Law Enforcement Lead West Virginia Efforts to Implement Syringe Exchange Programs

Some people were surprised when West Virginia became one of the first Southern states to operate an above-ground syringe exchange program. But for Jim Johnson, now retired Chief of Police for Huntington, West Virginia, syringe exchange was a common sense solution to an increasingly complex problem.

"We were looking at a drug problem that we didn't see any answers for," he says. "We were arresting more people than ever, housing more people in prison and jail, and narcotic seizures were higher than we've ever had, but the drug problem was just getting worse."

So Johnson met with Huntington Mayor Steve Williams, who launched an Office of Drug Control Policy to look into the problem. They started talking to community members about drug-related issues. With the help of Deputy Chief Jan Rader they also started collecting data and realized that heroin seizures and hepatitis C rates were rising rapidly at almost the exact same rates among the same population of drug users. They looked at costs. Shockingly, they discovered that their small county of 97,000 residents would spend $50 million to $90 million dollars in 2015 on the cost of health care treatment alone, including treatment for hepatitis B and C, HIV, and injection-related complications.

"When we started talking to the community we knew that we were probably going to have a problem with hepatitis C and possibly HIV if we didn't do something about injection drug use," says Johnson. "We were wrong. We were not about to have a problem. We already had a full-blown epidemic."

The Office of Drug Control Policy started looking into solutions to address the skyrocketing costs of injection-related disease (nearly all associated with the practice of sharing syringes among injection drug users who can't get new syringes), high addiction rates, and limited access to drug treatment. Members came up with a multi-pronged strategic plan to address all elements of the drug crisis, including law enforcement diversion programs for low level drug offenders, education for young people, expanding access to drug treatment facilities, transitional housing and career opportunities, and syringe exchange programs, which collect used syringes from people who inject drugs in exchange for sterile syringes and access to social services and drug treatment programs.

As a veteran of law enforcement for over four decades, Johnson was initially skeptical of syringe exchange programs. Once he looked into the results in other states, however, (including direct benefits to law enforcement in reduction in needle-stick injury), he became an enthusiastic supporter.

"Once we started studying the benefits of syringe exchange and harm reduction programs we found that communities could saves lives, save money, and that people who entered these programs had a higher percentage of success in fighting addiction," he explains.

Along with a team of advocates from law enforcement and the community, he started educating the public about the benefits of syringe exchange programs, which include drastic reductions in HIV and hepatitis C transmission among injection drug users, a 66% decrease in needle-stick injuries to law enforcement, reductions in crime (because participants are connected to social services such as housing), fewer used or contaminated syringes circulating in the community, and the biggest selling point: syringe exchange programs participants are five times more likely than non-participants to enter drug treatment programs.

"These programs provide much more than just a clean syringe," he says. "A syringe alone won't decrease drug use but if the program offers people you can talk to about getting help for addiction, I'm all about that."

Scott Lemley, criminal intelligence analyst for the Huntington Police Department was also part of advocacy efforts.

"The standard argument against syringe exchange programs is that they enable drug use," says Lemley. "But offering wraparound services as part of the program is shown to actually increase the number of people who access treatment services. The ultimate goal is to get people off IV drug use, but we want to keep them healthy in the meantime also."

Another major benefit of syringe exchange programs is the amount of money they save local and state government by preventing the transmission of costly diseases among a population unlikely to have private health insurance. "We looked at a syringe exchange program in Ohio that operates on about $10,000," says Lemley. "Because the cost of a single hepatitis C infection is $65,000 to $500,000 to treat, if you prevent just one infection, you have already saved money. If you prevent two infections, throw yourself a party."

He adds, "If you have good data and can explain it to people, even people who might have had knee-jerk reactions at first will see the benefits. It's common sense."

Since beginning in September, the syringe exchange program has served over 485 participants. Three other programs, in Wheeling, Morgantown and more recently Charleston, have also started serving the public, and multiple other cities are looking into starting a program.

But it's not just West Virginia that is starting to see syringe exchange programs as part of a broader solution to address problematic drug use. The U.S. South as a whole is extremely hard hit by skyrocketing rates of injection drug use and the accompanying health care costs. The CDC recently released a report on the situation in four states: Virginia, West Virginia, Tennessee, and Kentucky, which showed a 364% increase in acute hepatitis C from 2006-2012. North Carolina acute hepatitis C rates increased 187% from 2010-2014. In early 2015 Kentucky became the first Southern state to explicitly legalize syringe exchange programs and over the next couple of years, advocates in several other Southern states plan to introduce similar legislation.

West Virginia did not pass a state law to legalize syringe exchange. Technically, they still have a law on the books that prohibits the distribution of drug paraphernalia. But since law enforcement is supportive of syringe exchange programs in the areas where they have been implemented, departments have agreed not to charge for drug paraphernalia in the context of the syringe exchange program. The decision is part of a growing trend among law enforcement recognizing that a purely enforcement-based approach to drug use isn't working. In addition to syringe exchange, diversion programs are also becoming popular. The Huntington Police Department plans to roll out a LEAD (Law Enforcement Assisted Diversion) program to divert low level drug and prostitution offenders to social services instead of jail. Fayetteville, North Carolina, and Atlanta, Georgia, are two other Southern cities who will be launching LEAD programs over the next couple of years.

"The war on drugs just isn't working," says Jim Johnson. "Law enforcement everywhere are recognizing that we have to do something different."