State health department wants extension of needle-exchange law

Health Brigade in Richmond is providing injection drug users clean needles and syringes in an attempt to stem the spread of HIV and hepatitis C. (Katie O'Connor/Virginia Mercury)

In its first report to the General Assembly on needle exchanges in Virginia, the state’s Department of Health is hoping lawmakers will give them more time to get going.

Needle exchanges — also known as comprehensive harm reduction or syringe services programs — have only been legal in Virginia for about 18 months, and in another year and a half the law legalizing them is due to expire.

But only three have been approved in the state so far, and there hasn’t been much time to allow for the necessary data collecting that would show whether or not the programs are actually working.

And, the department points out, new programs like needle exchanges require time to gain trust and support. That’s time that the law’s original three-year-window doesn’t allow, officials say.

“Eliminating or extending the expiration date of the law would allow more time to garner the necessary community support, develop and implement programs and measure effectiveness,” the report says.

“CHR is a new initiative in Virginia involving a highly stigmatized behavior. According to social science theory, adoption of a new idea, such as CHR, does not occur immediately in a social system; rather, it is a process developed over time.”

The programs give injection-drug users a place to trade their dirty, used needles and syringes for clean ones. It’s one of the best ways, public health research shows, to prevent outbreaks of hepatitis C and HIV due to drug use, and it’s also been shown to successfully link users with substance-use disorder treatment.

“Beliefs that drug use is a personal or moral failing and not a health concern are prevalent,” the report states, and preconceived notions about needle exchanges abound as some are concerned they increase crime and contribute to increased drug use.

Though only three programs have been approved so far, the department expects to approve two more in the near future, with five hopefully up and running by July 2019.

It has also added 27 municipalities to the list of those eligible to start a program, based on the rates and numbers of hepatitis C infection, among other measures.

Previously, large localities like Arlington and Fairfax were excluded because the state was using rates, rather than absolute case counts, to determine eligibility. Now it uses both.

A needle used for heroin injection lies in the woods off Jeff Davis Highway in Richmond, where a woman was spending the night. Photo by Julia Rendleman.

During a state Board of Health meeting Thursday, Dr. Norman Oliver, the state’s health commissioner, said that the program in Wise County has served 29 people, distributed 1,900 clean syringes and needles and collected 3,200 dirty needles, “thus taking a lot of dirty needless off the streets.”

Because of the program, he added, there were “at least four instances” where naloxone, an opioid overdose-reversal drug, has been used to save someone from an overdose.

The experience of nearby states shows there is a need for more needle exchanges in Virginia.

Department officials visited a program in Asheville, N.C., in 2017, and a provider informed them that one-third of their participants came from southwest Virginia, according to the report.

But the way Virginia’s law is set up doesn’t help the department or others hoping to start needle exchanges in their localities combat the biggest barriers: stigma and misinformation.

While the law protects those who are collecting and distributing needles and other equipment, it doesn’t protect participants from paraphernalia charges.

That lack of protection might deter people from participating in the first place, the report states, and “creates a disincentive to return used syringes, since even a trace amount of substance in the syringe could result in a charge related to possession of an illegal substance. Correct disposal of used syringes is crucial to reducing disease transmission; therefore, collecting as many used syringes as possible is essential.”

The lack of protections also “creates a dilemma for law enforcement,” because they must decide not to enforce paraphernalia or drug possession laws if they encounter someone on their way to return a needle. The report does not explicitly suggest adding the protections to Virginia law, but calls for additional study of the topic.