CHARLESTON — Dissolved under pressure rooted in stigma rather than science, the suspension of the Kanawha-Charleston Health Department's syringe exchange program "fundamentally changed the health landscape" for intravenous drug users in multiple negative ways, according to a study published Monday night by Johns Hopkins University.
Since KCHD ended its syringe exchange in 2018, the study found Charleston's IV drug use population is now injecting with used syringes more frequently; has less access to naloxone, the drug used to reverse an opioid overdose; and is less likely to be tested for HIV in what the study now calls "a new era of increased risks for acquiring bloodborne infections and overdose."
Findings are based off research gathered by the Johns Hopkins Bloomberg School of Public Health in September 2018, roughly six months after the program's closure in March.
Researchers personally interviewed 27 active IV drug users in Charleston, the majority who had used the syringe exchange during its roughly two-year operation, to gauge how their lives and practices have changed.
The study found that not only did the program's closure defy best medical practice in restricting resources to a vulnerable population, it also left those who needed them most feeling "abandoned by the community and city leadership when it closed," said Dr. Sean Allen, the lead researcher who wrote the report.
"There's obviously a lot of stigma attached to drug use, and people need to be reminded these aren't just unknown people out in the community; these are somebody's sons or daughters and they all have a story," Allen said in a phone interview Monday.
"They need to be treated with dignity and respect, and we need to destigmatize (drug use) and provide access to these resources."
By 2018, KCHD's syringe exchange program served more than 400 individuals each week — "remarkable given the relative rurality of Kanawha County," the study states.
But the program was divisive in the community, exacerbated during the run-up to the November 2018 election when the syringe exchange became a flashpoint topic, particularly during the Charleston mayoral race.
Outgoing mayor Danny Jones was a vocal opponent of the program, calling it a "needle mill" and claiming crime had "skyrocketed" as a result.
Those surveyed in the study described being stigmatized for their drug use before, during and after the syringe exchange operated, adding it was a disincentive for them to access health care.
The 27 participants overwhelmingly described hardship in acquiring clean syringes elsewhere — either buying them legally or on the street, stealing from clinics and family members with diabetes, or through other nonprofit options.
"I mean, you've got four or five people sharing a needle," one male participant described, "And then they'll throw it down on the ground and maybe somebody else comes along and they pick it up and they think burning it with a lighter will sterilize it.
"Well, that's not so."
While the majority stated they did not want to share syringes for fear of contracting HIV or hepatitis, few were able to avoid it when the syringe exchange was suspended. Many described sharing syringes with only close friends or sexual partners.
"It grosses me out," one female participant said in the study. "Every time I do a shot I go 'I feel it. I feel the HIV coursing through my veins.'
"And it's a joke," she continued. "But at the same time, it's not. I laugh about it because if I don't I'd probably scream…"
In the study, Allen writes the survey serves as a call of action for Charleston's policymakers to stand by evidence-based best practices rather than "inaccurate and misleading reports" about syringe exchange, particularly with an active HIV cluster currently 50 miles away in Cabell County.
"Choosing to ignore the evidence-base for (syringe exchange) operations not only presents an ethical and moral dilemma, but also sets the stage for an HIV outbreak and worsening overdose epidemic," the study states.
The full study is available online at https://harmreductionjournal.biomedcentral.com/track/pdf/10.1186/s12954-019-0305-7.