In part 3 of our series on the opioid crisis in Appalachia, we talk to Dr. Sydnee McElroy. Dr. McElroy is a physician, harm reduction advocate, and podcaster from the great city of Huntington, West Virginia. We talk to Dr. McElroy about the benefits of harm reduction and the stigmas that still exist creating political obstacles to common-sense practices that save lives.
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Interview Transcript: Dr. Sydnee McElroy
Chuck Corra: Dr. McElroy. Thank you so much again for joining us. We’ll definitely get into a discussion about the recent legislation in West Virginia, about harm reduction and syringe service programs. But first I’m interested in learning a little bit more about harm reduction is, what it means to you and why it’s important to you as a medical professional.
What is harm reduction?
Dr. Sydnee McElroy: Sure. I think that’s a great question because I think a lot of people tend to assume first of all when you say harm reduction that if you’re not in this world, you might not know what we’re talking about. And then secondly, it, they reduce it to, oh, you mean a syringe exchange and that’s the end of it.
So I think it’s important to understand what harm reduction is as an entire concept because we do harm reduction in our life all the time, especially from a medical standpoint, from a wellness health care standpoint – wearing your seatbelt is harm reduction. We take part in risky behaviors and we try to do things to mitigate that risk.
That is at the heart of harm reduction. In my mind, it’s no different than taking care of a patient who has COPD and still smokes. I’m not going to say well until you quit smoking, I won’t give you any inhalers. I won’t admit you to the hospital. I’ll take care of you, encourage you. This would also help. And then when you’re ready to take that step, I’m there for you.
Harm reduction is the same idea when applied to people who use injection drugs.
So certainly part of that is what gets all the publicity clean syringes, access to clean syringes. But the other part of it is talking about it with people who use injection drugs – they’re the experts on it.
So let’s talk about how we keep you safe as a person and healthy and while you’re still engaging in these behaviors that as a medical professional, my thought is, are risky. Are dangerous and do have a lot of problems associated with them. How do I help keep you as healthy and safe as possible by providing you with all of the equipment that is necessary by giving you resources, by giving you access to medical care? That’s a big part of it.
I work primarily with persons experiencing homelessness in our community here in Huntington. And so a lot of those patients do use injection drugs and because they feel comfortable with me, I can not just talk to them about safe ways to use drugs, but also let’s look at your skin. Do you have any infections right now? How are you feeling? Are you healthy or have you been sleeping outside? Let’s talk about it. Are you safe? Are you being abused or threatened in any way? All of those things can be addressed as part of harm reduction.
Then I think the other piece of it, that is so important to our community and to public health as a whole is when we do all these things, we can reduce the transmission of bloodborne illnesses like HIV and hepatitis.
We reduce infections like endocarditis infection of the heart valves and infections of the bones like osteomyelitis all of these really serious infections that consume lots of health care resources. And then hopefully this provides an opportunity for recovery for a lot more people.
And we know that’s true, that kind of normalizing. You are a human and you are a person and you are looking for help. You’re looking for companionship. You’re looking for friendship and understanding and extending that hand is a way to help people take that step. Once they’re ready.
Chuck Corra: You make a lot of really great points there, especially with deconstructing what harm reduction actually is.
As you mentioned, for people that are not familiar with the term, it’s going to come off as foreign to them and something that made me think of that too. It was what you mentioned in your op-ed from, I think last month where you talked about how. Syringe exchange or certain service programs are an important conduit to people getting access to Narcan in order to reverse an opioid overdose.
And I thought that was a really interesting segue to that. I’m wondering if you can explain the connection there and how things like syringe service programs can help fight. The opioid crisis and help provide for people because it’s something that I think a lot of people don’t really know about the here syringe service program, they think injecting drugs, and that’s where it stops.
The connection between harm reduction and opioids
Dr. Sydnee McElroy: I think the piece of it, the Narcan or Naloxone part of it is really something that a lot of us were working on during this past legislative session to try to talk to our representatives about. The about the bill that was going to address syringe service programs and harm reduction programs in the state too.
To try to make it better. And I wish I w there were so many things to focus on. I wish we would have talked about the Naloxone part more. Cause I don’t know that it occurred to people. Naloxone can reverse an opioid overdose. So it is a life-saving drug. It is the same idea as having an epi-pen available to someone who might have a severe allergy.
