For the past few weeks, Edward Peters has been trying to spread the word about the new needle exchange that Health Brigade in Richmond just launched.
An outreach specialist with the Richmond-based free clinic, Peters said that most people he talks to on the street seem open to the idea of using clean equipment for injection drug use.
But they haven’t shown up yet.
Others are more openly skeptical. He’s heard everything from “It’s a set-up,” to the more direct, “I’m not going.”
The exchange, also known as a comprehensive harm reduction program, has only been open twice a week since mid-October, and so far it’s just had a couple of participants and a handful of calls asking for more details or information on where to go.
The slow start isn’t too surprising, said Emily Westerholm, Health Brigade’s comprehensive harm reduction program coordinator. Those dealing with addiction are afraid to be stigmatized and judged, and that fear often stands in the way of seeking services.
“When you’re dealing with people with active addiction, they’ve got their own culture, their own belief systems,” Peters said. “In their mindset, they’re probably thinking, ‘It could be a trap.'”
Needle-exchange programs allow drug users to pick up new, clean injection drug equipment, such as syringes and needles. It also offers them a safe place to dispose of dirty supplies, get tested for diseases and learn about the dangers of overdosing.
Most see the programs as a huge part of the public health response to the opioid epidemic, as it can decrease the spread of bloodborne diseases like hepatitis C and HIV.
But they’ve gotten off to a slow start in Virginia, even though they were legalized over a year ago. That’s due in part to the requirement in the law that organizations get a letter of support from their local law enforcement agency.
Those opposed or skeptical of needle exchanges question the logic of giving someone the tools to break the law, but Peters has a simple response: “They will use anyway.”
If they don’t have clean equipment, they’ll just share needles and risk contracting hepatitis C or HIV.
Westerholm uses the example of safe sex practices and public officials handing out condoms.
“I remember this sort of pushback to having condoms,” she said. “But people were obviously having sex. It’s not like not having condoms is going to make people not have sex.”
A slow start all over the state
The programs are so new to Virginia that the hesitation from participants probably just comes with the territory, said Elaine Martin, director of HIV prevention services with the Virginia Department of Health.
“It’s going to take time to build trust and rapport and I think that’s true with any new intervention, especially with a population that’s fearful of arrest,” Martin said.
The Council of Community Services Drop-In Center in Roanoke has been unsuccessful in its attempt to open a needle exchange because it hasn’t been able to secure law enforcement support.
Right now the city is conducting a study on the topic. Colin Dwyer, harm reduction and substance use program coordinator for the Council of Community Services, said he’s concerned that the more controversial opening a needle exchange becomes, the more difficult it will be to convince people to use it if it opens.
“It’s a hard balancing act to try and work with all the people in the community, without making it such a controversial issue that if it does become a reality, people don’t want to use it because they’ve heard so much, they’ve seen quotations in the paper,” he said.
The state is close to approving its third application from Mount Rogers Health District for Smyth County. Martin said the state hopes to announce the new program’s approval in about two weeks.
And she’s hoping to get a fourth application from an organization in Newport News any day now, she added.
The only other open program, which launched this summer in Wise County, so far has 29 registered participants.
The goal for Health Brigade right now is just to get the word out there, Westerholm and Peters said, and use their existing relationships with people in the community to prove that they can be trusted.
Participants recounted to Westerholm feeling stigmatized at other service organizations because of the track marks on their arms, the puncture wounds resulting from injection drug use.
“They felt that judgment and that pressure,” she said. “But now they can come here and hear, ‘Hey, that’s all right. Do you need a wound care kit?'”
When people come into Health Brigade for clean supplies, they don’t have to give their identification or even their real name. Westerholm does a short assessment to learn what type of drug use they participate in to ensure they’re injecting safely and to give them the appropriate supplies.
They’re told about other services, too, which aren’t limited to substance abuse treatment but also include mental health care and medical care.
But they’re not pressured to participate.
The goal is to just get them to continue using clean equipment to prevent the spread of diseases. They’re learning the importance of self-care, Westerholm said, and that some people are concerned about their well-being. And maybe that lesson will sink in over time and they’ll seek treatment.
“It’s sort of like teaching, not just to people in these communities, that they are human and they are worth it,” Westerholm said. “But also teaching the general public that this is not a moral failing. This is a disease, and if you look at it as a medical condition, maybe you can start approaching it more progressively.”