MORGANTOWN – Gov. Jim Justice said early this week that he will likely sign the bill to license and regulate needle exchange programs – SB 334. The executive director of Milan Puskar Health Right told The Dominion Post the bill could harm its Morgantown-based program, which was frequently called one of the state’s best during legislative testimony.
Referring to the bill’s tortuous journey on Saturday, the last day of the session, Health Right Executive Director Laura Jones said, “It went from a horrible to an almost decent bill to a fairly horrible bill again.”
One of its good points, Jones said, is that it provides legal immunity for staff and clients who may be returning, transporting or handling used syringes that might contain drug residue. That’s needed to encourage people to bring their syringes back rather than leave them somewhere or toss them out a window.
It also commendably calls for HIV and hepatitis screenings, she said.
But then come the problems. “The issue of requiring an ID is a huge problem. People are very fearful and nervous about coming to a syringe access program in the first place.”
Health Right gathers information from its exchange clients, she said. But “being able to be anonymous makes it much easier for them to share the kind of information we need to help them stay safe. That is clearly not considered best practice for harm reduction.” Most programs, she noted, operate anonymously.
The ID requirement is one of many aspects of the bill that deviate from CDC best practices for syringe services programs, as they’re formally called. CDC guidance advises programs to “ensure low-threshold access to services, encourage participant confidentiality and minimize administrative burden.”
The ID requirement, which was stricken from the bill then put back in at the last moment, is there to purportedly prevent program clients from serving drug pushers by giving them extra needles to fill and sell for profit.
People have access to free syringes through exchange programs, Jones said. “What we want is for people to have clean syringes.” If they can’t make it themselves and need to get them from a dealer, they can do that. But Health Right offers free syringes.
And, as strange as it may seem, Jones said drug dealers are now more concerned about HIV and hepatitis C, and are interested in providing syringes for free. She didn’t say the dealers may have an interest in keeping their clients alive to maintain their revenue streams, but that might follow.
The process of obtaining needles for others is called secondary exchange. Jones is concerned about the restriction for additional reasons. “We have such a transportation issue in our communities.” So the requirement poses a barrier to those who need clean needles – and may also be registered clients – but can’t come in person.
During COVID, Jones said, Heath Right encouraged friend and family groups to minimize their exposure by selecting one person to obtain syringes for everyone in the group.
The CDC says, “Secondary syringe exchange programs increase SSP reach and effectiveness.”
SB 334 requires that the program “ensure a syringe is unique to the syringe services program.” This means affixing or imprinting some kind of mark or label on each one.
Jones said, “The concern is that it’s a huge undertaking and will waste a great deal of time, when in reality we pick up every syringe we find; we don’t care where they come from. … All we need is a phone call to pick up syringes wherever they are.”
Health Right uses insulin syringes that come in bags of 10, Jones said. They’re not individually wrapped so requiring someone wearing gloves to handle each one to apply a sticker or mark poses sterility risks.
And while European syringes come in colors, they’re expensive. Programs may not use federal or state funds to buy syringes, and Health Right gets much of its supply donated through programs that offer support to free clinics and harm reduction programs. So additional expense may be in view.
As part of the initial and annual licensing process, SB 334 requires a “written statement of support from a majority of the members of the county commission and a majority of the members of a governing body of a municipality in which it is located or is proposing to locate.”
On the House floor last week, Delegate Mike Pushkin, D-Kanawha, tried to explain to his colleagues that politicizing the Charleston program destroyed it, opening the door for the current HIV outbreak.
Jones said the provision in the bill, which was removed then restored, subjects every program to politics. They’re worried about getting support in Upshur County, for example.
Bill lead Sponsor Eric Tarr, R-Putnam, frequently cited problems with unscrupulous sober living homes as a prime reason for the bill. These out-of-state businesses, he said, set up homes in West Virginia, import addicts and use them to collect money from their families and from Medicaid. When addicts’ resources are wrung dry, they’re tossed on the street.
Jones said Tarr’s argument was basically a sleight-of-hand move. “That has nothing to do with harm reduction. That is a specific issue related to sober living companies. To connect that with harm reduction just muddies the water.”
Jones said she believes the bill succeeded in its more restrictive form because of widespread ignorance. In the Legislature, she said, “No one understands or has done any research about harm redcution and how it works. Despite efforts by a parade of physicians and public health experts to educate them, “they just chose not to listen to the scientific reality, the evidence-based practices that have been agreed on for more than 30 years around the world.”
One problem with the bill won’t affect Health Right so much, Jones said. Its various requirements, such as having a licensed health practitioner on site, turn a public health intervention into a medical-clinical intervention. Health Right’s program operates out of a medical facility, so it will have an easier time following the guidelines than other programs.
It’s more important to have someone with knowledge about resources and some lived experience with drug use on site than to have a doctor or nurse there, she said. Most programs don’t have access to health care providers and will have to find willing volunteers.
Last year, Jones said, its program served 1,300 unduplicated patients – most come back weekly or monthly for new supplies – at a total cost just under $200,000, which covers a full time registered nurse and peer recovery coach and a part time social worker.
Jones’ concerns were heard regularly from others at the Capitol during the bill’s journey. Asked about the bill on Monday, Gov. Jim Justice indicated no desire to veto it.
“I really believe that everyone kind of came together on this thing and developed a real good scientific balance that can aid and help the public in every way,” he said. They want to strike a balance between needle litter and keeping clients safe. “I thought really and truly from what I understand it was a good balance and they did a good job.”
TWEET David Beard @dbeardtdp EMAIL dbeard@dominionpost.com