It is absolutely life-saving. And so if we’re in the business of. Trying to affirm life, trying to take care of people, keep people alive, give people the chance to survive. This illness that is addiction, this medical condition and gets to recovery. Naloxone is absolutely essential.
We know it is in order to get Naloxone. We do have in West Virginia, a standing order, which means you don’t need a prescription. If you go to a pharmacy, you can get Naloxone there without a prescription. Now just because that exists doesn’t mean it’s really that easy. The F the people where you go to whatever pharmacy you use, they have to know that too.
And I will tell you that is not always the easiest transaction, but you can go get it without a prescription. You could also have it prescribed to you by a medical provider. Assuming that you’re forthcoming about the fact that either you use injection drugs or someone you’re close to doing then you could get it from a provider.
But I’ll be honest. A lot of the clients that I work with, a lot of my patients, get it from the shelter where I work. Or they get it from the harm reduction program. Those are the main ways that people access that so that they can have it with them because we know that is the key is to not just have it in the hands of people in the hospital, not just have it in the hands of first responders.
All those things are important, but we also need it in the hands of people in the community, people who are with those who use injection drugs, and people who are using injection drugs, they’re usually the ones administering it and saving each other’s lives. And. I am very worried that with this new legislation, it’s going to be so much harder for them to access that in a really regular way.
Big John: An interesting thing that keeps coming up when we either talk about harm reduction or specifically here in West Virginia. One of the biggest arguments that people like to come up with is that harm reduction gives addicts or users an excuse to continue or a reason to continue abusing drugs. Obviously, you’ve stated all of these great benefits.
What do you say to somebody when they make that argument? Because I know senators are making it on the floor of the Senate in West Virginia. So what do you say to that?
Dr. Sydnee McElroy: The first thing is to acknowledge, I understand why you would think that. I can, and I think that’s a really important thing to do in having these conversations.
When I first had the idea introduced to me, my gut reaction was. Isn’t that kind of enabling. And a lot of people have that initial reaction, and that’s why I think it’s really important not to immediately. Cause at this point I’m very emotionally invested in harm reduction, but not to have that emotional reaction and say I understand why you might think that okay.
But we have decades of data that says otherwise, because syringe service programs and harm reduction programs have existed since the seventies really they were a lot more prominent in other places throughout the world, especially in the UK that there were lots of these programs long before they came to the United States.
And what we actually know is that. People who use injection drugs, people who have an addiction are going to use drugs, whether the needles they have been used before have been used by somebody else or brand new out of the package, that’s the way addiction works. So we can accept that as a reality. And then say, wouldn’t we rather, if they’re going to use those drugs until they’re ready for recovery if they’re going to use the drugs anyway, wouldn’t we rather them be able to prevent the spread of HIV, prevent the spread of hepatitis and prevent themselves from getting I can’t tell you how many patients I’ve cared for with these bacterial infections that you get from reusing needles or using a needle that wasn’t cleaned properly that are just.
They’re horrible. They’re painful, they’re devastating. They require weeks of IV antibiotics. They require surgery quite often. Extended hospital stays. It’s a really horrific thing to see someone go through. And we can prevent all that, by giving them these needles. Th they’re not going to not use, they’re just going to use.
An unclean needle.
Big John: Yeah. I used to always when people would say that to me, you might, my dad was an addict when we were growing up, but he wasn’t he didn’t inject anything. His big thing was like, Oxy loved the pop all the time, but I always said. It’s funny because whether somebody was trying to help him or not, he wasn’t it was his decision to stop and he, it wasn’t going to make him do more or make him do less.
He, it was his he was always doing the same thing over and over again. So I wish that there would have been opportunities for harm reduction, where we were living. Cause maybe that could have helped somehow. But in my opinion, I don’t think it, I don’t think it’s a negative at all. I think maybe there’s a percentage chance that somebody fixes that or fixes themselves the other.
The other argument that we hear is that this one is, I think the hardest one maybe to get around or at least needs more publicity, there needs to be some type of message that corresponds to it. And that is you have legislators now who are saying that harm reduction sends a bad message to our youth, essentially saying we tell them that drugs are bad, but then we do these kinds of things.
