Emily Baldwin recollects that day when she realized the COVID-19 epidemic was making her job harder. It was 2020 and the new coronavirus, which was still ravaging the east coast, was yet to take over West Virginia. One man ran to the Milan Puskar Health Right Clinic in Morgantown, claiming he believed there was a body in an alley just a block away.
Baldwin, who is a nurse and the coordinator for the clinic’s harm reduction program, ran outside and quickly realized a young man was overdosing. After running back to clinic, Baldwin grabbed Narcan to reverse the overdose and raced to the victim. By the time an ambulance showed up, Baldwin was administering Narcan, but the EMTs wouldn’t walk down the alley to help.
“‘We can’t go near people like that’,” Baldwin recalls them saying. They seemed to be afraid the man might have COVID-19 and so kept their distance, she said, adding, “It kind of set the tone for the entire pandemic around here.” Over the past two years, situations like that—in which the opioid epidemic smashes headlong into the ongoing COVID-19 pandemic—have become frighteningly common, Baldwin says.
The number of deaths from overdoses has risen since COVID-19 became widely known in the spring 2020. According to preliminary data, more than 100,000 Americans were killed by drug overdoses between April 2020 and April 2021. This is a new record, which was reported in the provisional data of the National Center for Health Statistics. The vast majority of deaths were related to Synthetic opioids like fentanylThis is yet another alarming trend, as powerful and deadly substances have flooded America’s street drug markets. West Virginia experienced the highest rate of overdose deaths, rising 62% since early 2020.
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Experts in public health say that, aside from the changes in drug supply, the pandemic has exacerbated addiction and high overdose rates because millions of Americans lost their jobs. The epidemic also interrupted drug treatment programs and left Americans isolated and without support. This, according to experts, is what caused worsening mental and physical health.
Since March 2020, nearly 2 years have passed since the beginning of the opioid epidemic. Community health centers, support networks and grassroots networks like this one in Morgantown West Virginia, tried to keep drug addicts safe and connected. But more than two decades into the opioid epidemic, those seeking to help are still grappling with small budgets, stigma and laws that can make their jobs difficult—all on top of a pandemic with seemingly no end in sight.
“It’s maddening to know how preventable it is,” says Baldwin. “It doesn’t have to be this way.”
‘It’s about just keeping people alive’
Baldwin runs West Virginia’s oldest program dedicated to what’s known as harm reduction, which means that instead of trying to help drug users attain abstinence, she and her colleagues are focused on trying to reduce people’s risk of dying or contracting infectious diseases like HIV. The program provides sterile equipment and strips for drug users to check for fentanyl. They also offer naloxone for overdose prevention, peer support, medical treatment for injuries, as well as a place for people to stay indoors. It’s all run out of Milan Puskar Health Right, a free health clinic for low-income and uninsured West Virginians.
While the clinic never fully shut down during the worst of the pandemic, it did make drastic changes that limited staff contact with clients and cost months of rapport-building—a crucial step that can help connect vulnerable people to HIV screenings, homeless shelters, treatment programs and opportunities to find food and other support. Online support groups and other programs could be offered in some areas. But the staff at Health Right couldn’t give out clean syringes or administer naloxone over Zoom, and for many of their clients who don’t have a permanent home, the in-person interactions are crucial.
Health Right staff decided to limit the amount of people allowed into the building, and instead of providing each patient with a private session with a peer recovery counsellor, nurse, or social worker, they began handing out supplies from the parking lot.
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“We are the kind of place that, if you’ve been here before, we remember your name and we smile at you. And there’s a lot of hugging. But we haven’t been able to do any of that,” says Laura Jones, executive director of the clinic. Staff members worked for many months to distribute sterile needles as well as naloxone, COVID-19 supplies and masks.
“It’s more about just keeping people alive,” Baldwin says.
Throughout the pandemic, Jones, Baldwin and their coworkers have worried when 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 that person for a while, it’s like everything is up in the air. They are where? Are they OK?” And as new waves of COVID-19 have continued, the limited rapport has also made it more difficult to help new clients navigate the pandemic in addition to substance use issues. “Without that rapport going into COVID, we didn’t have that trust to educate people about COVID,” Baldwin explains.
While many services were able to return thanks to the COVID-19 vaccines, West Virginia’s legislature passed legislation that would have imposed stricter penalties on harm reduction programs. Concerned about the possibility of harm reduction programs being found with used syringes, state lawmakers created new regulations that will be enforced next year. Although many of these new regulations are not necessary and do not contradict the CDC recommendations according to health experts, a lawsuit brought by Milan Puskar Health Right did not stop the law.
“The belief in West Virginia is still very much that drug use is a moral failure, addiction is a moral failure,” Jones says. “So that was really demoralizing for all of us, because we know that to not be true.”
Under the new law, the clinic has to apply for a new license to operate the needle exchange program they’ve run for six years, start requiring West Virginia IDs from every participant, switch to only offering as many needles as each person brings back rather than giving out supplies on a needs-based system, and stop giving people needles they can bring to friends or family where they live. A number of programs within the state were shut down due to insufficient funds and staffing.
West Virginia is close to many other states such as Ohio, Kentucky, and Pennsylvania. This means that people who need help will have to travel from West Virginia, Baldwin says, in order for them not be denied. It is difficult to find needles in rural areas so it will not be possible for people to take as many needles as they want. They also won’t have the right of picking up needles from their communities. Participants often travel more than an hour to reach the clinic in Morgantown, and many don’t have their own cars. This means that the clinic will require additional staff, and training to volunteers. It is already a difficult task.
Baldwin sees severe consequences if fewer people have access to her program and other programs around the state close. “The naloxone access is less and people aren’t getting to touch base with anybody,” she says. “People are literally going to die because of this law.”
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Other cities like Charleston have had overwhelming HIV outbreaks in the past few years, while Morgantown has largely avoided this—something Baldwin and Jones say may be due to easy syringe access. Other towns may also be at risk of developing an epidemic.
For a difficult winter, girding
Normally in December, the program’s three staffers would be focused on giving out flu or COVID-19 vaccines, helping homeless patients find shelter out of 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 rewriting policies to ensure they are in compliance with their state’s new law. They were still waiting for their license to run the harm reduction program. As Christmas approached they began to give out more supplies in case operations had to be temporarily stopped. Near the close of the day, Dec. 23, they received their license.
Jones and Baldwin both express frustration that as the pandemic continues, it’s only going to get even more difficult to help the people who need their program. But even with the third year of COVID-19 approaching and the West Virginia law’s requirements taking effect, they are committed to serving as many people as they can.
“The thing that has kept me going for 30 some years in West Virginia is just the belief that health care is a human right and that it can manifest itself in a lot of different ways. Housing is health insurance. Harm reduction can be considered health care. Emotional and mental health is health care,” Jones says. “I have worked really hard to find people who work here who have that same belief and that same mission. They work equally hard. There’s no one here that isn’t sacrificing a little bit of mental health or personal time with family to make sure that what we do can continue.”