A needle used for heroin injection lies in the woods off Jeff Davis Highway in Richmond. Photo by Julia Rendleman.
It’s been more than a year since Virginia’s legislature opened the door for needle-exchange programs to curb rising hepatitis C infection rates and the potential increase in HIV infections that could follow in the wake of the opioid epidemic.
While one program has been approved, none have actually opened anywhere in the state.
The reason? Some local law enforcement agencies refuse to sign off.
The bill passed by the General Assembly in 2017 requires local police to support the programs before they can launch. But some law enforcement agencies balk at the idea of endorsing the provision of drug paraphernalia despite the reams of public health data that show the programs prevent the spread of blood-borne diseases such as hepatitis C and HIV.
Needle exchanges, also known as harm-reduction or syringe-services programs, allow injection drug users to swap used needles for clean ones, considerably lowering their risk of contracting one of the potentially deadly infections.
The programs have not been legalized statewide. Instead, the bill that passed in 2017 created a patchwork effect by permitting the programs in 55 pre-selected cities and counties based on rates of drug use, hepatitis C and HIV as long as they had the support of local law enforcement agencies.
But for most, that support has been hard to come by.
Roanoke Police Chief Tim Jones refused the Council of Community Services Drop-In Center when it requested a letter of support to start a needle exchange to serve parts of southwest Virginia.
Colin Dwyer, harm reduction and substance use program coordinator for the Council of Community Services, said he approached Jones for support shortly after the law went into effect a year ago, to no avail.
“We’re kind of at a standstill here,” Dwyer said. “We have our mayor’s support, we have our health commissioner’s support, but the police chief doesn’t believe the research, I guess. We’ve sent him information and sent him articles, but he just doesn’t see that as a solution.”
Jones said the needle exchanges should rest firmly in the jurisdiction of health officials. He added that police can’t look the other way by giving drug users clean needles.
“I do not know why our state legislature put a sign-off by a law enforcement representative in this wordage,” he said. “I cannot condone the use of or facilitate a mechanism through which folks are going to do bad things to themselves.”
‘VIRGINIA WASN’T READY’
Dr. John O’Bannon, a former Republican state delegate representing Henrico County, sponsored the 2017 legislation. A statewide bill had just failed in committee the previous year, so O’Bannon and Dr. Marissa Levine, the former state health commissioner, worked on a compromise: a bill that would cover the municipalities most in need.
“It requires the local governing body, the health department and law enforcement, all three, to come together and pull the trigger on such a program,” O’Bannon said in an interview last week. “We all agreed: Virginia wasn’t ready for a full-bore needle exchange statewide when this came along, so that was the practical compromise that was decided. We would make it a high bar with comprehensive buy-in from multiple stakeholders, but we would do it at the local level to satisfy the areas of greater risk.”
But without statewide support for the programs, law enforcement officials are put in a difficult position, said Dana Schrad, executive director of the Virginia Association of Chiefs of Police.
The direction on whether or not police should support needle exchanges needs to come from the state’s elected leadership, she said. It should be a public-health position first and a law enforcement decision last.
“Law enforcement as a community will wait for leadership from our elected officials to see if that is something that our General Assembly, our governor wants to embrace,” she said. Then, for police the issue becomes operational.
“How is this done safely and equitably?” she said.
Among the reasons Virginia wasn’t ready for statewide legalization of exchanges, O’Bannon said, is that many are still uncomfortable treating addiction as a medical illness. Some think the programs abet criminal behavior by making it easier to use drugs.
The law that was passed was meant as a stepping stone, he said, adding that it could be easier to pass a statewide law once a few programs are already open in the cities and counties that most need them and the Virginia Department of Health has data to prove they work.
Then again, it’s hard to collect data when no programs have launched. The law has a three-year sunset clause — and one year is already gone.
‘PUBLIC HEALTH AND PUBLIC SAFETY GO HAND-IN-HAND’
A few law enforcement agencies have expressed support for needle exchanges and the state is close to at least one program opening. VDH has already approved one in Wise County, which had a soft launch in early July but has yet to officially open. The Lenowisco Health District, which includes Wise, secured the support of the county’s sheriff.
And the Richmond Police Department wrote a letter of support for an application that Health Brigade, formerly the Fan Free Clinic in Richmond, that is currently under review by the state health department.
“I think it’s important to understand that public health and public safety go hand-in-hand,” said Richmond Police Department Capt. Emmett Williams.
He said most law enforcement agencies asked to support a needle exchange fear the police department will have to be actively engaged in the program, which isn’t the case.
“All the police department does is we act as an agency that supports what they’re doing, we know what they’re doing, and if they have any concerns, they have a contact at the police department,” he said.
“I think it would be kind of hard to trudge our way through this opioid epidemic if we didn’t have the resources of the Virginia Health Department,” he added. “Law enforcement has a role … in the sense that we have to partner with all these other agencies that are involved in combating the opioid crisis and the HIV and hepatitis C increase that we’ve seen over the years.”
Last year, 1,227 people fatally overdosed on opioids in Virginia, up from 1,138 in 2016 and 812 in 2015. Health officials at both the state and federal levels are wary that the epidemic might ignite more HIV outbreaks, as it did in Scott County, Ind., in 2015.
The federal Centers for Disease Control and Prevention released a list of the counties most at risk of seeing a similar HIV outbreak. Eight of them were in Virginia: Buchanan, Dickenson, Russell, Lee, Wise, Tazewell, Patrick and Wythe.
While an HIV outbreak has yet to hit Virginia, the state has seen a spike in hepatitis C. In 2013, there were slightly fewer that 6,500 people living with the disease, but in 2017 that number had jumped to nearly 11,500.
HIV numbers in Virginia haven’t seen a similar surge, but often, high rates of hepatitis C will precede an HIV outbreak because hepatitis C spreads more easily, said Diana Jordan, director of the state health department’s division of disease prevention.
Needle exchanges won’t just help prevent the spread of disease. They also require the organizations running them to offer testing, risk reduction counseling and referrals to drug treatment.
“It would give us a platform for testing people more frequently who are in that risk category for HIV and hepatitis C… before they have a chance to spread it,” said Dwyer, with Roanoke’s Council on Community Services. “Needles are a lot less expensive than hepatitis C treatment or HIV treatment. It would be a great benefit.”
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