And I Although I disagree with them. I don’t, I haven’t heard really anything from the other side to go against that. Is there a message from those who support harm reduction discussing that
Dr. Sydnee McElroy: I think that isn’t something that we, I would say at least that I have spent a lot of time, like talking about that specific part of it.
But I would say a couple of things to that one in part, I don’t know that it would occur to me to address that specific issue because our kids know. They know this as a problem. They know they’re their friends, their parents, their grandparents, their aunts, their uncles. I don’t know anyone, myself included, I don’t know anyone living in West Virginia who hasn’t been touched by this in some way.
So these kids are living it and they’re seeing it. I think these kids would prefer if they can have their parents come back to them. And be in recovery and have survived the illness that is addiction. They would choose that every time, so the message we’re sending is your friends, your family, your parents, they matter to us.
They matter to us as a society, they matter as people they’re worth something. Which is a more powerful message in general, not just these people that you might know or love or care about, but people matter. Individual humans matter in their lives matter. And to treat people with compassion and understanding and not just be punitive because you don’t like something they did is a reality that’s such a huge value to pass on to our children and something.
I try to instill in my children, forgiveness, compassion there, but for the grace of God, I go that kind of attitude. That. And I, as a lifelong West Virginia, and I don’t know, what’s more, West Virginia. And then that kind of approach to your fellow humans. That’s how I was raised.
It speaks to me.
How the West Virginia legislature limited harm reduction programs
Chuck Corra: I wanted to pivot to, and the governor and among the, in my opinion, a lot of detestable things that they’ve done this year is that they took up and passed and the governor signed SB334, which put a lot of strict limitations on certain service programs.
And I think you I think you mentioned it or referenced it at least to some extent and an episode of Sawbones that you did on harm reduction about how it’s not effectively banning these programs. But it’s essentially regulating them out of existence. And I’m wondering from your perspective, as someone who both is involved in the community, there’s also a health care provider.
What’s the real impact of this and what burden is it going to place on the community? And non-healthcare
Dr. Sydnee McElroy: the, in terms of individual programs throughout the state. I know there’ve been several who have come forward already and said, ours will. Close under these new guidelines, we will not be able to achieve the cause what it is.
It’s a licensure program, which is by the way, when you’ll see a lot of people say, it’s the strictest in the nation. and it’s the most difficult legislation in terms of having a harm reduction program. It’s because it requires that licensure, which no other state does. There are lots of other pieces of it that other states might require, but to do all of this and then obtain a license to run a program that’s unique.
And it takes another step and it requires so many different levels of government to sign a letter to buy in. That it’s going to be incredibly difficult for some programs throughout the state to meet all of those requirements and some will close. Certainly. I think I don’t know what the question we’ve all had is will they close the 90 days after the bill was signed?
Or are they going to close when we have to apply for licensure? Which I think is like in December. But there’s been fear. We know some will close completely. But what the other affect some specific issues with the bill, one is you have to have a state ID to use these harm reduction services.
That’s going to be, it’s going to reduce their effectiveness. So it’s not that the programs would close if that was the only stipulation it’s that a lot of people are going, they don’t have a state ID. Again, with the community that I work with, it’s incredibly rare for them to have an ID. And if we don’t.
If they don’t have one, they can’t go. And so if you have a program that will serve. The community, but only a small fraction of it can actually access it. You’re not going to see those big public health benefits, the people who can go still benefit, but you don’t see the big things, the reduction of the spread of HIV, which is absolutely critical in Kanawha county and Campbell county canal where they have the most concerning HIV outbreak in the country and Cabell County, where we have our own HIV cluster.
And I guarantee you, we are seeing the tip of the iceberg in our communities. The very tip I think unfortunately there’s a lot we don’t know about already. And once all of the stipulations of this bill go into effect, it’s going to get much worse. So I think all those things, some programs will close.
Generally. They’ll all become less effective because of these requirements. And I don’t know. My hope is that enough of us are passionate about it and can work together in court. I’ve actually been talking with people who work with harm reduction programs in several different parts of the state to try to come up with a coordinated effort, to keep as many as possible alive, and to keep resources going throughout the state to try to coordinate to some extent because I feel like there are going to be placed in the state where right now, I don’t know what Charleston’s going to do.
