More than a year ago Virginia lawmakers gave nonprofits and local health departments in more than 50 localities the green light to set up needle exchanges. Permission was targeted to places where the opioid crisis is worst and Hepatitis C rates are high.
Since then, only three localities have decided to set up needle exchanges. In a two-part series RADIOIQ explores how the first one is going, and why there haven't been more.
Part I: ‘We Know the Possibility is Coming’ Why One Community Got on Board
For years, substance abuse counselor Shirley Smith has worked with the homeless and addicted in Big Stone Gap. She’s heard stories about how people get the needles they use to inject illegal drugs.
“I had someone to tell me they went on a riverbank where they knew where the addicts use and all -- they went and picked the needles up and then resold them,” Smith recalled.
Dealers will sell the needles along with drugs, and dirty ones come cheaper than clean ones.
Nurse Practitioner Teresa Tyson has seen the impacts of that. People come into her clinic, the Health Wagon, with abscesses and skin infections. But that’s not the worst of it. She’s seen increasing cases of Hepatitis C.
“And the treatment for that is very very expensive,” Tyson said. “The medications are over $100,000.”
Hepatitis C rates are spiking not just in Wise, but all over the state, with concentrations in much of western Virginia.
Many localities in Virginia have been slow to get needle exchange programs started, while officials here in far southwest Virginia acted quickly, working out of fear for what could happen in their community if users continued to share dirty needles.
That effort was spearheaded by Dr. Sue Cantrell, the Lenowisco Health District Director. Cantrell wasn’t available for an interview, but Nurse Practitioner Theresa Tyson says Cantrell was critical to getting the community on board.
Tyson is well known for organizing the once-a-year Remote Area Medical clinic, but she treats underserved patients all year long. She says Virginia is a wealthy state and much of that wealth never made it west to the mountains.
“We have a culture of extraction. And so once the coal was extracted there’s not a lot of resources that are left here,” said Tyson. “Our patients, unfortunately, they face a lot of healthcare disparities.”
Disparities that Tyson has seen evolve into drug use, and now the spread of Hepatitis C.
For health officials, the fear is what could follow. According to the Center for Disease Control, parts of western Virginia are some of the most vulnerable in the country when it comes to the rapid spread of HIV.
“We know the possibility is coming and we would not have enough resources to deal with that. And that’s the reason we’re fighting really hard to get the treatment for Hepatitis C and the reason that the harm reduction, or needle exchange program, was such a wonderful concept to have here,” Tyson said. “So we can get ahead of it.”
Users can now go to the local health department for free clean needles. Tyson has been referring not just her patients with substance abuse disorder, but also those with diabetes - whom she says often are also forced to reuse dirty needles.
The exchange is run out of a brick building tucked among the trees on a dead end road. In its first five months, 36 people have visited regularly.
“You go in the front and they’ll lead you into the back where the needle exchange program is taking place,” described support counselor Shirley Smith.
Participants get canisters with clean needles, plus an ID card they can show police if they’re stopped. So far, staff have collected far more needles than they’ve handed out. Participants are also asked if they would like to consider recovery.
One person has already been referred to Smith, and she’s still working with them. Another local counselor said the same.
Smith says the program helps plant a seed in people they wouldn’t otherwise reach.
“If they are out on the streets using they have no clue if there’s help and recovery. But if they are coming in to the health department they are told about recovery,” Smith said. “If we can help one, you’ve helped an entire family.”
So far, a handful of the needle exchange users in Wise have started treatment programs. One is sober.
Part II: ‘A Free Pass’ vs. Keeping People Safe
In Roanoke, Police Chief Tim Jones has a binder on his desk. It’s full of newspaper clippings and research. All about needle exchanges.
He flips through a presentation by Virginia’s Department of Health, which he’s read at least three times. But it hasn’t changed his mind, he’s still opposed.
Needle exchanges are a proven way to help slow the spread of HIV and Hepatitis C. They also help connect addicts to recovery and treatment. But despite approval by state lawmakers, there are only three exchanges so far. One roadblock is getting permission from local law enforcement like Jones.
Jones points to pamphlets that show how to use needles as safely as possible.
“And this is one that really kind of rubs me the wrong way,” he said, pointing to literature provided by the Department of Health. “‘Providers recognize that participants are experts in their own lives.’ Really? If I’ve got a substance abuse disorder I think I’ve already messed that up. Obviously they are not the experts in their own lives. Or they wouldn’t be coming to get free clean heroin needles.”
Needle exchanges are part of a strategy called comprehensive harm reduction. The hope is that if you get drug users in the door, then you can provide other services -- like disease testing and recovery support.
State officials have embraced the strategy, but others, like Jones, are not on board.
“So if we as a community are endorsing and lifting up and supporting the use of heroin? What does that say to our kids?” Jones asked during a recent interview in his office.
Jones’ resistance has led to a standoff in Roanoke, where city officials say an exchange would help battle rising rates of Hepatitis C. But state law requires law enforcement to support the program, and Jones has refused to sign a letter of endorsement.
One of his sticking points is that it’s illegal to carry drug paraphernalia, and he’s being asked to look the other way.
“To me that translates to 'Give me a free pass chief if you catch me with a syringe and heroin on my person. As long as I can give proof that I’m involved in the harm reduction program.' Nah-ah. That doesn’t work that way,” said Jones.
Roanoke isn’t the only locality facing resistance from police. In a recent report, the Department of Health says lack of support from law enforcement has been a barrier in several jurisdictions.
But it hasn’t been in Wise. The rural county is another three hours west of Roanoke. With the support of law enforcement the health department here began a needle exchange this summer.
Ronnie Oakes has served as the sheriff here for 23 years. He’s seen the decline of coal, followed by the subsequent rise of drug abuse. Through it all, he says, his job has been not just to enforce the law but also to help keep his community safe.
He says he doesn’t think his support translates to facilitating drug use.
“We feel that these people who are going to use it and abuse it, they want to be safe as they can. If that’s possible,” Oakes said. “And that’s the reason they want to exchange the needle in the drug program, they want to be involved in it. And if they do that of course it’s helping us.”
At first Oakes was opposed to the program. But Dr. Sue Cantrell, who is in charge of the local health district, helped convince him the need was too great. He began to re-evaluate, thinking of the lives that could be saved.
He’s been to at least a dozen funerals for people who have overdosed.
“You see the family who are there and you try to have a good word to say to them, you know. Nothing helps,” Oakes said. “I feel for them. But I don’t know what we do. We just keep trying to make a difference.”
Since the needle exchange began, the health department has distributed more than 20 overdose reversal kits to people who have come in for clean needles. At least three kits have already been used to revive someone.