Harm reduction programs, mainly the syringe exchange portion of them, have been a divisive issue for many West Virginians over the past several years.
The Legislature has passed regulations that will make such programs harder to maintain. Whatever slivers of daylight that existed in state law were sealed off in the capital city, as the Charleston City Council passed further restrictions on such programs. This as Charleston is facing one of the worst HIV outbreaks in the country, all traceable to sharing contaminated needles for intravenous drug use.
It’s a shame to see things go in this direction, because harm reduction programs do save lives, cut down on infectious disease rates and introduce users to avenues of recovery. There’s plenty of data to back that up, but I’ve also seen it happen.
In late 2014, Huntington was in the throes of an overdose crisis. Dozens were dying every couple of weeks, with more having to be revived, because they were overdosing on heroin, fentanyl or some mixture of the two. The city had never seen anything like it.
On top of that, hepatitis C rates in Huntington and surrounding Cabell County were exploding because of shared needles. Needle litter was a rising concern.
Huntington’s response was nothing short of masterful.
Mayor Steve Williams created an office of drug control policy and staffed it with the three best minds for addressing the problem — former longtime police officer Jim Johnson, Huntington firefighter, EMT and emergency room nurse Jan Rader and Huntington Police statistical analyst Scott Lemley.
Williams and Johnson admitted to me during an interview at the time that, while the goal was obvious, they were unsure just what the new office would do or how it would all work. In a sense, figuring that out was the mission. The office spent its first couple of months looking at the data and potential solutions. They invited me in one day to show me what they had found, and what they were likely going to need to do.
I remember Lemley showing me a particularly high number of deaths in a short span of time, saying, if that number of people had died in car crashes on Interstate 64 in the same time frame, it would be recognized as a full-blown crisis. There was detailed data on hepatitis C and prostitution arrests linked to getting money for drugs.
I could see where this was going. They were reluctant to use the phrase “needle exchange,” and wanted to point out other aspects of the program — like supplying lifesaving nalaxone and having counselors available to get people into recovery. But the needle exchange was a big part of it, and they were nervous about how it would be perceived.
Before ever taking the plan to the Huntington City Council, they took it to news media outlets, churches and community groups. When Johnson, the sort of grizzled cop who had fought crack cocaine in Huntington in the 1980s and 1990s, made the argument that these were people who needed help, and that no amount of arrests would solve the problem, it was powerful. The data was powerful. Rader’s insight into why people across all socioeconomic boundaries were suddenly using heroin was powerful.
The office of drug control policy created a coalition of community support. It was going to take everyone to make this thing work. When community leaders and residents across the city saw the numbers, the projections and, most importantly, that those suffering were human beings worth saving, it clicked.
That’s not to say the plan had a 100% approval rating. Nothing ever does. And there were some of the stereotypical arguments against the program — that it enabled users or created more addicts. But the office of drug control policy had the data to show that wasn’t the case. Even if they couldn’t reach someone’s heart, they could show the astronomical cost of treating a hepatitis C patient for the rest of their life, or how outbreaks of diseases associated with IV drug use created a greater health risk for everyone.
When it finally came time for the City Council to take up the proposal, it was clear the approach had paid off. There was massive public support.
The program was successful right off the bat. It didn’t solve every problem, but overdose deaths decreased, as did disease rates.
Williams, Rader, Johnson, Lemley and others were frequently featured guests at gatherings of civic leaders from across the country, showing city officials from places like Milwaukee how Huntington had built a successful harm reduction program.
Public support wavered from time to time. There was a period when the Cabell-Huntington Health Department — which ran the program — stopped following what were considered best practices after some public pressure. The fallout was predictable, and soon they were back to the original blueprint.
Things went much differently in Charleston, where the health department’s program became a political issue and was shut down. Other programs have come and gone, but it’s always been a polarizing concept in the capital city. And now, thanks to the Charleston City Council and the West Virginia Legislature, it looks like such a program will never get off the ground, let alone fight the problem effectively.
Sadly, the new, restrictive state legislation likely will also impact the effectiveness of Huntington’s program.
It didn’t have to be this way. Huntington laid out a clear plan for how it can work. Unfortunately, it’s hard to go back to the ground level and try to garner broad support after the issue has become politically radioactive. Public health in many West Virginia cities will continue to suffer because of such short-sightedness.