Community program

‘Just keep people alive’: How a West Virginia community program tries to reduce overdoses amid COVID-19

Emily Baldwin remembers the morning she realized the COVID-19 pandemic was going to make her job more difficult. It was spring 2020, and the new coronavirus was raging on the east coast but had not yet passed West Virginia. A man rushed into the Milan Puskar Health Right clinic in Morgantown and said he believed someone was dead in an alley about a block away.

Baldwin, who is a nurse and coordinator of the clinic’s harm reduction program, ran outside and quickly realized that a young man was overdosing. She ran to the clinic, grabbed Narcan, a drug that can reverse overdoses, then ran to the collapsed man. By the time an ambulance arrived, Baldwin was administering Narcan, but the paramedics were unwilling to walk down the alley to help.
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“We can’t get close to people like that,” recalls Baldwin. They appeared to be afraid the man had COVID-19 and therefore kept their distance, she said, adding: “It kind of set the tone for the whole pandemic here.” Over the past two years, situations like this – where the opioid epidemic is making its way into the ongoing COVID-19 pandemic – have become terribly common, Baldwin says.

Deaths from drug overdoses have increased since the first spread of COVID-19 across the country in the spring of 2020. More than 100,000 Americans died of overdoses during the year from April 2020 to April 2021, a record number, according to provisional data from National Center for Health Statistics. The majority of deaths were linked to synthetic opioids such as fentanyl, signaling yet another disturbing trend as the potent and deadly substance has flooded the US street drug market. West Virginia saw the second highest increase in overdose deaths of any state, jumping 62% from early 2020.

Read more: Fentanyl and COVID-19 may have made the opioid epidemic even deadlier

In addition to changing drug supplies, public health experts say the pandemic has exacerbated the number of drug addictions and overdoses as it has cost millions of Americans their jobs, halted treatment programs addiction, left isolated people in their homes without support networks and worsened mental health across the country. .

In the nearly two years since March 2020, community health centers, support groups, local networks, and programs like the one in Morgantown, West Virginia, have tried to help addicts stay connected and in good health. security. But more than two decades after the opioid epidemic began, those looking to help still struggle with tight budgets, stigma, and laws that can make their jobs difficult, all on top of a pandemic. with no end in sight.

“It’s maddening how preventable it is,” says Baldwin. “It doesn’t have to be that way. “

“It’s just about keeping people alive”

Baldwin runs West Virginia’s oldest program dedicated to what’s called harm reduction, which means that instead of trying to help addicts achieve abstinence, she and her colleagues are focusing on reducing the risk of death or contracting infectious diseases such as HIV. They provide sterile equipment, strips to test their fentanyl drugs, naloxone to reverse overdoses, free medical care for wounds, peer support, and even a safe place to spend time indoors. . Everything is run by Milan Puskar Health Right, a free health clinic for low-income, uninsured West Virginia people.

Although the clinic never closed completely during the worst of the pandemic, it made drastic changes that limited staff contact with clients and cost months to build relationships – a crucial step that can help connect vulnerable people to HIV tests, homeless shelters, treatment programs and opportunities to find food and other supports. In some places, support groups or other programs for people with substance use disorders may come online. But Health Right staff couldn’t hand out clean syringes or administer naloxone on Zoom, and for many of their clients who don’t have permanent homes, face-to-face interactions are crucial.

Instead of offering each person a private meeting with a nurse, peer recovery counselor, social worker, or exam room volunteer as they would before the pandemic, Health Right staff began to limit the number of people who can enter the building and have to get supplies in their parking lot.

Read more: Johnson & Johnson has been ordered to pay $ 572 million for its role in the opioid crisis. This might just be the start

“We’re the kind of place where, if you’ve been here before, we remember your name and smile at you. And there are a lot of hugs. But we couldn’t do any of that, ”says Laura Jones, the clinic’s executive director. For months, staff focused on distributing sterile needles, naloxone, and COVID-19 supplies like masks and hand sanitizer.

“It’s more about keeping people alive,” says Baldwin.

Throughout the pandemic, Jones, Baldwin and their colleagues have worried that they haven’t seen their regulars in a while. “Sometimes we’re the only place they check in with anyone,” Baldwin says. “If we don’t see this person for a while, it’s like everything is in the air. Where are they? Do they agree? And as the new waves of COVID-19 have continued, the limited report has also made it more difficult for new clients to navigate the pandemic in addition to substance use issues. “Without this report going into COVID, we didn’t have this confidence to educate people about COVID,” says Baldwin.

A political battle

COVID-19 vaccines have helped many services return this year, but West Virginia’s legislature then passed legislation to crack down on harm reduction programs like Milan Puskar Health Right’s. State lawmakers concerned with finding used syringes in the community have created a series of new requirements that harm reduction programs will need to meet in order to continue operating next year. Health experts say many of the new rules are unnecessary and contrary to CDC recommendations, but a lawsuit brought by Milan Puskar Health Right has not stopped the law.

“The belief in West Virginia is still that drug use is moral failure, addiction is moral failure,” Jones said. “So that was really demoralizing for all of us, because we know that’s not true.”

Under the new law, the clinic must apply for a new license to operate the needle exchange program it has run for six years, start requiring West Virginia identification from every participant, move on to l ” offer as many syringes as each person brings back rather than handing out supplies on a need-based system and stopping giving people syringes they can take to their friends or family wherever they live . Several state programs have already closed because limited funds and staff prevented them from adapting.

West Virginia has many neighboring states including Pennsylvania, Ohio, and Kentucky where people travel to get clean needles, so the ID requirement will mean far fewer people. will be able to get help, Baldwin said. The rural environment also means that limiting the number of needles people can take and prohibiting them from picking up needles for their community will be significant hurdles. Participants often travel over an hour to the Morgantown clinic, and many do not have their own cars. All of these demands also mean that the clinic will need more staff and new training for volunteers, further straining limited resources.

If fewer people can use his program and others in the state shut down, Baldwin predicts dire consequences. “There is less access to naloxone and people cannot come in contact with anyone,” she says. “People are literally going to die because of this law. “

Read more: Special Report: The Opioid Diaries: Photos of America’s Opioid Epidemic

Other cities like Charleston have seen overwhelming HIV epidemics in recent years, while Morgantown has largely avoided this – something, according to Baldwin and Jones, could be due to easy access to syringes. Without it, other cities could also experience epidemics.

Girdle for a harsh winter

Normally, in December, the three program staff would focus on distributing flu or COVID-19 vaccines, helping homeless patients find shelter from the cold or even helping plan the holiday party. to bring the staff together. But the past few weeks have also been filled with mountains of paperwork and rewrite policies to ensure they comply with their state’s new law. As Christmas approached, they were still waiting to hear about their authorization to operate the harm reduction program. So they started distributing additional supplies to people in case they had to temporarily suspend operations on January 1. day December 23, the license arrived.

Jones and Baldwin both express frustration that as the pandemic continues it will become even more difficult to help people who need their program. But even with the approach of year three of COVID-19 and the requirements of West Virginia law coming into effect, they are committed to serving as many people as possible.

“What kept me going for 30 years in West Virginia was simply the belief that healthcare is a human right and that it can be manifested in different ways. Housing is health. Harm reduction is part of health care. Emotional and mental health is health care, ”says Jones. “I have worked very hard to find people who work here who have the same conviction and the same mission. The team is working just as hard. There is no one here who doesn’t sacrifice a little sanity or personal time with their family to make sure what we are doing can continue.

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