In a typical year, historically, Kanawha County records fewer than 5 new positives linked to injection drug use. There were 32 recorded in 2020. Photo by Lauren Peace.

Charleston Mayor Amy Goodwin says she supports changes to the way West Virginia’s capital city addresses injection drug use and the overdose crisis — including considering expanding needle exchange programs.

“There’s no question about it,” Goodwin said in an interview with Mountain State Spotlight. “Our medical professionals have reported that they are seeing an increase in HIV from intravenous drug use. We need to have a serious discussion about the use of harm reduction, and that does include syringe exchange programs.”

The mayor’s comments come three weeks after Mountain State Spotlight published an investigation into the rise of HIV linked to needle sharing in West Virginia’s capital city. 

For decades, research has shown that syringe access programs — commonly called needle exchanges — prevent the spread of infectious disease, can reduce syringe litter and provide pathways to treatment for people living with substance use disorders. Goodwin said that beyond the spread of HIV,  she’s concerned about the rate of overdose deaths in Kanawha County, and that harm reduction is a tool to address that crisis.

“We are seeing an increase in overdose deaths,” Goodwin said. “The pandemic has brought more despair and a loss of hope for so many. This is about physical health and mental health.”

A nurse conducts HIV testing during SOAR street outreach. In a typical year, historically, Kanawha County records fewer than 5 new positives linked to injection drug use. There were 32 recorded in 2020. Photo by Lauren Peace.

Despite misconception, needle exchanges do not increase the likelihood of drug use, and people who have access to them are three times more likely to enter long-term recovery when the time is right. Even so, the topic in Charleston has remained highly stigmatized, and since the Kanawha-Charleston Health Department closed its needle exchange in 2018, officials have largely avoided it. 

But as HIV rates rise — in a typical year Kanawha County sees fewer than five new positives associated with injection drug use, compared to the 32 identified just last year — the cries for increased syringe access programs by public health experts have gotten louder. 

“The numbers are only going to continue to grow if we don’t get people connected with resources,” said Christine Teague, who has run the HIV intervention program at Charleston Area Medical Center since 2001. “We know that harm reduction and syringe access programs work. And those programs should be guided by health professionals, not by law enforcement.”

Amid the rising HIV numbers a local nonprofit stepped in and began quietly offering clean syringes to help combat the spread and increase access to overdose reversal medication. But that effort resulted in a shutdown prompted by a police investigation in October.

A Charleston city ordinance that predates Goodwin’s time in office puts needle distribution at the discretion of the chief of police. While the ordinance remains intact, Goodwin says the city needs to be listening to medical experts like Teague.

“Chief [James ‘Tyke’] Hunt and I both agree that medical decisions and [decisions about] syringe exchange programs should not be made by the Chief of Police,” Goodwin said. “We both agree strongly about that.”

Goodwin did not respond to questions about whether or not she’d work to overturn the ordinance to better align with that shared belief, but did say that more information would be available next week.

“We’re taking this very seriously,” Goodwin said. “We’re not saying the right things, we’re trying to do the right things. This is a conversation which we have to have. We have to be open, honest, respectful and thoughtful.”

And Goodwin isn’t alone in that sentiment. Mountain State Spotlight contacted all six members of the Kanawha-Charleston Board of Health. Of the three who responded, all acknowledged that evidence-based research supports the use of needle exchanges.

“There are folks at the CDC that are smarter than I am, and their data shows that needs-based [syringe access programs] are what we should be considering,” said Board of Health member Danny Scalise. “I’d like people to understand the patients living with substance use disorders are people. They’re ill, they need help and it’s impacting our community.”

Last month, the U.S. Center for Disease Control and Prevention came out in full support of needs-based syringe access programs — those which don’t require people bring used needles to get new, sterile needles, speak with a counselor or show ID. According to the CDC, evidence shows that needs-based programs are best practice “for reducing new HIV and viral hepatitis infections.”

The report also reiterated that more restrictive policies — like those practiced at the only needle exchange currently certified to operate in Charleston — are associated with higher rates of HIV and other infections.  

“The CDC is normally the gold standard. That’s normally what we follow,” Scalise said. “This shouldn’t be any different.”

Board member Stephen Weber echoed the sentiment.

“People want to think that if you don’t have needles out there, people are going to stop being addicts,” Weber said. “The empirical studies show that that is not the case. Needle exchange programs are shown to be an effective prevention for [the spread of disease]. People who think they will make more people drug addicts are incorrect and we have to take steps to correct that impression.”

Public health vs. politics

The reason Charleston has gone without sufficient supply of clean needles, and why HIV cases linked to injection drug use are spreading at an unprecedented rate is simple.

Politics. Misunderstanding. Fear.

Goodwin said open conversations and educational outreach on the topic should have begun years ago. 

“There has to be some healing with this community about harm reduction,” Goodwin said. “This has become a political issue, but it’s not. And it shouldn’t be.”

