Diving Deep into Harm Reduction Part 1: Why W.Va.’s Largest Needle Exchange Closed

Nov 26, 2018

In December  2015, with support from the city of Charleston, the Kanawha-Charleston Health Department launched a harm-reduction program that included a needle exchange. The primary goal was to reduce the risk of diseases commonly spread by sharing needles.

The secondary goal was to connect illicit drug users to treatment and recovery services. The program became controversial and closed a little more than two years after it opened, amid controversy.


Now, only thing that remains of the harm reduction program is a syringe kiosk where people can deposit used hypodermic needles.

At its peak  the program served more than 400 people a week,mostly from Kanawha County. But some came from surrounding counties as well,a factor that became a point of contention for many in the city.

“It became basically, a line of people just to line up to get needles between 10 and 4 on any given Wednesday,” said outgoing Charleston mayor, Danny Jones who been an outspoken critic of the program.

In the months before it closed, Jones publicly called the program a “needle mill” and “mini-mall for junkies.”

“On any given Wednesday, they might have given out 12,000 needles,” he said during a recent interview.

In reality, the average number of needles given out during the weekly Wednesday exchange was about 5,000 serving about 190 visitors, according to data obtained from the health department. That’s about 26 needles per person, per week. The highest number of  needles the program ever gave out in a single week was just over 11,000 to 417 people.

While 5,000 seem like a lot, the average heroin user injects several times a day. So 26 needles a week gets a person about three injections a day with a clean needle.

“A syringe exchange program should really be called a harm reduction program,” said Dr. Artis Hoven, an infectious disease specialist with the Kentucky Department of Health.

She said harm reduction is an all-encompassing idea to reduce the risk of many things associated with addiction such as “provide naloxone, provide referral to care for people with substance use disorder, they do HIV and Hepatitis C testing.”

And in Charleston, it seemed to work.

While the Charleston program was open, the city did not see an HIV outbreak, according to interviews conducted by Charleston-Gazette Mail. During that same time period, 15 counties in southern West Virginia did have a small HIV outbreak -- none of the three counties where the outbreak started had a harm reduction program, according to a Centers for Disease Control and Prevention Report.

Recorded incidents of Hepatitis C rates in West Virginia did increase -- by a lot -- during the course of the program, but so did efforts to test more people.

But in Charleston, reports of discarded needles in the community began to skyrocket and people were alarmed.

Firefighters reported having to crawl over them while putting out fires in abandoned structures; a local elementary school requested a biohazard container from the city so they could clean up an alley before school; and police officers reported finding huge numbers of syringes on people who were arrested.

Both the Fraternal Order of Police and the Charleston Professional Firefighters Association wrote letters to City Council expressing major safety concerns for first responders.

Concerns might have been exacerbated because the program grew really fast. In the two years the program was open, more than 651,000 needles were distributed. Only about 66 percent of those needles were returned.

According to the Centers for Disease Control and Prevention, the risk of contracting HIV is nominal for for healthcare professionals stuck by needles on the job -- around .3 percent -- with some studies suggesting even less. Outside experts like Peter Davidson from the University of California San Diego say needle litter is an annoyance but not the major public health concern an HIV or Hepatitis C outbreak would be.

“No one in the world has ever obtained HIV from stepping on a needle in the street,” said Davidson. “Needles in the street are a piece of trash. It’s not something you want seeing laying in the gutter, but they’re not actually a very hazardous object.”

In some ways, it doesn’t matter what the risk is. If someone finds a dirty needle on a playground or in a shopping mall bathroom, public reaction is strong. And for non-users, any risk of contracting HIV or hepatitis from a dirty needle is too much.

But closing a harm reduction  program in the biggest city in the state could have huge public health implications for the region, according to former state Commissioner for Public Health Rahul Gupta. Gupta said it’s “not in the best interest of the community” when needle exchange programs like this one are shut down “reactively.”

“It plays into that stigma and is more harmful long-term than it is beneficial,” he said in an interview shortly before he left his job.  

Gupta said it’s more harmful because not only are you removing your best tool for preventing needle-born illnesses, but, as we’ll hear later in this series, the closure may impact public perception and support for other harm reduction programs across the state that are trying to open or stay open.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Marshall Health, Charleston Area Medical Center and WVU Medicine.