Joe Solomon is the co-director of SOAR, a syringe-exchange and harm-reduction services group in Charleston, the capital of largely poor and rural West Virginia. When I spoke to Solomon in late March, SOAR was handing out large supplies of clean needles to hundreds of injection drug users (IDUs), many of them experiencing poverty and homelessness, in a region long known for having an overdose fatality crisis as well as the kind of HIV outbreak among IDUs that has become rare in the age of widespread needle exchange. SOAR also distributed large amounts of Narcan, which people who use drugs can easily administer to one another to reverse opioid overdoses.
But when I talked to Solomon again in early May, everything had changed: The state had just passed a slew of restrictions on syringe-exchange programs (SEPs). The biggest restrictions force recipients to show a state ID like a driver’s license, something many of them don’t have. Additionally, exchange must have a goal of 1:1, meaning users only take enough clean syringes for themselves, not a supply to take back to their communities of drug users that might all live under a certain overpass or in an abandoned building. Plus, users can only get as many new clean needles as they bring back old, dirty ones—presumably as a way of reducing dirty-needle litter, a major cause of community opposition to SEPs. All these new restrictions tie SOAR’s hands in major ways.
But then leadership in Kanawha County, where Charleston sits, went even further, passing a local code saying that any SEP found in violation of these and more restrictions would receive a fine per violation of $500 to $1,000.
Solomon called it a “huge blow.” Solomon grew up on Long Island, New York, and was a climate activist in the Pacific Northwest before moving to West Virginia to go “where there’s more help needed” on social issues. (“There’s so much despair and anxiety here.”) He said all the new restrictions amount to “the flat-out end of any legal needle exchange in the state. One program in Marion County already shut its doors. All programs must now become licensed, but many politicians see needle exchange as something to be weaponized to win elections, so the chance of getting those licensure letters is virtually impossible.”
For SOAR and other SEPs, he said, “We’ve seen our state turn its back on us, and now we have to ask ourselves if we’re going to turn our backs [on our IDU clients] or figure this out, come what may.” He wouldn’t say so, but his remark carried the possibility that his and other groups may need to find ways to do what they do while flying below the radar of the law.
Defying Public Health Recommendations
Health statistics in West Virginia would seem to preclude the closing down of SEPs at this time. In the past two years, including during COVID, the state has seen a rise in documented cases of HIV among IDUs—from 38 in 2018 to 91 in 2019 and 89 in 2020 (with five reported cases in 2021 as of early March).
The numbers may seem small, but the sharpness of the increase is alarming, with Demetre Daskalakis, the HIV prevention chief at the CDC, calling it “the most concerning HIV outbreak in the United States at this time,” with a case count that possibly “represents the tip of the iceberg.” He also urged the state to increase and ease, not decrease and complicate, access to SEPs. The CDC has long supported and promoted SEPs as a heavily proven way to decrease—even nearly eradicate—HIV spread among IDUs, and even as a service gateway for IDUs who desire so to get into drug treatment.
Because most states had at least one syringe-exchange program as of 2018, with many states having several, HIV cluster outbreaks among IDUs in the past several years have become rare. West Virginia is now among outliers like Indiana, which had an outbreak in 2015 under then-Gov. Mike Pence, who reluctantly agreed to allow some SEPs only once the outbreak was underway. Outbreaks have also occurred in Boston and smaller cities in Massachusetts, where SEPs are legal but, as in many places, have been upended and slowed somewhat by the COVID pandemic.
Moreover, West Virginia has the highest opioid-overdose death rate in the nation, with a 45% increase in such deaths between 2019 and 2020. And clean needles are the reason why IDUs often show up at SEPs, where they then can get access to overdose-preventing Narcan. According to Solomon, when SOAR briefly stopped giving out clean needles late last year during a police investigation into impropriety (which ultimately charged nothing), the number of users who showed up at their weekend fairs for any services dropped from 250 to 10 or 20.
“Syringes are the hook to get your arms around people for wound care, Narcan, drug treatment, and other stuff,” he said.
