by Lilah Crews-Pless
The Emory School of Nursing’s neighbor across the street, the Centers for Disease Control, reports that West Virginia has the highest rate of drug overdoses in the country. Opioid-related deaths in 2017 was nearly 50 per 100,000 people, up 14% from the previous year. This epidemic has touched nearly every patient I have seen at the New River Clinic either directly or indirectly. I love podcasts, so to get the rundown on the history of the Opioid Epidemic before it came to West Virginia, I listened to Throughline’s podcast from April 4th, 2019 called America’s Opioid Epidemic and The Uncertain Hour’s third season: Inside America’s Drug War. Historically, so much of West Virginia’s industry has been comprised of very physically demanding, but poorly compensated work. Staying home to heal was not a possibility for many, and painkillers, particularly opioids, helped many people working people keep the lights on and food on the table. They trusted their healthcare providers to do no harm, and we failed them.
In true grassroots fashion, the Fayetteville Health Department has created an innovative program to help reduce the harm of this epidemic through a program comprised of dedicated staff, both paid, and volunteer. On Wednesdays from 1-4, people are able to turn in used needles and receive the same number of clean needles (30 needles max) in return. In addition, the program provides wrap-around health and social services. Health services include Hepatitis and HIV screening, vaccines and wound care. They also provide birth control counseling and LARC placement. The social services they provide include help with obtaining an ID, health insurance, housing, and food. Patients trade in their dirty needles for clean with an addiction coach. Coaches are others who are recovering addicts and can use their own experiences to help steer others towards recovery. Coaches provide patients with clean needles, but also dispense other supplies like alcohol pads, cotton balls (used for filters), tourniquets and “cookers” to help avoid spreading infection. These supplies are important because hepatitis can live on a surface for 14 days and is not killed by the small flame used to “cook” IV drugs. Narcan is also given out to patients, and patients are educated on West Virginia’s Good Samaritan Law that allows drug users to give Narcan and call 911 without fear of being arrested for drug possession.
Cliff Massy is the main addiction coach and the coordinator for the Harm Reduction and Quick Response Teams. Massy is kinda a big deal ‘round these parts. In 2017 1 on 1 Films, a documentary production company based out of Ithaca, New York made a short film called Out of Pills, which has won a bunch of awards in the short film circuit. As Quick Response Team coordinator, he or someone in his team follow up with everyone who overdoses within 48 hours, as people are more open to recovery programs during this time. If recovery is not of interest, they can at least be connected with the Health Department program for harm reduction services. The health department is currently writing grants for a new program called Engage. This would provide clean needles and harm reduction services and education at local emergency rooms where many underserved people receive their primary care.
The Public Health Department the building seems innocuous, newly painted in fuchsia and lavender, but it is surrounded by the Police Department, County Sheriff, Fayette County Court, and Judge’s office. This location is obviously not ideal for illegal drug users looking to access care.
Anita Stewart is a DO who helps head up the harm reduction program. We talked about the importance of community (particularly law enforcement) buy-in to ensure sustainability in the program. Sometimes this buy-in comes with compromise. For example, While the health department takes in more dirty needles than they give out (as measured by weight) there is still minimal support for giving out more than 30 needles because of fears that that will increase the number of discarded needles in public areas. Similarly, the police have an agreement with the public health department that they will not arrest people at the clinic, or after receiving care there. Last month, however, the police recently broke this agreement, arresting a patient who had a minor parole violation. The number of patients at the clinic plummeted and are only just starting to rise again. The clinic is hoping to have more sites to serve a wider population with sites away from the police. However, while Anita Stewart says that it can be hard to “play nice in the sandbox,” there has been greater acceptance among its critics as the program becomes more established. She says that when people are skeptical about harm reduction, she invites them to volunteer and see the wide range of people who have become dependent on opioids. She says that type one diabetics, nurses, and other people who have a greater comfort with needles seem more likely to become IV drug users. Stewart also stresses the importance of healthcare providers using their professional privilege for advocating harm reduction among stigmatized populations. “After all,” she says, “many of these people got hooked on opioids through legal medical prescriptions, we did this to them.”
Needle exchange can be a controversial issue, and until 2016 federal funding could not go to these kinds of programs. These programs are still illegal in 15 states, but while stigma still remains, needle exchange programs are slowly gaining popularity across the country because they work. Not only have decades of studies shown that they reduce the spread of blood-borne diseases and the number of needles in public spaces, they also can help connect people to treatment when they are ready. Because of the increase in opiate-related incarceration around the country, another controversial program is gaining momentum in WV and across the country, called the Law Enforcement Assistance Diversion (LEAD) program. It allows public safety officials to work with behavioral health providers by diverting low-level drug offenders away from jail time and towards treatment and support services.