Diving Deep into Harm Reduction Part 2: Public Safety and Public Health

Nov 27, 2018

Best practices for harm reduction programs call for flooding a community with clean hypodermic syringes. Research shows that in addition to reducing the prevalence of blood-borne pathogens in the community, well-run programs help remove potentially infectious syringes from the community. But some people say that wasn’t happening in Charleston.


Reports of needles found in public places in Charleston began to escalate in early October 2017.

Mayor Danny Jones said the city tried numerous times to complain and the Kanawha-Charleston Health Department didn’t do anything to address their concerns.

Then city health officer Michael Brumage took issue with that accusation,pointing to efforts, such as the founding of the statewide harm reduction coalition. He said one of the objectives of the coalition was to bring needles into other communities so there wouldn’t be such a burden on the city.

But in October 2017, the city public safety office established a code for needle pickup calls to help the city accurately collect data on locations, numbers and types of needles to be picked up.

About a week later, the city proposed running a pilot program with retractable needles. The idea was that if the needles could only be used once and then retract into a plastic chamber, it would reduce the risk of needlestick injuries to the community and first responders.

At the time, Brumage was all for the idea. He wrote an an email, which was part of documents released to West Virginia Public Broadcasting through a Freedom of Information Act request, to city attorney Paul Ellis.

“[T]he limitations ... are acceptability and cost. Should we get support or donated supplies, I am all in for a pilot with evaluation. This could be a very interesting trial. We would like to bring in some researchers for this as well. Let’s do it! It’s worth a shot.”

Over the next few weeks, the Charleston Fire Department found a manufacturer willing to donate the needles in exchange for tracking how well they worked. After consulting with Brumage and his staff, the city requested 250,000 needles from the manufacturer for a six-month trial.

Everything seemed to be on track to start a pilot project using retractable needles in early spring 2018.

At least that’s what the city thought. Meanwhile, Brumage was in communication with a researcher at Johns Hopkins University in Baltimore, Maryland. The researcher reinforced something with him that  he said he already knew -- that “retractables were unpopular among people who used IV drugs.”

In 2010, the national Harm Reduction Coalition issued a statement against auto disable syringes. They said the syringes do little to help control epidemics of HIV, hepatitis C, and other blood-borne viruses among people who inject drugs because many people inject drugs a half dozen times a day. Without needles you can use more than once, users revert back to sharing equipment.

“So, at that point I was kind of in a bind since I told the city we would implement the retractable syringe program. But now knew if I did, we’d actually be putting the public at risk,” said Brumage.

So given the current recommended practices, Brumage and the Johns Hopkins researcher decided to reduce the pilot instead to about 10 to 12 people. In meeting minutes from a call, also released in the FOIA,, Brumage’s staff appeared to confirm the new plan with the company that had agreed to donate the syringes.

Brumage said he thought the needle manufacturer then told the city about the change. But no one did. So city officials said they felt blindsided several weeks later when they learned the pilot program no longer included the entire patient population.

“They refused retractable needles,” Jones said in an interview.

It was more complicated than that, but it probably felt like a refusal to the city because of the  change in plan wasn’t communicated. And I mean, remember, law enforcement, emergency responders and some members of the community were now expressing a lot of concern about needle litter and felt like they had to do something.

“I want to protect the public. I want to protect the law abiding public,” said Jones.  

In late March of this year, Charleston Police Chief Steve Cooper decided -- as he was legally empowered to do -- that the health department may only give out retractable needles.

Essentially, Brumage said, the police were “ directing the health department to adopt -- what appeared to be from the medical literature to be dangerous and unethical practices.”

But other public health experts said making a harm reduction program fit the needs of the community takes a lot of compromise.

“Public health has never been and will never be about my way or your way. It will always be what’s the best way to input science and marry it with art and put it into practice,” said former public health commissioner Rahul Gupta.

 

From a public health perspective, harm reduction programs are still the best tool the city a city? has to prevent the spread of needle born illnesses. But politically -- at least in the state’s largest city -- it’s closed indefinitely.

11/28/2018 This article has been updated to change "Then state health officer Michael Brumage" to "Then city health officer Michael Brumage."

 

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