In 2015, in the midst of an opioid epidemic, an HIV outbreak linked to injection drug use in Scott County, Indiana, that made national headlines highlighted the need in rural America for needle exchange programs, which had been operating for decades in more urban settings.

At the time, the Kanawha-Charleston Health Department joined the ranks of programs around the country supporting needle exchanges. For around three years, the health department provided clean needles and safe disposal equipment among other services, to residents living with substance use disorders. It served 483 people in a single day at its height.

But in 2018, with a mayoral election underway, then-mayor Danny Jones thrust the program into the spotlight, referring to it as a “needle mill.” Although Jones was not seeking reelection at the time, the campaign tainted the public’s perception of harm reduction and syringe access services. The effect stuck and the needle exchange was eliminated.

A Mountain State Spotlight investigation found that the 2018 elimination of the health department-run needle exchange left Charleston providing hundreds of thousands fewer sterile syringes — through a separate program — than much smaller communities across the state according to previously unreported data. 

But ridding the city of its clean needle supply didn’t get rid of drug use. 

With the drought in clean injection supplies, and a population still struggling with substance use disorders, people began sharing needles and spreading HIV. Although warning signs were there, including an outbreak just 50 minutes away in Cabell County in 2019, which prompted CDC intervention and ramped up needle exchange services, the topic in Charleston remained highly stigmatized. 

Charleston City Council member Will Laird understands that.

“Look, needles are scary,” Laird said. “I understand the science behind it and tend to lean into that. But I’ve found needles in my yard, where my kids play. I support harm reduction wholeheartedly, but it’s a difficult topic.”

Laird said the city has a lot of work to do educating community members. He sees a gap between public perception of addiction and the science that tells us how to treat it.

“There’s a solution to this, but we’re not going to get there by yelling on Facebook and playing polarized politics,” Laird said.

Mountain State Spotlight reached out to all 26 members of Charleston’s city council. Only five returned interview requests. Four of those, including Laird, said that they believed there was a need for more syringe services in Charleston and believed public health officials should be leading those decisions.

‘The most important thing is that we’re having this conversation’

While HIV numbers linked to injection drug use continued to climb in Kanawha, small actions were taken in response to the rise. An HIV task force was established through the health department “to increase capacity for HIV testing and linkage to care in Kanawha County.” But the conversation around access to clean needles remained relatively silent until a nonprofit organization thrust the topic into the spotlight, becoming the subject of a criminal investigation by the Charleston Police.

In the absence of clean syringes and as an HIV crisis loomed, Solutions Oriented Addiction Response (SOAR) began operating an exchange of its own. 

The grassroots group, run and supported by a conglomerate of social workers, medical professionals and people in recovery, was originally established to engage the public in conversations about fighting the overdose epidemic. But what started as distribution of  naloxone — a medicine used to restore breathing after an overdose — soon developed into biweekly street outreach.

The group continued naloxone distribution, but started handing out food, first aid care, flu shots, recovery services and kits of sterile needles.

SOAR street outreach. Photo by Lauren Peace.

For months, the group operated off the public’s radar. But at the end of October, a local TV segment aired on the underground needle exchange, prompting an investigation by police on the grounds that SOAR violated the city ordinance requiring harm reduction programs be either approved by the police chief or licensed by the state.

The group, which maintains that its actions were legal, suspended its services while the investigation ensued. But the event reignited conversations in the city around the subject of harm reduction.

“I don’t have any information on the investigation and I’m not a lawyer,” Laird said. “But what SOAR did was bring the issue to the forefront. The most important thing right now is that we’re having this conversation.”

Since the organization became the subject of a police investigation, the group has applied to be certified as a harm reduction program by the state and for grant money to fund future distribution.

On Friday, it was denied both. The group now has 30 days to appeal the denial.

In the interim, the Charleston Police investigation remains ongoing. At a City Council meeting on Monday, council members questioned Goodwin about its length and the lack of public disclosure.

“I think it would certainly help my position within my constituency if we could all just choose sides and move forward and get through this SOAR investigation,” council member Courtney Persinger told the mayor during the meeting. “I feel like we’re stalled, and that keeps us from being able to speak in our communities about what’s going on. We are getting a lot of questions.”

In an interview with Mountain State Spotlight, Goodwin confirmed for the first time that the investigation will come to an end next week.

She couldn’t comment on the findings of the investigation but said that the public can expect more information soon. The announcement should come on Monday or Tuesday, and will be followed by a public safety meeting on Thursday at 5:30 p.m.

Regardless of the outcome of the investigation, Goodwin said that members of SOAR should be a part of conversations regarding harm reduction and syringe services moving forward.

“I think that any program or any entity that has a syringe exchange program currently operating in the city or currently wanting to operate in the City of Charleston all have to be a part of this conversation,” Goodwin said. “What has become a continued story about SOAR really shouldn’t be. It should be about all harm reduction practices.”

Lauren Peace is a Report for America Corps Member who covers public health.