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Needle exchanges hurt by lack of buy-in, legal uncertainty

RICHMOND — A needle exchange service in the Culpeper area has been put on hold by local health officials due to lack of police support and uncertainty around a law due to sunset next summer.

The Culpeper site would be the fifth to open in Virginia, but April Achter, the population health coordinator for Rappahannock-Rapidan Health District, said a combination of factors convinced organizers to halt and reevaluate before moving forward.

The law requires approval from both local government and police and Achter said when they did not receive buy-in from the police right away, there was no point in moving forward when changes to the law could alter the process.

“We’re waiting and making sure the law is extended. It would take that amount of time to get the doors open anyway,” Achter said. “But we took a pause when we didn’t receive support from local law enforcement.”

Harm reduction programs provide drug users with access to clean needles and safe disposal of used ones to prevent the spread of diseases such as HIV and hepatitis C, which have been on the rise since the start of the opioid epidemic.

The possession of “dirty needles” is a crime and Culpeper Police Chief Chris Jenkins said he does not support the program because his office is responsible for enforcing the law.

He said he fully supports reducing the spread of HIV and hepatitis, but the General Assembly has shirked responsibility by passing the buck to local law enforcement instead of writing a bill removing the penalty for possession.

“Change the law and we will completely support the program,” Jenkins said. “I think that’s a real cop-out from the General Assembly to kick the can down to us and if they truly wanted this program they could have crafted a bill that would have allowed it.”

He said he also thought the opioid crisis was a much larger issue that would not be solved by needle exchange programs which are treating side effects several years removed from when the crisis originated.

“This is a health crisis, not a law enforcement crisis,” Jenkins said.

Achter said the program never asked police to look the other way on possession of paraphernalia, only that they do not use the center as a stakeout point knowing one of the primary functions of a harm reduction center is needle exchange.

Police were still opposed, though, and former GOP Del. John O’Bannon, who introduced the original bill in 2017, said they can sometimes be hard to sway because it is antithetical to cops to serve as what could be construed as enablers.

However, he said data on the programs’ benefits are substantial and should serve as evidence they are good for communities.

Harm reduction programs are already operating in Wise County, Smyth County, Roanoke City and Richmond City, according to Bruce Taylor, drug user health coordinator for the Virginia Department of Health.

The clinics have served around 550 people to date and referred 398 to either social services agencies or substance use disorder treatment as of last quarter’s report. The sites have also distributed more than 90,000 syringes and disposed of more than 90,000 syringes, a nearly 96% return rate and an increase from the 86% rate earlier this year.

The bill’s expiration date has also contributed to police apprehension and hindered program advocates’ efforts, according to Wade Kartchner, district health director at Rappahannock-Rapidan, who said the uncertainty has been an impediment.

He said if there was permanency added to the bill it would be helpful for strategic planning and help assuage the skepticism of some law enforcement agencies.

The original bill passed by comfortable margins in 2017. Del. Betsy Carr, D-Richmond, said while it was too early to know specifics on whether the bill will change or expand, she sees no real hurdles to at least an extension in the upcoming session.

Carr, who for years pushed for legislation on safe reporting of overdoses before a bill finally passed this year, said the positive results of the programs made a compelling case for their continuation.

“If you look at the statistics on the places that have been started, like Richmond, they’ve had more needles turned back in than they’ve given out,” Carr said. “With those kinds of things, I don’t see why we should have major obstacles against the legislation.”

Health Department officials also said they have not finalized their recommendations to legislators for the upcoming session, but Elaine Martin, director of HIV and hepatitis prevention services, said the programs have already had an impact.

Operators have seen no new HIV infections among participants since the programs started and there haven’t been any complaints from the public or police at any of the sites, according to Martin.

She said these successes and others are helping build momentum that she hopes communities can continue to build on.

Achter said in the new legislative session she would like to see some adjustments made to the criteria a locale must meet to qualify for starting a program.

Currently, in order to qualify, a community must be above the state average in several of 13 categories including HIV and hepatitis disease morbidity, poverty, prescription opioid volume, prevalence of drug overdose and others. Only certain areas are permitted.

She said some communities interested in starting harm reduction programs did not meet the current criteria and are ineligible regardless of local support.

The bill stipulates that certain criteria must be used, but Taylor said the Department of Health reviews the thresholds every year so changing needs can be reflected in the following year’s policy.

Jordan McNeish, who operates the Jefferson Area Harm Reduction program in Charlottesville, said he was also optimistic the General Assembly will be more aggressive in their policy decisions next session based on the results of those operating already.

His program does not have a clinic and he said while he has not been met with opposition from local officials and law enforcement, he’d like to see them take a more active role.

A more comprehensive program with proper funding could channel the people he helps into mental health and addiction support programs so others could get clean rather than just avoiding the dangers of sharing needles, McNeish said.


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