Nearly six months after syringe services programs, known as needle exchanges, became legal in Virginia in an effort to curb surging rates of hepatitis C, the Department of Health has yet to receive a single application to launch one from any of the 55 eligible districts.
The state health commissioner, Dr. Marissa Levine, told the Board of Health during a recent meeting that law enforcement agencies have been hesitant to provide letters of support, which is a requirement for the applications.
“To date, we have gotten no applications because the barrier has been the law enforcement,” Levine told the board. “Nobody wants to be the first in law enforcement to say they support this, and we have to get past that. We absolutely have to get past that.”
A bill to legalize the programs, referred to by the department as comprehensive harm reduction, was passed by the General Assembly during the most recent session and became effective in July.
People are also reading…
The letters from law enforcement are a critical component of the applications to ensure the protection of people who participate.
“This is a complete culture change for law enforcement,” said Chesterfield County Sheriff Karl Leonard. “Law enforcement traditionally have been trying to prevent drug use and the use of illegal drugs, and now we’re going to say, ‘Hey, we’re openly giving you a needle to use your drugs.’”
The programs provide injection drug users with clean equipment, such as needles and syringes, and are meant to stem the spread of hepatitis C and HIV as a result of the ongoing opioid epidemic.
“I know of somebody who actually died from hepatitis C as a result of heroin use,” Leonard said. “I have a gentleman in our program who tells a story of knowingly using a bloody needle from someone he knows had a disease, but the addiction is so strong, he didn’t care.”
As the opioid epidemic rages on, chronic hepatitis C cases have skyrocketed.
Between 2009 and 2013, rates of hepatitis C stayed relatively constant at about 6,500 cases a year. But in 2016, the number jumped to more than 11,300, according to Virginia Department of Health data, an increase of nearly 3,000 compared to the year before.
While the most recent data do not show a similar spike in HIV, a jump in the rate of hepatitis C usually precedes rises in HIV.
Meanwhile, the use of opioids — including prescription painkillers and illicit drugs like heroin — doesn’t seem likely to slow down anytime soon, with 1,181 projected overdose deaths, according to the Department of Health. Drug overdoses kill more people in Virginia than car crashes or guns.
Syringe services programs have been shown through research and data to be effective in hindering the spread of hepatitis C and HIV. Both the Centers for Disease Control and Prevention and the U.S. Department of Health and Human Services call them effective components of a comprehensive approach to HIV prevention.
But the evidence behind the programs — as one of the best ways to stop the spread of drug-related infections — doesn’t always translate among everyone involved in tackling the opioid epidemic. For law enforcement, the idea of giving someone the equipment to illegally use drugs may be too big a pill to swallow.
Elaine Martin, director of Virginia’s HIV prevention services, said that, in some cases, law enforcement agencies are on board with the programs, but the applicants have not been able to pull together their applications yet.
That’s the case in Richmond. Karen Legato, executive director of Health Brigade, a free clinic in Richmond’s Museum District, said her staff is working on the design of a program and, once that is completed, will reach out to other community stakeholders such as the police for support.
“I am optimistic we will get the support,” Legato said in an email.
Gene Lepley, public affairs director for the Richmond Police Department, did not definitively say the department was for or against a syringe services program, but that it will need to review any proposed plan before signing off with a letter of support.
In some areas, though, everything is in place on the applicant’s side, but a letter of support from law enforcement has not been forthcoming.
“Harm reduction is not something that probably the local police are that familiar with,” Martin said. “It’s a public health concept. It’s been around for a long time. ... We’ve had great support on the state level from law enforcement, which is encouraging. We’ve been able to share science and data with them and get the buy-in. I think we need to do the same thing at the local level.”
She declined to share which localities are having difficulty getting support from law enforcement, as she was wary of hampering potential collaboration, but said there is a handful of localities facing the problem.
Leonard said he sees the need for the program to such an extent that his staff is exploring the idea of applying for its own syringe services program.
“I’m not encouraging anybody to put a needle in their arm who’s never done that before, and by me providing needles in a needle exchange program, nobody’s going to say, ‘I’m going to get needles from the sheriff? Let me start using a needle,’” he said.
He pointed out that the programs do not add needles to the general population, but allow drug users to swap dirty needles for clean ones. It does not add to the number of people using drugs, he said, a common misconception of the programs.
“If anyone isn’t paying attention, we’re losing this battle already,” he said. “Overdoses and deaths are going to surpass 2016, which surpassed 2015, which surpassed 2014.
“This heroin-opioid epidemic is extremely unconventional. We’re struggling to find ways to deal with it, and it’s going to take these unconventional approaches to start making some headway into it,” he continued. “At least let’s start with reducing the number of people who contract AIDS, hepatitis or anything else through the use of somebody else’s needles.”
In a testament to the hesitation among many lawmakers on syringe services programs, the law to legalize them does not apply to the entire state, which is why only 55 districts are eligible. It also ends in 2020, which adds some urgency to the state’s desire to get as many applications as possible.
Martin said the hope is to launch enough programs in time so that the Department of Health can gather the necessary data to prove they work and to then approach the General Assembly about extending their legality.
The programs not only provide clean equipment to injection drug users, but also the option of connecting them to hepatitis C and HIV testing services, as well as addiction treatment programs. The hope is that the programs will encourage users to come in for clean needles, and then match them up with necessary services to fight their addictions.
In the meantime, Martin said the Department of Health is working on a webinar for local law enforcement agencies to explain why the programs work based on research and evidence, and to bring law enforcement personnel up from North Carolina, where the programs are running, to talk with local agencies.
“Many different agencies and entities have a role in addressing the opioid epidemic,” she said. “The police have a specific role of what they’re responsible for, and so does public health. I think getting them to understand how that merges together to create an approach to addressing the myriad issues that the epidemic brings about is what’s going to be important.”
Meanwhile, as the Department of Health tries to convince law enforcement of the evidence behind these programs, Martin said she gets regular calls from families of injection drug users asking for information as to where to send their loved ones for clean equipment.
Leonard said the need is evident.
“If a loved one wants to get them a clean needle, why should we not provide those?” he said.