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West Virginia Drug Intervention Institute, Inc. Launches Project to Discern Community Perceptions of Harm Reduction Efforts

 

West Virginia has the highest fatal drug overdose rates in the nation. Reports nationwide suggest a significant increase in both fatal and non-fatal overdoses since the beginning of the COVID pandemic in early 2020. Data from the West Virginia Office of Drug Control Policy indicate that since the pandemic, the number of fatal and non-fatal overdoses have significantly increased in many counties.

Additionally, while the total number of HIV diagnoses in the State as a whole has decreased from 2019 to 2020, cases in Kanawha County have increased by 34% (from 29 total HIV cases in 2019 to 39 cases in 2020). Over 80% of HIV cases in Kanawha County in 2020 report injection drug use. The total cost of lifetime HIV medical treatment in Kanawha County for those individuals diagnosed with HIV in 2019 and 2020 (as of December 15, 2020) is $17,844,396. 

HIV is not the only concern. According to the CDC, 28 of West Virginia’ 55 counties (including Kanawha) are at risk for a Hepatitis C (HCV) outbreak, largely because of intravenous drug use. Hepatitis C is the No. 1 infectious-disease killer in the country. In West Virginia, rates of acute hepatitis B increased 220 percent over seven years — 14 times the national average. In Kanawha County alone, there was a 322 percent increase in hepatitis B cases from 2012 to 2015. In 2016, Kanawha County had the highest number of newly reported cases of both acute Hepatitis B Infection and acute Hepatitis C Infection.

 

One way to prevent the spread of infectious disease and decrease overdose deaths is through the implementation and operation of harm reduction programs. As defined by the US Centers for Disease Control (CDC), harm reduction is any behavior or strategy that helps reduce risk of harm to self or others. Harm reduction in relationship to substance use disorder (SUD) often refers to naloxone distribution, STD testing and treatment, contraceptives, access to SUD recovery and treatment, and syringe exchange. Currently, West Virginia DHHR recognizes 18 harm reduction programs throughout the State. All of these programs include some type of syringe service program--more commonly called “needle exchange.” 

 

Best practices suggest that harm reduction programs include syringe service programs (or SSPs) that provide a wide range of services including linkage to primary care, SUD treatment, vaccination, and testing as well as needle exchange. Some programs require a 1:1 exchange (clients must return one needle for each needle dispensed). However, the CDC recommends a needs-based approach that does not limit the number of needles dispensed versus returned.

 

The CDC reports that syringe service programs result in an estimated 50% reduction in HIV and HCV incidence. And, when combined with medications that treat opioid dependence (also known as medication-assisted treatment), HCV and HIV transmission is reduced by over two-thirds. These programs also serve as a bridge to other health services, including HCV and HIV testing and treatment and medication-assisted treatment for opioid use disorder. In addition, The majority of SSPs offer referrals to medication-assisted treatment, and new users of SSPs are five times more likely to enter drug treatment and three times more likely to stop using drugs than those who don’t use the programs. 

 

Despite documented outcomes and identification of best practices,SSPs are often controversial due to lack of community support, stigma surrounding SUD, and concerns about public safety. Some communities are able to overcome these barriers while others remain stuck.

 

During January 2021, the West Virginia Drug Intervention Institute, Inc. will conduct an analysis of community opinions on SUD, harm reduction and syringe exchange. The project is not intended to assess or evaluate any specific program but will assess community perceptions and attitudes and determine gaps that exist in addressing SUD (specifically in Kanawha County). The research will include an online (anonymous) short-survey individuals can complete. The survey will be open to the public via the Institute’s website, www.wvdii.org, from January 8 through 22, 2021. Individuals wishing to participate in additional discussion (listening sessions or focus groups in late January) can choose to identify themselves and share contact information. The project will culminate the release of a document summarizing the survey data and focus groups along with recommendations for addressing SUD in Kanawha County and the State. 

1 Centers for Disease Control. 2018 Drug Overdose Death Rates. https://www.cdc.gov/drugoverdose/data/statedeaths/drug-overdose-death-2018.html. Last reviewed March 10, 2020.

2 Centers for Disease Control. Overdose Deaths Accelerating During COVID-19. https://www.cdc.gov/media/releases/2020/p1218-overdose-deaths-covid-19.html. Last reviewed December 18, 2020.

https://oeps.wv.gov/hepatitis/documents/data/Summary_2016_Acute_HBV-HCV.pdf

4 Centers for Disease Control. What is Harm Reduction? https://www.cdc.gov/hiv/pdf/effective-interventions/treat/steps-to-care/my-stc/cdc-hiv-stc-what-is-harm-reduction.pdf.

5 West Virginia Department of Health & Human Resources Office of Epidemiology & Prevention Services. WV Programs At a Glance. https://oeps.wv.gov/harm_reduction/documents/about/wv_hrp.pdf.

6 Centers for Disease Control. Syringe Services Programs. https://www.cdc.gov/ssp/docs/SSP-Technical-Package.pdf?fbclid=IwAR0RxYold2P24jIHDqRI6yP2tSqeitkeTDDj5lVv2xDmIMFSHHEVrwO1-aA.

7 Centers for Disease Control. Syringe Services Programs. https://www.cdc.gov/ssp/docs/SSP-Technical-Package.pdf?fbclid=IwAR0RxYold2P24jIHDqRI6yP2tSqeitkeTDDj5lVv2xDmIMFSHHEVrwO1-aA.

8 Centers for Disease Control. Syringe Service Programs (SSPs) Fact Sheet. https://www.cdc.gov/ssp/syringe-services-programs-factsheet.html.

9 Centers for Disease Control. Syringe Service Programs (SSPs) Fact Sheet. https://www.cdc.gov/ssp/syringe-services-programs-factsheet.html.

10  Centers for Disease Control. Syringe Service Programs (SSPs) Fact Sheet. https://www.cdc.gov/ssp/syringe-services-programs-factsheet.html.