But in recent years, state lawmakers have seized on complaints about needle litter—a real problem, admittedly, but one with relatively simple solutions such as more public sharps disposal boxes—plus the disproven but still widely held idea that SEPs cause more drug use and crime, to call for restrictions or outright bans on SEPs. That’s a move that often plays well with conservative West Virginia voters who know little about public-health science, despite the state’s glaring opioid crisis. Foremost has been Republican Sen. Eric Tarr, who last year sponsored a failed bill to outlaw SEPs altogether before coming back this year with a successful bill, passed by supermajorities in both state chambers, to restrict them nearly out of operation. (Tarr’s office did not reply to an email from TheBody asking for comment.)
According to Solomon, the rights and lives of drug users experiencing homelessness don’t have the kind of broad populist mojo behind them to beat the state’s right-wing politics—as did, for example, the state’s nationally followed 2018 teachers’ strike that led to a 5% pay hike. And drug users can be a hard group to organize politically—especially in pandemic times.
“Our movement clearly has the science behind us, but movements need to be powered by a loud enough mass of people closest to the pain,” he said. “The drug-using community in Charleston is small. We’ve had some wins organizing social workers and people in recovery, but a really successful movement of drug-user health as a human right is going to need to go deeper.”
As an example, he pointed to Canada’s Vancouver, which has not only syringe exchange but North America’s first legal site where drug users can inject under medical supervision to prevent overdose. “It’s a mecca of what you can get when you organize [a critical mass of] people who use drugs.”
SOAR is trying to organize a protest of the new laws for later this summer, Solomon added.
Not the Only Place With Assaults on Syringe Exchange
Efforts to roll back legal needle exchange do not seem to be becoming a conservative trend across states in the way of, for example, current efforts to block transgender youth from receiving trans-related medical care or playing on their chosen gender of sports team. That’s according to Mary Sylla, J.D., M.P.H., senior staff attorney at the national Drug Policy Alliance, which advocates for SEPs among other policies that treat drug use as a public-health rather than a criminal issue. Sylla worked with SEP advocates in West Virginia to try to get passed as unrestrictive a law as possible.
But, she says, despite years of science backing them up, SEPs remain vulnerable to community backlash—even in blue states like California. There, she says, in places like Santa Cruz and Orange County, critics have tried, so far unsuccessfully, to use preexisting environmental regulations to get SEPs banned on the charge that they create needle litter.
Such pushback, says Sylla, is enough to keep syringe-exchange advocates in states with local SEPs but no state law pro or con from trying to get a pro-SEP law passed, to avoid drawing attention to a bill that could be trounced by its opposite. That’s the case in Texas, whose first needle exchange opened in San Antonio in 2019.
But Sylla also thinks that the single greatest obstacle to more SEPs everywhere is not state-level resistance but the ongoing ban on federal funding for actual needles, even if federal funding for other aspects of SEPs finally opened up in 2016. “There’s $30 million in the most recent COVID bill for needle exchanges,” she says, but the money actually flows through the federal agency SAMHSA, “which requires SEPs to jump through a lot of hoops, which may prevent the money from getting to mom-and-pop places.” (Many SEPs are run by volunteers and not licensed health professionals—yet another burden that the new West Virginia law now puts on SEPs.)
Regardless of locality, says Sylla, the best way to preserve or expand SEPs is to continue with the long-term slog of educating electeds and community members about their benefits, and to fight back myths such as that they increase crime and drug use. For example, she says, research shows that “people who use SEPs are more likely to dispose of their syringes properly. If that were at least understood, it would be helpful. We also need to create more places for proper disposal, such as biohazard boxes on every street corner” in some areas. “And we need better social services for people who are homeless, so they can use more safely.”
All those things, she admits, “are not a simple answer—but it’s the real answer.”
The assaults on SEPs in both West Virginia and parts of California suggest that “you can’t necessarily draw a neat line between coastal and inland,” says Sheila P. Vakharia, Ph.D., deputy director of the Drug Policy Alliance’s research department. “Every win [for SEPs] is tenuous, and you can’t take it for granted.”
Meanwhile, in Charleston, Solomon isn’t sure what SOAR is going to do now that its work has been so restricted—by both the state and the county. “That’s how thick the blanket of fear [of drug users] is in this city,” he says. “It’s like a smog. Our mayor [Amy Goodwin] always said she would listen to health care experts on issues. I don’t know a single nurse who told her to go and arrest people doing needle exchange.”