By TAYLOR STUCK
The Herald-Dispatch
HUNTINGTON, W.Va. The consensus is clear — syringe exchanges save lives and save money.
In the past two weeks, both the U.S. Surgeon General and the U.S. Centers for Disease Control and Prevention have advocated for more harm reduction programs, particularly syringe exchanges, in response to the nation’s opioid epidemic.
Heroin use has increased more than 60 percent in recent years. While use of needles and syringes is not the only way to get high off of heroin, sharing needles and other injection equipment put people who inject drugs at a higher risk for getting HIV and other infections like hepatitis C.
While annual HIV diagnoses fell by about 50 percent among black and Hispanic/Latino IV drug users, they only dropped 28 percent for white IV drug users.
The CDC also found 46 percent of new white IV drug users were likely to share syringes, compared to 28 percent of Hispanic/Latinos and 28 percent of blacks. White drug users also begin using syringes younger, and are more likely to share.
“We didn’t have the perception of the problem before,” said Dr. Michael Kilkenny, medical director of the Cabell-Huntington Health Department, which operates one of West Virginia’s three syringe exchanges. “First you have to perceive the problem. I’m not saying it wasn’t here before. You have to perceive it, you have to own it, you have to take responsibility for it, then you have to work on solving it. I’m convinced that’s the correct approach.”
The harm reduction program in Cabell County, the first of its kind in the state, was started in September 2015 and has since served nearly 2,000 different people. Kilkenny said an average of 30 new individuals are seen every week.
During the exchange, participants turn in used syringes and receive sterile ones. Participants also get to meet with a nurse to discuss risk factors and any other health issues associated with drug use. A peer recovery coach is also at the exchange ready to assist anyone wanting to make a move toward treatment.
The goal is to keep drug users healthy while they wait for treatment and prevent an additional health crisis, such as an HIV outbreak.
“I’m convinced what we are doing is effective,” Kilkenny said. “We have evidence we have reduced syringe sharing. It’s going to take a long time to prove a reduction in hepatitis C, and if we never get that outbreak of HIV we will never be able to prove it was because of our effort. But we do have a big hepatitis C problem, and we will impact that. If we prevent just two cases of hepatitis C, we will save enough money to fund the program for a year.”
Two other harm reduction programs that include syringe exchanges have since opened in the state, one in Charleston and another in Ohio County.
Expansion: Cabell County
The Cabell-Huntington exchange is already primed to expand.
“What we’ve known for at least a year is we are not serving all of the injection drug users in Cabell County,” Kilkenny said. “We are not even serving all of them in Huntington. A lot of that stems from the limited location and time that we can devote to this. So, our first expansion here in Cabell County will be to expand access to a wider geographic area in Cabell County and serve more people who need the service.”
Kilkenny also wants the program to be more aggressive in reducing overdoses, which increased this year over last.
“It’s easy for me to sit here and say, ‘Well it’s increased awareness and increased reporting’ – that would be great, but that’s like saying ‘Why did you lose the football game?’ ” he said. “We have to do what it takes to win. We need to do what it takes to reduce the overdoses, rather than explain why we are not. That’s not going to be acceptable to us, and I don’t think the citizens are going to accept anything less than success, and they shouldn’t. We have to be accountable to our population. We have to succeed.”
He also wants to expand access to medication-assisted treatment, something he admits is a little scary to him. But, he said, removing all judgements, even ones he holds, is the only way to make headway.
“It comes with recognition,” Kilkenny said. “That’s the double-edged sword of what are you known for. It’s known we have a big problem here. That allows us to obtain more solutions than we would if they didn’t think there was so much of a problem.”
Expansion: West Virginia
The Cabell-Huntington Health Department exchange has been lucky with funding, Kilkenny said. Funding has been an issue for other programs in the state, and will continue to be so as the state once again will face budget cuts.
“How do you create a new statewide initiative in the face of budget cuts?” Kilkenny said. “That’s going to be a huge challenge to the state.”
The other barrier is public perception.
“There are counties that have a huge problem, and their population doesn’t understand that they do,” Kilkenny said. “So there’s education at a public level that has to occur statewide for some of the communities to understand what the problem is and to take ownership of it the way Cabell County has.”
Funding for both education and syringe exchange programs could come in the form of federal aid. The 21st Century Cures Act, which passed in the House of Representatives last week, includes $1 billion over two years to combat the opioid epidemic. Rep. Evan Jenkins, R-W.Va., told The Herald-Dispatch the funds will be targeted to states where the need is great, which he thinks is code for West Virginia.
See more from The Herald-Dispatch