And that’s where a lot of our people who use injection drugs, people living with HIV, that’s where they are. So I think it’s a really concerning the situation. I think in Cabell County, our program. What I believe is we will stay open, but I think we’ll probably serve a smaller percentage of the community and we’ll be less effective, unfortunately.
Chuck Corra: It’s really shameful, to see that and to think about it because there are so many broad-reaching implications of just a bill like that. You think about all the people that go to those places for the resources and that won’t have that resources anymore.
You mentioned the requirement for a state ID, really, interestingly enough, mirrors, a lot of voter restriction laws in these countries as well. And it targets people who are of low income or experiencing homelessness, those types of things. And they’re the ones that benefit the most from this.
I’m curious, and I don’t know if you’ve had any conversations with lawmakers or maybe talk to people who have There’s obviously a huge stigma around syringe service programs and I’m wondering if that is a prevailing stigma within the people who are pushing this. Because when I read up about some of the reasons and justifications for why they want to pass this bill, it’s oh, we want to make things safer.
Because this is this wild west unregulated needle exchanges. We’re just here stepping in to take the little role of government to make things safer. And that doesn’t seem to be the case for me, but I’m just wondering if the stigma of this in your opinion has an outside influence.
Stigmas about harm reduction
Dr. Sydnee McElroy: It absolutely has an outside influence because the truth is the programs we have in West Virginia.
And I can’t speak to every single one because I don’t know all the ins and outs of every single one, but generally speaking, the ones that I’m familiar with and especially a lot of ours are run out of health departments. These are not the wild west of harm reduction programs. These are. Closely regulated, tightly run monitored programs that already a lot of the stipulations in the bill were that if you’re going to have a harm reduction program, you have to provide recovery services.
Sure. Access to things like that. You have to provide access to. STI screening and treatment. And yeah, a lot of health departments do that, but like beyond that things like you have to provide vaccinations and access to birth control and family planning and all that. We already do that. These programs do these things, so they were already very closely run and in some ways already a little over-regulated because of a lot of local government action to try to tighten controls for the same sort of stigmatized fear-mongering kind of reasons.
Even a little more tightly than really, we’d like to see if you’re talking from a pure CDC, like what would they recommend perspective a good harm reduction program wouldn’t even attempt to do a one-to-one needle exchange. You wouldn’t use the word exchange. The idea is people come in and when they need needles, you give them to them.
That is a more effective pro when we know that we have the data to back it up, but we already were reducing that that we were already tightening that to try to avoid this kind of situation. So what they’re regulating was unnecessary, to begin with, what they’re going to do with this is just reduce the effectiveness and a lot of the.
The rhetoric that they would tell me when I would speak to some of my representatives and people who were concerned was it increases crime. There’s no data to back that up there. There is no city in the US where they had a harm reduction program and crime increased, and in fact, there are some places where it goes down and somewhere it stays the same.
It doesn’t go up. So that’s a myth. The other thing is needle letters. That was the biggest thing. And all of the really overwrought, emotional stories that people like to tell on the Senate floor, in the house floor, whereof kids finding needles in the park, which by the way, I have two small kids.
I’m raising them in Huntington. We’ve played in the park many times. I’ve never found a needle anywhere. I’m not saying it doesn’t happen. I’m just saying. Lived here, my whole life, raising children here never found one. But even if there were, there is no evidence that harm reduction programs increase the amount of needle litter in a community, the needle litter is there because we have people who use injection drugs.
And because that’s so terribly stigmatized, they’re forced to live on the outskirts of society. And not interact consistently with medical care, with places to dispose of their syringes. They, many of them don’t have a home where they can use and have a needle disposal system and all those things that are why that’s happening.
It has nothing to do with the harm reduction program. So eliminating them won’t fix the needle litter. There, there was one study that suggested eliminating. It might make it worse, but it certainly isn’t going to improve it at all. And no matter how many times I can’t tell you I’ve given this speech to people and written emails and made phone calls till I was blue in the face.
