Study: Closure of Rural Harm Reduction Program ‘Fundamentally Changed’ Health of a City

May 22, 2019

“They made me feel like I was a person.”

That’s what a 40-year-old man told researchers from Johns Hopkins University about a now-closed syringe services program in the heart of central Appalachia.

The Kanawha-Charleston Health Department, based in West Virginia’s capital city, opened its program in December 2015 and for about two and a half years, provided not just a place to get clean needles and dispose of used ones, but also access to testing for a number of infectious diseases, including HIV and hepatitis C — diseases commonly associated with intravenous drug use.

But the politics in Charleston around the program shifted during its existence. Restrictions were placed on the syringe services program, known as an SSP, and local politicians began criticizing the health department in the media, claiming the city was experiencing a spike in crime because of the syringe program.

On the outside, the Kanawha-Charleston SSP faced intense stigma and scrutiny, but on the inside, the people who took advantage of the program’s services say it was a place where they were treated with respect and compassion.

“[The staff] were always very open to listening to anything we had to say,” a 41-year-old woman is quoted as saying in the study. “They would always ask questions [and] they weren’t asking like in a nosy sort of way or anything. They were asking because they wanted to know. They wanted to learn. They wanted to understand. And I mean, they treated us in no way, shape, or form like we were any less.”

But pushback in the city grew and by early 2018, the SSP closed its doors indefinitely. Now, a new study says that closure has ushered in “a new era of increased risks for bloodborne infections and overdose” in Charleston.

The Findings

The study of the Kanawha-Charleston SSP, titled Understanding the Public Health Consequences of Suspending a Rural Syringe Services Program, was published Tuesday in the Harm Reduction Journal.

Researchers interviewed 27 participants anonymously about the services they accessed at the site and their habits, and the broader habits of the community they observed since its closure. Each interview subject was over the age of 18, considered a resident of Kanawha County – although a majority of the participants were homeless- and had injected a drug intravenously in the past 30 days.

The majority of participants reported that it had become increasingly difficult to access clean needles since the program’s closure and as a result, have undertaken behavior that put their health at risk, including reusing, sharing and buying used needles. One participant said he found used needles on the street and would bleach them before use.

Participants split by gender when researchers asked them about their perception of the risk of contracting HIV since the closure of the SSP. Female participants reported being more afraid of contracting the disease because of the increase of needle sharing, while men perceived their risk as about the same.

Both genders, however, reported that they were less likely to seek out HIV and other infectious disease testing since the closure. While many said they knew that testing was available at other clinics or area hospitals, they had negative experiences in those locations in the past and did not want to return.

“I don’t mean to badmouth them because I know they have hard jobs, [but] I haven’t met a nurse or an assistant or any of them that hasn’t treated me like a drug addict. Whether I’m red-flagged or not, I still deserve the same care, the same respect as anyone else as far as I’m concerned. And if they’d really do their job, they would understand this disease,” a 40-year-old male said.

Those adverse experiences also were reported at a non-profit clinic in Charleston that has an SSP of its own, but operates under the restrictions put in place by the city that led to the closure of the Kanawha-Charleston location. That includes only offering retractable needles and a one-for-one exchange policy, both of which are not considered best practice in the public health sphere.

The study also found participants considered the Kanawha-Charleston program their primary source for accessing the overdose-reversing drug naloxone. After the program closed, many study participants assumed naloxone was no longer available in Charleston.

“I thought it disappeared into thin air or something because I have not seen not a one,” a 24-year-old woman reported. “Oh, it’s been months. Months.”

A Call to Action

Researchers say the closure of the Charleston SSP has “fundamentally changed the public health landscape” for people who use drugs intravenously in the area.

The study attempted to fill a gap in the research about how these programs affect rural areas, but existing studies showed that a syringe exchange program reduces the rates and spread of HIV and other infectious diseases in a place, which leads to not just healthier communities, but also cost savings. The programs also provide access to overdose-reversing drugs that save lives and allow for greater access to information that can lead to rehabilitation and recovery.

The authors write that their findings should serve as a call to action for rural policymakers “to take a stand against inaccurate and misleading reports about SSPs and enact immediate plans to ensure…access to sterile injection equipment and overdose prevention resources.”

“Choosing to ignore the evidence-base for SSP operations not only presents an ethical and moral dilemma, but also sets the stage for an HIV outbreak and worsening overdose epidemic,” the study says.

Policymakers should “learn about the realities of addiction and evidence-based programs for [people who inject drugs],” the authors write, “but also vocally defend them in the face of fear-based, inaccurate, and stigmatizing messaging by those who attempt to subvert public health.”

This story was originally published by 100 Days in Appalachia.