having an outbreak and not having the tools to fight or defend ourselves against it,” said Michelle Akers, executive director of the Southwestern Regional Day Report Center, which works with those in recovery in Logan and partners with the county health department for harm reduction services. “I know Logan County is not ready for a needle exchange program, but my hope would be that citizens better be aware we need to do everything else, absolutely everything we can, to prepare.”
Cabell County is currently experiencing an active HIV cluster, with 49 confirmed cases as of last week. According to a health advisory released by the state Bureau for Public Health, a majority of the cases are linked to injected drug use as opposed to male-to-male sexual contact, which has been the leading cause for past HIV outbreaks and clusters in the state.
In Logan, Akers and those at the day report center work directly with community members — not just those who use drugs — administering health screenings and other services. She and others in her office have sat side by side with people, holding their hands as they received an HIV diagnosis.
She worries that some in the county don’t understand the difference between needle exchanges and harm-reduction programs — which can include everything from condom distribution, testing for sexually transmitted diseases and screenings for HIV, hepatitis C and hepatitis B to referrals for rehab, treatment and mental health services. The former can be part of the latter, she said, but it’s not always and it certainly doesn’t have to be.
With the conversations she’s heard around the county since the commission’s vote on Tuesday, she worries the phrases are being used interchangeably, which could lead to further stigmatization and isolation for those in the area who utilize harm-reduction services.
Destigmatizing addiction is one of the biggest goals of the day report center, and for Akers, it’s an integral step in fighting the ever-growing drug epidemic in her home county.
“We need to look at each other as humans, no one is less-than,” Akers said. “We all need help sometimes and struggle — we need to support fact-based policies, not opinion-based policies, to help those struggling.”
Akers was never approached by the county commission or anyone else to speak about the science or evidence for harm-reduction services before the idea to draft an ordinance was voted on.
Browning, at the health department, said the agency did not oppose the ban because he wants to focus on working with the Sheriff’s Office — which supported the ban at the commission meeting — and the county commission to do the most with services currently provided for harm reduction, instead of worrying about ones they don’t even offer.
A few years ago, the county health department, under Browning’s direction, purchased an old 84 Lumber lot to offer satellite harm reduction services, as well as other health department services, like blood pressure clinics.
The location meant those who needed care wouldn’t have to feel nervous about going to the health department, which is located in the county courthouse, right next to the sheriff’s department.
“It was a way for us to make care, any care, as accessible as possible for people, and that’s what we need to do. We need to offer the services we do have as widely and as efficiently as we can,” Browning said.
In 2017, the agency also applied for a grant for harm-reduction services. While the funds, were they awarded, could have gone to needle exchange programs, that was not the intent of the application or the plans of those who wrote it.
“Harm reduction is a wide, wide classification of care,” Akers said. “We want money for those types of programs as much as we can — we need it; we’re at the brink of public health concerns here, and we should try to have as much in place to prevent that as we can.”
For longer than a decade, West Virginia has held the highest incident rate of hepatitis B of any state in the nation, and either the first- or second-highest incident rate for hepatitis C, according to data from the CDC and a study by DHHR.
Data from the 2016 surveillance summary for hepatitis B and hepatitis C infections in West Virginia, the most recent numbers available, lists Logan County as holding the 14th highest rate of hepatitis B transmissions of all counties in the state, and the 16th highest rate of hepatitis C infections.
The county is considered at high-risk by the CDC for an HIV cluster, mostly due to increases in injected drug use. Per DHHR data, overdose deaths in the county also more than doubled from 2016 to 2017, from 11 to 27, a rate of 82 per 100,000 people.
The DHHR study states there is ”overwhelming evidence” that harm-reduction programs can reduce the risks and rate of infections for hepatitis, and specifically, needle exchange programs can help quell the transmission of HIV.
As such, harm-reduction services are usually offered in direct response to statistics like the above, Akers said. The more people that can get screened or educated about overdoses and risks, the better protected communities are. There needs to be an effort, though, to make individuals at high risk — mostly people who inject drugs — feel like they are worthy and welcome to the services provided, to make them feel not ashamed, Akers said.
Building this trust can help transition more people into recovery, but without it — and with some of the things being said about those with addiction throughout the county lately — Akers worries what the future will bring for Logan.
For Barry Hensley, a Chapmanville native who has been in recovery for 18 months and will graduate from drug court on Wednesday, the county commission’s move to prematurely cut off a service like a needle exchange program before it even exists, sends a clear message.
“They don’t care about us. We’re not their people, and they don’t care if we live or die. That’s what it says to me,” Hensley said. “People are out here using dirty needles — paying for them — and they don’t even want to hear how we could be safer, how they could save lives?”
Hensley injected drugs — mostly meth — for years before getting clean. He now works at a coal truck company, managing a fleet of trucks, and supports his wife and two children. He said he’s happier than he’s ever been, but it was hard to get there, and the fact that he didn’t contract HIV or hepatitis while in active addiction was “a miracle.”
“I was lucky — incredibly so,” Hensley said. “I think, if I got something like that, HIV or [hepatitis] … I wouldn’t be clean today, I’d be dead. I wouldn’t have gotten into rehab, probably, what would have been the point? If we can save people from that hopelessness, that caring about nothing, why wouldn’t we?”