A nurse conducts HIV testing during a harm reduction event. In a typical year, historically, Kanawha County records 5 new positives linked to injection drug use. 35 new cases were diagnosed in 2020. Photo by Lauren Peace.

Efforts to restrict harm reduction programs both across the Mountain State and in its capital city could come to a head this week. 

With just five days left in this year’s legislative session, state lawmakers are still considering a bill that, if passed in its current form, would eliminate many harm reduction and syringe access programs in West Virginia. 

At the same time, the Charleston City Council is set to consider rewriting laws that govern harm reduction programs operating in the city at its Monday night meeting. 

These programs, often called needle exchanges, provide sterile injection supplies to people who use drugs, as well as related services like HIV testing, medical care and access to overdose reversal medication. They’ve been shown to increase the likelihood that participants enter recovery, and can reduce syringe litter by providing sites for safe disposal

And public health experts say these types of programs are especially needed in a state where overdose mortality rates are the highest in the country and infectious diseases like HIV and hepatitis C linked to shared and reused needles are spreading. They’ve called for more access to harm reduction programs, but the bills being considered on both the city and state level would do the opposite.

Last year, officials identified 35 new cases of HIV linked to injection drug use  in Kanawha County. In New York City, with a population nearly 50 times the size of Kanawha’s, only 36 cases were diagnosed in 2019. Complete 2020 data for New York City is not yet available.

In a presentation before Charleston’s public safety committee on Feb. 24, Dr. Demetre Daskalakis, the CDC’s head of HIV prevention, warned that the cases already diagnosed in Kanawha County’s outbreak are likely just the tip of the iceberg. The HIV outbreak here was the “most concerning” in the country, he said, adding that without urgent action to combat the spread, including increasing access to clean needles for people who inject drugs, the public health crisis would only get worse. 

Instead, the bill that city lawmakers are considering would hamper harm reduction efforts and syringe distribution in the midst of the emergency.

If passed, the ordinance would rewrite Charleston law to mandate that all syringe access programs operating in the city require users to return one needle to get a sterile replacement. It would also require providers barcode syringes for tracking purposes and require participants to have a West Virginia ID. Those are among other restrictions that experts say make it unnecessarily difficult for people to stay as safe as they can while struggling with substance use disorders.

In an interview on Friday, Mayor Amy Goodwin said that the driving force behind the bill — community concern around syringe distribution — shouldn’t be ignored. But also important is the current risk to public health posed by the HIV and hepatitis C outbreaks.

“This is a crisis. There’s no other way to put it,” Goodwin said. “You cannot have a successful [syringe access] program without community involvement. But health care officials need to be at the table when crafting this bill, and that hasn’t happened yet.”

When asked via email whether the proposed legislation was concerning, Dr. Sherri Young, the Health Officer for the Kanawha-Charleston Health Department replied with a single word: “yes.”

Goodwin declined to say how she would vote on the measure, but did say that she anticipates proposed changes to the legislation will be made on Monday before council makes a final vote. She also noted that what happens in the state house will impact local legislation, and that the issue will likely take more time.

“We still have a long way to go, and this conversation will not end on Monday, whether something is passed or not,” Goodwin said.

Meanwhile, the body charged with protecting communities from the spread of communicable and preventable disease, including HIV — the Kanawha Charleston Health Department board — was not consulted in the writing of the current proposal. 

“The CDC has been clear about the best approach [to addressing the outbreak], and I think we should be listening to the CDC,” said Stephen Weber, one of the six board members.

Weber said rather than restricting syringe distribution during a public health crisis, the focus should be on efforts to support more syringe cleanup around the city. Those are efforts that Goodwin said she supports.

Board member Danny Scalise, who is also the executive director of the West Virginia State Medical Association, said the same. Scalise also noted that the health department is required by law to work to protect the public from the spread of infectious and preventable disease. The city’s pending legislation would impede those efforts, he said.

The other four board of health members did not respond to requests for comment.

To follow the discussion and possible vote on Monday night, and to stream the meeting live, click here.

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