‘Not in the political appetite’: WV counties not using opioid funds on harm reduction

On a warm summer day in late May, about 100 people wait for their turn to go inside the Neighborhood S.H.O.P., located in the annex of Bream Memorial Presbyterian Church on the West Side of ÂÒÂ×ÄÚÉä.

Inside the S.H.O.P. — which stands for Showers Healthcare Outreach Program — they find resources like naloxone, clothing, first-aid supplies, food, showers and people offering services from rental to legal assistance. Director Derek Hudson says the no-barrier organization aids almost 2,000 people a month.

“The whole goal is to have people come in, be heard and know that at least someone is trying to help them,� Hudson said.

The kind of help the S.H.O.P. provides, broadly speaking, is harm reduction.

“Harm reduction for us focuses on meeting people where they are and empowering them with the tools to help prevent negative health outcomes from substance use,� Hudson explained. “Harm reduction, simply put, saves lives.�

What they won’t find inside, however, is one of the most well-known forms of harm reduction: new syringes.

Syringe service programs are highly regulated in West Virginia, and service providers say it makes it almost impossible to run one. But SSPs are associated with an approximately 50% reduction in HIV and HCV incidence, according to the Centers for Disease Control and Prevention. They also benefit communities and public safety by reducing needlestick injuries and overdose deaths.

Hudson’s S.H.O.P. received about $80,000 in state opioid settlement funds from the West Virginia First Foundation specifically to create a re-entry program that will house people who are coming out of incarceration. It’s a program that will reduce recidivism and homelessness in the community, Hudson says, but it is not considered a harm reduction program.

Programs that provide more typical harm reduction in the form of practical strategies that reduce the negative consequences of drug use — which can include anything from free naloxone to wound care — are not receiving any of the tens of millions of dollars coming into state, county and city level government coffers in West Virginia from the 2021 global opioid lawsuit settlement agreement so far, according to an analysis by students from West Virginia University’s Reed School of Media of Freedom of Information Act responses from 50 of the state’s 55 counties.

And without those funds, many of the people working to provide these services worry that disease transmission and overdose death rates will buck a national trend and rise in West Virginia once again.

The high cost of a crisis

The funds are the result of a global settlement, agreed to in federal court, of a class action lawsuit brought by states, counties and cities across the country against opioid distributors, manufacturers, pharmaceutical companies and others, in the wake of the country’s opioid epidemic.

According to the Centers for Disease Control and Prevention, more than 720,000 people died from an opioid overdose in the U.S. between 1999 and 2022. West Virginia saw its peak in 2022, when 1,335, or 75 out of every 100,000 people, died of an overdose.

West Virginia will receive about $980 million in total from the settlement agreement, split into payments over 18 years, with larger payments coming up front. The West Virginia First Foundation — a nonprofit created by the state Legislature — will control the spending of 72.5% of the funds, local governments 24.5%, and the West Virginia Attorney General’s Office 3%. A Memorandum of Understanding dictates what the money can be spent on, ranging from law enforcement, prevention education, treatment and recovery to harm reduction.

In 2023, more than $73.5 million of those funds were distributed to county officials in the state’s 55 counties. An analysis of FOIA responses by journalism students at West Virginia University’s Reed School of Media lacks information for five counties, but of the 50 others, Logan County received the highest distribution at $3,983,631, and Jefferson County received the least at $62,773.

Kanawha County received just more than $3.9 million, and, according to County Commissioner Lance Wheeler, is focusing on funding recovery options. But Wheeler says they are also considering funding harm reduction organizations as well.

“This is something I strongly support,� Wheeler said. “We’re going to continue to do that, helping those who have a track record of success and those who are helping people who are struggling.�

The collapse of a program — and the fallout that followed

Harm reduction has a long, complicated history in Kanawha County and ÂÒÂ×ÄