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Syringe study reaffirms current practice

By BISHOP NASH The Herald-Dispatch bnash@heralddispatch.comMay 27, 2019

HUNTINGTON — While a study published last week by Johns Hopkins University roasted Charleston leadership for the climate of stigma that led to the Kanawha-Charleston Health Department shuttering its syringe exchange program, it’s mostly carried only passing interest 50 miles away in Huntington.

The study concluded the suspension of the Kanawha-Charleston Health Department’s syringe program “fundamentally changed the health landscape” for intravenous drug users in multiple negative ways, leading to “a new era of increased risks for acquiring bloodborne infections and overdose.”

The Cabell-Huntington Health Department’s syringe exchange, now the largest in the state, continues to operate as normal.

And while the report could be seen as a minor affirmation that the program is working in public health’s best interest, years of science have already done that, said Dr. Michael Kilkenny, physician director at the Cabell-Huntington Health Department.

“The science in harm reduction programs is much older than any West Virginia program,” Kilkenny said Wednesday night following the department’s monthly Board of Health meeting. “It’s sound, but so much of what’s known about harm reduction is based on misunderstanding, and it’s bad that those misunderstandings can grow to the level that people are harmed.”

The purpose of a syringe exchange is ideally to provide clean syringes to IV drug users to curtail the spread of bloodborne diseases through needle sharing. Cabell-Huntington’s syringe exchange has operated since 2015.

There’s certainly no joy in a nearby community’s suffering, Kilkenny added, but the study should be taken as a reminder that specific policy changes can have impactful effects on people’s lives.

Since the Kanawha-Charleston Health Department 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.

The study also noted that not only did the program’s closure defy best medical practices in restricting resources to a vulnerable population, but 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, in a prior interview Monday.

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 had changed.

But the fact that Cabell County developed the state’s only HIV cluster — now at 49 cases — more than three years after its syringe exchange began could be taken as an indictment that the Cabell-Huntington Health Department’s syringe exchange isn’t working by those who oppose it.

Kilkenny refuted that, adding that harm reduction has been proven to work, particularly within at-risk populations during a cluster.

The Johns Hopkins study backs that up, stating that “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 full study is available online at https://harmreductionjournal.biomedcentral.com/track/pdf/10.1186/s12954-019-0305-7.

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