Feinberg, Macmadu, Stone, Parker: Shutting down local syringe programs bad idea

What are the impacts of limiting access to sterile syringes? What happens when you shut down your local syringe services program? To gain a clear view of the damage it does, we need to look no further than Cabell and Kanawha counties.

In the spring of 2018, after political pressure forced the closure of the Charleston syringe services program, the Cabell-Huntington Health Department tightened the rules of their program despite being labeled the “overdose capital of America.” These changes went against the evidence-based practice of supplying people who inject drugs with what they need: a sterile syringe for every injection. This alone decreases the spread of HIV, hepatitis B and C, and other infectious diseases in our communities. But we can’t blame the Cabell-Huntington Health Department for their choice to scale back — the tea leaves showed they could have been shut down entirely if they didn’t bend toward more politically palatable changes.

Following these restrictions, the number of monthly clients who sought support from the Cabell-Huntington program quickly dropped by more than half, from 1,050 clients in April to only 463 clients in December.

Less than a year after the program began operating under new restrictions, the first reports of a spike in HIV cases in the area went public. In March 2019, 28 new cases were reported, and it went up steadily from there, reaching 73 cases by the end of the year. Huntington was soon labeled on the national scale as the West Virginia town with an “unprecedented HIV outbreak.”

Even if you don’t care about people who use drugs (or their friends and family, or their friends and family, and so on — see, that’s the nature of infectious diseases, they spread even to those who never used drugs), the issue of syringe access has clear implications for healthcare budgets. Failing to provide access to simple, evidence-based, low-cost harm reduction programs carries a heavy burden in healthcare costs. In 2010, the Centers for Disease Control estimated that the lifetime cost of treating someone with HIV is $379,668 — or $447,837 in 2020 when accounting for inflation, and the costs only go up from there. Unrealistically, the CDC estimate also assumes that a person is only infected with HIV and not with hepatitis B or C, heart infection (endocarditis), or any other complications.

That’s a lot of avoidable anguish, a lot of lifelong infections and a lot of money lost in the wind.

It’s worth remembering: a new, sterile syringe costs only 15 cents or less.

Since the closure of the Kanawha-Charleston Health Department syringe services program, cases of chronic hepatitis C have increased more than two-fold, from 458 in 2017 (the lowest number since 2012) to 1,114 in 2018. The rate of new HIV diagnoses among people who inject drugs increased by 350 percent, from an annual average of two cases to nine new cases in 2019, heralding another HIV outbreak in our state.

At its height, the Charleston syringe program served over 6,000 people in 126 zip codes. By denying access to sterile syringes, thousands were denied access to other key resources: vaccination for hepatitis B, naloxone, mental health care and treatment for substance use disorders. The CDC reports that people who access harm reduction programs are five times more likely to enter treatment than those who don’t. When you shutter a syringe program, you also shutter a gateway to recovery.

By passing a statewide law prohibiting syringe service programs, we are setting a dangerous example. West Virginia is still recognized as the overdose capital of the country. We have the highest rates of new hepatitis B and C infections, and we have the highest number of babies born in withdrawal from maternal drug use. By closing our syringe programs, we are communicating to the country that West Virginians who use drugs are second-class citizens, unworthy of care. But we know better: They are our family, friends, neighbors and co-workers. Let’s rethink our approach and refocus on a fiscally responsible strategy that offers a humane response to the crisis we are living in, rather than support policies that hurt people and harm their chances to enter recovery and regain their lives.

Dr. Judith Feinberg is a professor at the WVU School of Medicine and chairwoman of the HIV Medicine Association.

Alex Macmadu is a doctoral student in the Department of Epidemiology at the Brown University School of Public Health.

Sarah Stone and Brooke Parker are members of SOAR-West Virginia.

Funerals for Thursday, April 2, 2020

Cox, Raymond - 1 p.m., Ferrell Cemetery, Harmony.

Hemlepp, Pauline - 11:30 a.m., Henson & Kitchen Mortuary, Huntington.

Nichols, Ronzel - 4 p.m., Hebron Cemetery.

Payne, Nancy - 1 p.m., Casto Funeral Home, Evans.

Williams, Romeo - 2 p.m., Sunset Memorial Park, South Charleston.