The syringe access program in Morgantown is operated out of a free clinic that provides medical and dental services to the uninsured. Photo by Chris Jones/100 Days in Appalachia.

A bill that experts say would worsen the HIV outbreak and overdose epidemic in West Virginia’s capital city passed the state Senate with a vote of 22 to 11 on Thursday and will now be sent to the House of Delegates. 

Senate Bill 334, sponsored by Sen. Eric Tarr, R-Putnam, seeks to limit the distribution of clean needles to West Virginians who inject drugs by placing a number of hefty restrictions on syringe access programs and their participants.

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Mountain State Spotlight reporter Lauren Peace visited one of the state’s most effective syringe exchange programs — in Morgantown — and filed this report, which also ran on West Virginia Public Broadcasting.

If signed into law, the bill would require people using the state’s needle exchanges to have a valid West Virginia ID in order to access sterile injection supplies, and would not allow participants to pick up supplies for friends.

Programs in the state would be required to obtain explicit consent from the county commission and county sheriff before beginning operations, and the 14 programs already certified by the state would be required to do the same or cease distribution beginning in January 2022.

Also, the bill requires programs to barcode and track their syringes, encourages a strict 1-for-1 exchange (meaning someone has to return one needle to get a new one), gives county sheriffs the ability to shut programs down and subjects noncompliant programs to a $5,000 to $25,000 fine.

Those barriers, according to top public health experts and the U.S. Centers for Disease Control and Prevention, will limit the number of programs and discourage people from using them — which will further the spread of infectious disease. They point out that these are medical programs and decisions should be made by medical experts, not politicians or public safety officials.

‘Pouring gasoline on a fire’

For decades, research has shown that harm reduction and syringe access programs prevent the spread of diseases like hepatitis C and HIV by drastically reducing the likelihood that people who inject drugs will share or reuse needles. Research shows that these programs do not increase crime. They reduce needle litter. And people who have access to these programs are three to five times more likely to enter recovery when the time is right for them.

Just last month, the CDC called an HIV outbreak linked to injection drug use in West Virginia’s capital city the “most concerning” in the U.S. and said that increasing access to sterile syringes is more important than ever, in order to reduce spread.

But those facts didn’t seem to resonate with a  majority of the state’s senators on Tuesday. Nor did the likely multimillion-dollar cost — borne mostly by taxpayers — of treating these diseases through the state’s Medicaid program. 

Instead, those in favor of SB 334 focused on the damage they say harm reduction has done to their communities, while relying on vague and unattributed anecdotal assertions to help sell the bill.

“This is a situation where real risk is out there to the public,” Tarr said on the Senate floor, talking about needle litter that he says poses a threat to the broader community.

“There’s a criminal component that comes with needle exchange. Because when you bring a product that is paraphernalia for drug use, the people who use drugs tend to be involved in criminal activity as well to support that habit,” Tarr said. 

Tarr did not provide any evidence to support an increase in crime connected to these programs, and that assertion has largely been disputed by research.

The bill’s co-sponsor, Sen. Amy Grady, R-Mason, echoed Tarr.

“This bill as it’s written now does not hamper harm reduction programs. I believe it actually enhances them,” Grady said.

But experts say that isn’t true.

The most effective programs, according to the CDC, are those with low barriers to entry. That’s because it can be difficult for people struggling with substance use disorders to comply with rigid requirements, like requiring IDs, extensive counseling sessions or returning used needles. These hurdles increase the likelihood that needles will be shared and people won’t be able to also take advantage of a program’s wrap-around services — like wound care, disease testing and treatment.

People gather for a grassroots needle exchange and harm reduction program in Charleston in October, 2020. Photo by Lauren Peace

Right now, in Morgantown, a participant at one of the state’s oldest and most successful programs provides a testament to that.

After a 15-year-battle with a substance use disorder, Sasha Crist said that the harm reduction program at the Milan Puskar Health Right in downtown Morgantown helped her find a recovery program and ultimately overcome her addiction. The program is operated per the CDC’s best practices, and doesn’t require a strict 1-for-1 exchange, a valid ID or time with a recovery coach if a participant is not interested, but does make the option available.

But Crist said, had it not been for the sterile syringes and overdose reversal medications, she wouldn’t have ever come to the clinic or built trust with the staff. If she felt like she was being judged, Crist said, she would have just stopped going. She wouldn’t have gotten the help that she needed.

“I was nervous because I felt like I was going to be judged,” Crist said. But the first time she visited the program back in 2016, she “was shocked. They treat you with compassion and they don’t look down on you at all. That’s what continued to help me come until they were able to get me to get clean.”

Crist said she would be dead if it wasn’t for the program at Milan Puskar Health Right. But if SB 334 is signed into law, it would outlaw this program, along with others like it across the state.

That, said Sen. Richard Lindsay, D-Kanawha, is the problem.

Before the vote on the senate floor, Lindsay cited the evidence in support of harm reduction and syringe access programs. Along with other legislators who opposed the bill, he also acknowledged concerns about needle litter. 

“We do have a needle litter problem, I agree with that. But what we have before us goes further and hurts [programs that work],” Lindsay said. 

He went on, “These aren’t anecdotes. This is based on education and experience. This is based upon facts. This is based upon science. That’s how you create good policy for the people of West Virginia.”

Before the final vote on Tuesday, Sen. Ron Stollings, D-Boone, offered up an amendment that he said could serve as a compromise. The amendment, which was essentially a rewrite of the bill, focused on supporting syringe access programs while also working to reduce needle litter and providing programs with oversight through a licensure process. It also would have designated money to clean up discarded needles and required public hearings before a syringe access program could open.

But that amendment was rejected, and now, SB 334 is on its way to the House.

“Public health [departments have] a mandate to prevent and control the spread of communicable diseases. They will not be able to do that with this bill passing,” said Stollings, who is a physician. “We’re pouring gasoline on a fire with this bill right here. When we talk two or three years down the road, I’m going to say ‘I told you so.’”

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