Volunteers hand out safe injection supplies to participants at a needs-based syringe access program. Photo by Lauren Peace

$47 million.

That’s the approximate lifetime cost of treating just the people in Kanawha County diagnosed with HIV and hepatitis C in 2019. The estimate from the West Virginia Center on Budget and Policy, looked at the financial impact of the 14 HIV cases linked to injection drug use and more than 600 hepatitis C cases the county reported that year.

With another 35 people diagnosed with HIV in the county in 2020, that number will grow. And the burden will fall on West Virginia taxpayers.

“Not having harm reduction has a moral cost, but it also has financial implications,” said Dr. Daniel Ciccarone, an HIV researcher who has studied outbreaks in West Virginia and worked in HIV prevention for the last 20 years.

As West Virginia’s capital city faces an HIV outbreak and other cities and counties around the state are at risk of the same, state and federal public health officials say that West Virginia needs to increase access to syringe exchange programs or risk the physical and economic toll that will result from uncontainable spread. These programs — also called needle exchanges — provide access to sterile needles and other services for people struggling with substance use disorders.

But rather than increase the programs to stem both a public health threat and skyrocketing costs, a bill before the West Virginia Senate would do the opposite. At a Senate Health and Human Resources Committee meeting Thursday the potential for major economic implications wasn’t discussed by the bill’s sponsor.

Instead, before a table of 13 colleagues, Senator Eric Tarr (R-Putnam) talked for nearly 30 minutes about the threat he says syringe access programs pose to communities across West Virginia.

“The crime associated with it, the health risks associated with it, and the fact that we perpetuate it with tax dollars, is the problem we’re solving,” Tarr said during the hearing of Senate Bill 334, which seeks to effectively outlaw syringe access programs across the state.

Tarr didn’t respond to multiple requests for a follow-up interview. But his arguments are unsupported by research. 

His concerns about syringe distribution are in direct contrast with what decades of research shows: that harm reduction programs do not lead to an increase in crime. Instead, they reduce syringe litter by incentivizing safe disposal 0f used needles, they increase access to recovery services for people struggling with substance use disorders, and they prevent the spread of diseases like HIV and hepatitis C.

“There is a wealth of evidence that shows that the popular concerns about syringe programs are not supported,” said Dr. Judith Feinberg, a professor of epidemiology and infectious disease at West Virginia University’s School of Medicine.

Feinberg, along with other experts, including State Health Officer Dr. Ayne Amjad, testified before the committee on Thursday, and said that Tarr’s legislation would sacrifice public health for West Virginia’s residents by eliminating a supply of sterile syringes, fueling the spread of infectious disease and limiting access to naloxone for people with substance use disorders in the midst of an overdose crisis.

Experts like Feinberg and Amjad also acknowledged concerns about needle litter around the state, but said instead of decreasing access to safe injection supplies, communities should work to promote safe disposal. One way to do that would be placing sharps disposal containers in public places.

Besides the vital health component, there’s the economic argument that the bill has yet to address.

By preventing needle sharing and the related risks, syringe access programs save communities millions of dollars in costs associated with treating diseases like HIV and hepatitis C each year. Research has shown that for every dollar spent on syringe access services, communities get an approximately $7 return on investment. 

And because many of the new infections are among people who are uninsured or supported through Medicaid, the burden of the cost of treatment falls largely on already-struggling hospital systems and West Virginia’s taxpayers.

“The lifetime cost of treating [one case of] HIV is $510,000,” said Dr. Kevin Yingling, a pharmacy practitioner and former Dean of Marshall University’s School of Pharmacy. “That cost will be burdened onto the taxpayers of West Virginia.”

Ciccarone said that for the first time in more than a decade, HIV cases related to injection drug use are upticking nationally as more people have substance use disorders and stigma gets in the way of the work that syringe access programs do to curb the spread. 

“This is not the time to stand in the way of opening a syringe exchange,” Ciccarone said.

New cases of HIV linked to injection drug use more than doubled from 2019 to 2020 in Kanawha County. Without intervention, he expects to see similar increases annually and the potential for additional outbreaks in other communities across the state.

As of Feb. 26, the sole cost estimate in a fiscal note attached to the proposed legislation — submitted by the West Virginia Department of Corrections and Rehabilitation — listed $0 in anticipated costs that would result should the bill become law.

Though wildly inaccurate fiscal notes aren’t unusual in the West Virginia Legislature, the committee has requested a new fiscal note from the Department of Health and Human Resources. Yingling said he expects it will take some of the medical costs into consideration, and thus more accurately reflect the cost of eliminating West Virginia’s needle exchanges.

SB 334 will next be on the Senate Health Committee agenda on March 2, when committee members will introduce amendments and vote on the bill.

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