Needle exchange is a hot topic again in Charleston with the City Council expected to vote in upcoming weeks on an amendment that would criminalize needle distribution.
Here are answers to common questions about needle exchange programs based both on interviews with public health experts and on peer-reviewed research and guidance published by the Centers for Disease Control and Prevention, the World Health Organization and the National Institute on Drug Abuse, among others:
What is a syringe service or needle exchange program?
These programs are part of what’s known as harm reduction services. They provide people who inject drugs with clean syringes to reduce the risk of contracting HIV, hepatitis or other bloodborne diseases.
Some programs require syringes to be returned in exchange for clean ones, though this practice is not endorsed by the CDC or other public health groups.
Why give people needles to use drugs? Isn’t it enabling?
Experts agree that people who inject drugs will do so regardless of whether they have clean needles. Studies show increased access to these supplies — which help lessen disease spread — does not increase drug use. Needs-based syringe service programs can be three times more likely to get people into recovery, even while that is not the goal of such programs, according to the CDC.
What does ‘harm reduction’ mean? What does it entail?
Harm reduction means reducing harm to people for the sake of public health, and while the term is mostly used in relation to addiction and drug use, the strategy can be applied to many public health concerns. When it comes to harm reduction for addiction, the goal is simply to lessen harm people with substance use disorder incur by using drugs. The opioid overdose reversal treatment Naloxone is a large part of harm reduction efforts for addiction, as are wound cleaning kits, tourniquets and other tools used by people who use drugs.
What is a ‘best practice’ needle program?
The CDC says best-practice models should: involve people with addiction experience, including those who actively use drugs; use a needs-based model where there is not a requirement to return as many needles as one takes; provide expanded services (such as HIV testing) along with needles; collect data on needs and trends of the community; and ensure program sustainability.
What is Solutions Oriented Addiction Response, or SOAR?
SOAR is a grassroots, community health group specializing in assisting people who use drugs in Kanawha County. The group is volunteer-run and donation funded.
The group was founded about two years ago by Joe Solomon, a community organizer and social worker, and Sarah Stone, who is in recovery. Solomon said he and others he knew in the recovery and social work realms were motivated into action as they saw Kanawha County’s HIV and hepatitis rates soar among people who inject drugs.
SOAR volunteers teamed up with residents at Recovery Point, a local rehabilitation facility, to visit local businesses for the Charleston Lifesavers project. SOAR provided more than 100 businesses in the Kanawha Valley with Naloxone to keep in their first aid kits. From 2019 to 2020, dozens of people were revived with those Naloxone doses. About 18 months ago, SOAR began distributing syringes.
What happens at SOAR street outreach?
Typically held at the Unitarian Universalist church on Charleston’s West Side, SOAR’s street outreach events offer people coats and blankets and free rapid HIV testing onsite. People at the events are trained in administering Naloxone. Food, water, masks, hand sanitizer, sterile equipment and sharps containers are handed out, in addition to needles. Among SOAR volunteers are doctors, peer recovery coaches, addiction specialists, lawyers, social workers and advocates. Some help people navigate how to get into safe housing or answer health-related questions.
Why did Charleston police investigate SOAR? What did they find?
In 2015, as Kanawha County and the City of Charleston were preparing to start a syringe service program, the City Council passed an ordinance that, at the time, was meant to decriminalize needle distribution in the city.
The ordinance required syringe distribution programs to be approved by the city police chief or licensed by the state health department to operate in Charleston.
In October, following a television news report about SOAR’s program, Charleston police Chief Tyke Hunt opened an investigation. That probe found the wording of the previous city ordinance was too loose to inform anything since the state does not operate a syringe service program licensure program.
Further, Hunt said, law enforcement should not be responsible for approving a medical program.
What do people who support this program say?
Program backers say clean syringes are integral to slowing the spread of communicable diseases, including HIV and hepatitis. They also say harm reduction programs that include syringe services can connect more people to other tools and resources, including Naloxone and rehabilitation services. This can lessen the risk of overdose deaths and give people who use drugs more resources to use to stay safe and healthy. Backers cite more than 30 years of peer-reviewed studies and research on syringe service programs.
What about those against it?
Opponents’ concerns center on needle litter, needle sticks and community safety related to drug use and crime. There are more nuanced concerns, such as the impact of running a program for people who inject drugs — who tend to be mostly white — in a predominantly Black neighborhood. SOAR officials say the latter concerns are justified and they plan to work more with representatives in this area.
How much needle litter is there in Charleston?
In 2020, Metro 911 reported receiving less than 130 calls for syringe pick-ups. Since November, SOAR has operated a syringe pickup hotline but has received just one text for a pickup, representatives say.
How many stray needle-stick injuries occur in Charleston?
No entity in Charleston or beyond tracks needle-stick injuries in West Virginia. Reports filed with the Occupational Safety and Health Administration show 20 needle-stick injuries among Charleston City employees over the last three years: eight in 2018, two in 2019 and 10 last year. Five cases involved people being stuck while searching belongings. Most cases were punctures from uncapped needles in trash or people pricked while disposing of or bagging needles.
What is the risk of getting HIV from a needle-stick injury?
A 2014 German study found about 100 people worldwide, all of them health care workers, had contracted HIV from a needle-stick injury. There has been one such case in the U.S. since 1999. There are no documented cases of people contracting HIV from a discarded needle in a public place, according to numerous global public health agencies. Needle-stick injuries are usually only skin deep, limiting the chance of contracting blood-borne disease. Viruses in infected blood rarely survive on needles left outside exposed to the elements.
How does recovery and rehabilitation fit into needle exchange programs?
Recovery is not the main goal of these programs, but it is part of the services offered. The programs are more focused on ensuring people who inject drugs can stay alive and healthy until they decide they’re ready to enter a recovery program. The programs are also about building trust with people who use drugs so they have connections if they do decide to enter treatment.