Harm Reduction Program Improves Health, Encourages Treatment

“Jane” and “Stephanie” both use heroin now, but, like many people, their substance abuse addictions started with prescription pain pills.

Stephanie, 49, had been clean for 20 years before she started using again a couple years ago, she said. A physician, she said, got her started, prescribing pain pills for her back injury and then cutting her off after two and a half years.

Then, someone introduced her to heroin.

“And from the first shot, I was gone,” she said.

Jane, 41, never so much as smoked a cigarette before she was 32. Then a man she eventually married introduced her to pain pills.

“I had no idea what they did to your body,” Jane said. “I just liked the feeling that I felt. Eventually I just woke up one morning and I thought, ‘what the heck is wrong with me?’ It controls you. You lose control.”

Jane and Stephanie (not their real names) are two of the patients of the Kanawha-Charleston Health Department’s harm reduction clinic. Because of the stigma attached to drug addiction, they agreed to share their stories on the condition of anonymity.

The health department’s harm reduction clinic, which, among other things, offers intravenous drug users clean needles in exchange for their dirty ones, continues to grow. The weekly clinic is roughly a year old.

Stephanie and Jane are regulars at the weekly clinic. They said it’s kept them out of the hospital and out of physician’s offices, where they would end up after getting infections from dull and dirty needles. Stephanie said since the clinic’s been open, she’s not had to seek medical attention for needle-related infections.

“[Used needles are] harder to use and harder to catch a vein [with],” Stephanie said. “So you’ve got to poke yourself a million times. But it’s also not sterile, even though we try to keep it sterile. And you get infections.”

Before the harm reduction clinic opened, there was only one pharmacy in Cross Lanes that offered needles without a prescription, the women said. People often didn’t have transportation to the pharmacy, so they’d reuse needles, they said.

“Now [other users] ask for a new one because they know you’ve got it,” Stephanie said.

Dr. Michael Brumage, executive director of the KCHD, said studies of other syringe-exchange programs have shown they reduce rates of HIV and Hepatitis C. The health department is teaming up with researchers from Johns Hopkins University to see if the same holds true in Charleston.

“Because I address skin infections and wounds in the clinic when I am here, we know we were able to prevent visits to the emergency rooms,” Brumage said. “Our program pays for itself for a year by preventing a single case of endocarditis, a bacterial infection of the heart lining and heart valves. This is one of the most cost-effective public health programs around this epidemic you can have.”

The women said some of their friends have contracted Hepatitis C from dirty needles. They see fewer dirty needles around because users are turning them into the clinic, they said.

Brumage said treating the patients with respect is an important component to the clinic.

“The first most important thing [we do] is to get them into recovery,” Brumage said. “The second most important thing is to knock down the stigma, to make them feel connected. Because ultimately disconnection is the underlying root cause that gets them into addiction in the first place.”

Brumage said the staff at the clinic shows kindness and love to the patients, who are generally disliked because of their addictions. In time, that kindness gives the staff a chance to refer patients to treatment.

“We can suggest that to them as many times as we’d like, but if we demonstrate the kind of love and compassion that’s required, then thats a bigger incentive for them to want to quit,” Brumage said. “So we’re not looking to perpetuate their problem; we’re looking to end it, but it can’t be on our schedule.”

For Jane and Stephanie, that might be working.

“They’re really nice people here, too, and they don’t force recovery, but they promote it, which is very helpful,” Jane said.

“It’s got me close to the point where I want to quit,” Stephanie said.

The clinic continues to grow. On Dec. 2, 2015, the first day the clinic was offered, eight patients were seen, five needles were returned and 159 needles were given out. Last week the clinic saw 182 patients, received 2,595 needles and gave out 4,643 needles.

Most weeks, dozens of new patients come to the clinic. Brumage said the clinic is following 1,660 unique patients.

“In many ways we’re a victim of our own success,” he said. “People know it’s a safe place they can come, and so the word is starting to spread more and more and we’re seeing more and more new folks.”

Brumage said the health department gets questions almost daily from other counties looking to start their own harm reduction programs.

Patients have access not only to the needle exchange but also STD testing, flu vaccines, recovery coaches, health insurance navigators and other services offered at the health department.

There’s also a weekly half-hour training on naloxone, a drug that reverses the effects of opioid overdose. The naloxone given out at the clinic has saved 25 lives officials of, Brumage said earlier this month.

The clinic is run on donations and volunteers from the community, including a $5,000 donation from the Kanawha County Commission.

Brumage said the health department is working with the state Department of Health and Human Resources to apply for federal grants to sustain the program. Federal funding cannot be used for direct paraphernalia — cookers or needles, Brumage said.

“But for anything else, like contraceptive devices, other sort of supplies, then, yes, and there are plenty of other supplies, as you’ve seen in there, that are not paraphernalia-related,” Brumage said.

But despite the fact Brumage said the program is “running on fumes,” the health department will continue to offer it.

“We are obligated to continue to do this because this is basic public health,” he said. “We are doing communicable disease risk reduction, we are improving the environment by getting needles off the street.

“So we’re committed. It would just be easier to do this if we had a known stream of resources to have us continue to do this.”

The women said they think the Charleston area needs more medically assisted detox centers. Many people are afraid to go through detox without medical assistance, Jane said.

“People are scared to do it on their own,” she said. “It’s like living hell, especially [for] people who are older.”

The women said they hope the health department always offers the program. It’s easy for people to judge them, Jane said.

Jane said before she became an addict, she had a good job, but drugs eventually caused her to spiral. Neither of the women are working now.

“Everyone goes through struggles in their life,” Jane said. “Maybe it’s not addiction, maybe it’s other things but still, you have to have help.”

See more at: http://www.wvgazettemail.com/news-health/20161226/harm-reduction-clinic-offers-addicts-kindness-referrals-to-treatment-#sthash.tFYK4wv6.dpuf

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