And it just, I don’t know, it just didn’t seem to make a dent. Because people are so predisposed to believe drugs are bad. So people who do drugs are bad and they end up doing bad things like throwing needles all over the ground and committing crimes in my community. And so it’s just a, not in my backyard attitude, send them somewhere else.
Big John: It is easier to get votes with a saying you stop needles in the playground than it is to say you helped to you helped people maybe become clean. Which is really sad. And especially in a state like West Virginia, we should be we actually should be honoring people that, that help people get clean.
Cause it’s an epidemic here. You mentioned this a little bit, but. I guess maybe discussing what’s the outlook here? So let’s say a state like West Virginia, obviously Appalachia all across Appalachia. We’re seeing these types of issues. We’re seeing that harm reduction in legislatures is constantly being shunned across the region.
So what’s the outlook. As you know this bill obviously passed, it was signed into law. And let’s say we see a bunch of closures. What’s the outlook for those communities?
Dr. Sydnee McElroy: I think fortunately I would love to say that those of us who are involved with harm reduction and that have been anticipating and working to address this, I would love to say that, oh, we’re going to, our whole plan will be spring.
We’ll spring into action. And we’ll cover every deficiency and there’ll be no effects felt. But I think that would be an overstatement, I think in communities where their PR, where their programs close, they’re going to see More morbidity related to IV drug use. So you’ll see more patients overdosing and.
More deaths are related to overdose. You’re going to see more people admitted to the hospital with serious infections. And hepatitis C is a problem essentially everywhere where people are using injection drugs. So you’re going to see more of that, but specifically, in communities where we already see HIV, that’s going to spread.
And I think something that’s really important to note is that even in places in the state where we don’t have HIV outbreaks, If you have people who are using needles and sharing needles, and you have hepatitis C they’re already, we know just history tells us statistics, tell us we will HIV in those communities eventually as well.
And we were saying that. In Huntington. I have been practicing medicine here for a decade and we were in training here for longer than that, we were saying that we would see an HIV outbreak here if we didn’t do something long before it came. So these are predictable courses. We looked at Scott County, Indiana.
We knew what could happen here and we didn’t do enough to prevent it. I don’t mean everyone. Here in Huntington. Dr. Kilkenny who runs our health department and our harm reduction program is an amazing public health advocate. And he works his butt off, but we don’t have enough of those people.
We have some of them, we have some really hardworking, well-meaning caring people who have the knowledge and the background and the drive, but there’s never enough. And. We saw HIV come and it will spread to other parts of the state where these programs close and people are going to lose people.
That’s the other part of it. It’s all this idea that people who use drugs deserve punishment. That’s really at the core of this and. There, these are our people, the people I take care of. I know a lot of them, I went to school with them. I know their families like I’m, I can’t I’m they’re not others.
They’re not from somewhere else. There are people and we’re going to lose more of them than we already have, We’ve already lost more relatively than anyone else in the country.
Big John: I think people miss that a lot, especially when it comes to cause obviously like drug use or anything illegal people throw their hands up because they do want punishment.
You’re right. And I think that for a lot of people, they forget that the end punishment for a lot of these people is death. Obviously, this is not you, we can call it a crime, all we want, but it’s not a crime that should be punishable by death. And they said you should have resources that can fix that.
The prevailing views in the medical profession about harm reduction
So I’m with you on that quick question. Are our doctors, a lot of doctors in agreeance with you as the field split? I’m not actually heard anything like how doctors feel about it again, general.
Dr. Sydnee McElroy: The majority of healthcare professionals support harm reduction for the very, very basic reason. It’s I think a lot of doctors can get unemotional about the science is there.
The data is there, the evidence is there. They are overwhelmingly there, and this is not a controversial area of medicine. There are controversial topics in medicine. This isn’t one, this works. A lot of people might not want to be the one in the health department handing out the needle. I might be more unique in that respect.
Like I, and I enjoy this work. I enjoy being able to do this. But generally speaking, the medical community is United that, yeah, this is effective at works. We should be doing it. Why are we regulating it at all? Like, why is the government getting involved in this area of health care? Cause that’s what it is.
It’s. Healthcare it’s providing treatment for a disease. And why did the government decide to stick its hands in this when there are so many other areas of healthcare where they trust our judgment and our science and our evidence to do the right.
