As clinics pivot post-Roe, battle rages over syringe service in opioid-ravaged West Virginia

CHARLESTON, W.Va. (AP) — Staff at Women’s Health Center of West Virginia know what it’s like to provide controversial health services that government officials have sought to ban or restrict.

The Charleston clinic was the state’s only abortion provider for years until the state Legislature passed a near-total ban on the procedure last year. The clinic remained open, providing other reproductive care. Now it’s trying to open a syringe service program for drug users, which is another contentious health service that has been regulated by Republican lawmakers in the deep red state.

The proposal, which is scheduled to go before Charleston City Council for a pivotal vote Monday, comes as abortion providers across the country are pivoting or expanding services post-Roe, often to other hard-to-access care for marginalized communities they say face stigma and barriers similar to abortion patients.

Some, like the Women’s Health Center of West Virginia, have added gender-affirming services for transgender adults, like hormone therapy. Additionally, the West Virginia clinic and another in Oklahoma are incorporating harm reduction services, which work to mitigate co-occurring health impacts of intravenous drug use such as HIV.

The Charleston clinic already offers wound care, substance use disorder treatment referrals and opioid-overdose reversal drug training. But it faces an uphill battle in syringe service for West Virginia, the U.S. state with the highest rate of opioid overdoses. In 2021, the Centers for Disease Control and Prevention declared Charleston, the state capital, the scene of the country’s “most concerning HIV outbreak” due to intravenous drug use.

Almost everyone in West Virginia has been impacted by addiction and loss in some way, and many people have firmly-held beliefs about the best way to treat addiction and those suffering from it, beliefs that often conflict despite shared experience.

Pam Stevens, who lost her 44-year-old son Adam to a drug overdose, lives a block from the Women’s Health Center. She believes the program will unintendedly enable those who are addicted.

At a recent public hearing, she called the idea to locate a syringe service program at the long-time abortion clinic “an abomination.”

“Let the Women’s Health Center do what it’s supposed to do: provide quality health care to women, not drug addicts needing needles,” Stevens said.

Danni Dineen, who contracted hepatitis C from intravenous drug use, said a syringe service program she attended in the throes of her addiction was about more than getting access to needles. Addictions specialists built up a trust and rapport with her, and ultimately helped get her into treatment.

Without syringe service, “I honestly and truthfully do not believe that I’d be standing here before you today,” said Dineen, a coordinator for city-run services for people struggling with substance use, mental health disorders and homelessness.

Syringe service programs operate by allowing people to exchange dirty syringes used to inject drugs for clean, sterile ones. They are CDC-recommended methods to curb the spread of infection and typically offer a range of services, including referrals to counseling and substance use disorder treatment.

Such programs exist nationwide, but they are not without critics, who say they don’t do enough to prevent drug use. That’s despite CDC research showing people with syringe service are more likely to recover.

West Virginia Health Right in Charleston offers a syringe service, but it is only a small component of the organization’s services, which target underinsured populations. In 2022, for every 100 syringes given out by a program in the slightly smaller city of Morgantown, home to the state’s flagship university, Health Right gave out fewer than one, according to state-collected data.

West Virginia Republican Gov. Jim Justice signed a law in 2021 requiring syringe providers to be licensed with the state and recipients to show proof of residency and return each needle after use.

The Charleston City Council followed with an ordinance requiring programs to collect at least 90% of the syringes distributed. Exchange programs violating the restrictions can be charged with a misdemeanor criminal offense, adding fines of $500 to $1,000 per offense. The programs also must be approved by the council and county commission.

The Women’s Health Center is on Charleston’s west side, an area that historically has seen the city’s highest percentage of emergency overdose calls.

In the year since the abortion prohibition, executive director Katie Quinonez spearheaded the launch of the Women’s Health Center of Maryland, a sister clinic directly across the state border. Charleston providers can refer people to the Maryland clinic and cover the procedure cost using its abortion fund.

Quinonez’s staff looked to other areas where they could leverage their medical resources in West Virginia: “Looking at the data, harm reduction was at the top of the list.”

Both practices “respect that people are the experts of what they need and what’s best for their life, that the patient and their body is the most qualified clinician in the exam room,” Quinonez said.

The program would operate under restrictions outlined in state and city code, but with some provisions attempting to make it more accessible, like allowing people without state-issued IDs to use letters from homeless shelters or rehab.

But some feel one program is more than enough, and the Women’s Health Center is the last place they want to see another.

Phil Chatting, who described himself as a long-term volunteer at the anti-abortion crisis pregnancy center next to the Women’s Health Center, said he believes the program would pose a danger to families going there for resources.

“Are we more interested in providing assistance to drug users than we are in protecting innocent bystanders?” said Chatting, who is listed as the center’s principal officer in December 2022 nonprofit filings. “That user at some point in their life made a choice to willfully use a drug, as opposed to that mother who is simply attempting to provide for her family.”

Anti-abortion sentiment, and the beliefs underlying it, are still prevalent, said Iris Sidikman, the Women’s Health Center harm reduction coordinator. During months of canvassing the neighborhood to discuss the proposal, one resident asked: “So, your clinic’s going to be handing out needles and abortions?”

“That kind of comment shows to me that folks who didn’t respect the abortion work that we are doing also don’t respect the harm reduction work that we’re doing,” Sidikman said.

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