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West Virginia has the highest fatal drug overdose rates in the nation. In addition, data from the West Virginia Office of Drug Control Policy indicate that, since the pandemic hit, the number of fatal and nonfatal overdoses has significantly increased in many counties — particularly in Kanawha.

Additionally, in the past year, HIV cases in Kanawha County increased by 34%; and more than 80% of those cases are linked to intravenous drug use. The total cost of lifetime HIV medical treatment in Kanawha County for those people diagnosed with HIV in 2019 and 2020 (as of Dec. 15, 2020) is estimated at $17,844,396.

HIV is not the only concern. According to the federal Centers for Disease Control and Prevention, 28 of West Virginia’s 55 counties (including Kanawha) are at risk for hepatitis C (HCV) outbreaks, largely because of intravenous drug use. In 2016, Kanawha County had the highest number of newly reported acute HCV infections in West Virginia.

One way to prevent the spread of infectious disease and decrease overdose deaths is through the implementation and operation of harm reduction programs that often include syringe service or needle exchange. Currently, the West Virginia Department of Health and Human Resources recognizes 18 harm reduction programs in the state. All of these programs include some type of needle exchange program.

National best practices suggest that harm reduction programs should include syringe service programs (or SSPs) that provide a wide range of services, including linkage to primary care, substance use treatment, vaccinations and testing, as well as needle exchange.

Some programs require a one-to-one exchange (clients must return one needle for each needle dispensed). However, the CDC recommends a needs-based approach that does not limit the number of needles dispensed versus returned.

The CDC reports that these programs result in an estimated 50% reduction in HIV and HCV incidence. When combined with medications that treat opioid dependence (also known as medication-assisted treatment), HCV and HIV transmission is reduced by more than two-thirds. In addition, new visitors to needle exchange programs are five times more likely to enter drug treatment and three times more likely to stop using drugs than those who don’t use the programs.

Despite documented outcomes and identification of best practices, needle exchanges often are controversial, because of a lack of community support, stigma surrounding substance use disorder and concerns about public safety.

Some communities are able to overcome these barriers while others remain stuck.

On Jan. 8, the West Virginia Drug Intervention Institute Inc. launched a survey to conduct an analysis of community opinions on substance use disorder, harm reduction and syringe exchange. The project is not intended to assess or evaluate any specific program but will assess community perceptions and attitudes, and determine gaps that exist in addressing substance use disorder (specifically in Kanawha County).

The research includes an online, (anonymous) short-survey people can complete. The survey is open to the public via the institute’s website, www.wvdii.org/harm reduction, through Friday.

People wishing to participate in additional discussion (listening sessions or focus groups in late January) can choose to identify themselves and share contact information.

The project will culminate in the release of a document summarizing the survey data and focus groups, along with recommendations for addressing substance use disorder in Kanawha County and the rest of state.

Susan Bissett is president

of the West Virginia Drug Intervention Institute Inc.; Charlee Fox is the institute’s assessment and research director.

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