Big John: Yep. All about those votes. I just always liked to continue to bring it back there.
Ultimately we know now in, in a state like West Virginia, this bill is passed. This will go into effect. Jim Justice has signed it and it’ll go into effect in a lot of places around Appalachia. I predict this because of how many bills are coming up. What do you think organizations or people can do to help?
I know that they’re limited in some sense but are there options for people that want to maybe either get involved or want to help a donation or anything like that?
Dr. Sydnee McElroy: I think so in terms of donation, too, I would say there are two different pieces to think about moving forward, the harm reduction programs themselves when it comes to actually hand out.
Equipment that people will use to do drugs so that the needles and everything that comes with that piece of it are going to really have to be run by the program. So I don’t know that there will be a lot of opportunities to donate specifically to that. But the Naloxone piece, the Narcan part of it, really is something people could Do more for because we can still hand it out.
And I’m part of groups that do that too, that just go around, handing out Narcan and we do it through fundraising. You can get some grant funding for it, but not huge grants. So we do that by raising money, getting Narcan, taking it out, and giving it to the community. A lot of places I know in Huntington and I’m sure most places in West Virginia are the same.
Your local health department will probably teach you. You just check online or call they’ll have classes where you can learn how to use Narcan administered appropriately, and then give you some to carry with you. And I think that is maybe the most important thing. If there’s one piece of all this, other than the understanding and the compassion and all that, that you can take away as an action, it would be that if you’re not already certified to do that, Look into it.
Cause it takes no time. It’s super Narcanned, especially now we have the nasal sprays, not just the injections. There’s the auto-injector, which talks to you. It’s a little thing that, literally tells you what to do. Take the cap off, put it on their leg. Hold still. It’s super easy and you can learn how to do it.
You can get the Narcan, you can carry it with you, and you can save a life. Really it’s the same as having an epi-pen to save somebody’s life. If they get a, B, a, B, C, I think that’s a really powerful thing that people can do and pay attention to. There will be fundraising efforts around this without.
Money to buy the exact equipment. There will definitely be fundraising efforts around this, within your local community that I would look out for. And then the other thing is, look for opportunities to volunteer and connect, especially with a community of marginalized people, where you live. I know and understand and feel so much more in touch with all of this now because of my work at harmony house in Huntington because these are the people that I spend with.
A good bit of my time with now. And I, once you do that, it’s so hard. Like the stigma, it’s so much easier for it to fall away. All of that stuff that you were I don’t want to say taught in school or at home or anywhere necessarily, but it was ingrained in us from a society that people who use drugs were scary or bad.
It spent a few weeks with them because they were not there. People. And sometimes they’re making a decision that isn’t the best for them and their health, but who doesn’t. We all do. We all make decisions where I’m going to eat this big piece of cake, even though I know it’s not good for me, or drinking is a thing that a lot of people engage in their own.
Sickness or discomfort or whatever, and we don’t stigmatize those people the way we do injection drug users. So I would really encourage you to look for outreach opportunities, whether it’s going and volunteering to feed people or going with an outreach committee to hand out like little care packages or hygiene bags in the streets there, I guarantee you, there are efforts like that in your community and just engage with people, get to know them.
Chuck Corra: That’s all really great advice. And I think especially encouraging people to challenge the presumption of how you view somebody who is a drug user and emphasizing compassion over punishment and starting to treat addiction as a disease instead of a character flaw is something that’s so important with just changing the narrative around that.
And that’s something that. I know that John and I, when we started this podcast, we really wanted to focus on stereotypes around the region. But even with something like this, where it’s ingrained in you a certain mentality when you’re young, it’s so important to challenge that presumption and encourage others to that as well.
So I really appreciate you bringing it up. Dr. McElroy, thank you so much for coming on. We’ve been wanting to talk about harm reduction. I think pretty much ever since we started this about a year and a half ago, and I think that you were the perfect person to have on to discuss it, especially within this context.
Again, we really appreciate, and we know from other people we’ve talked to and Huntington Cabell county around the area of all the important work that you’re doing, and I know that it’s really appreciated. So thank you so much. Thank you both so much for inviting me. It was my pleasure to come and talk to you both.
Dr. Sydnee McElroy: And I will always talk about harm reduction. So thank you.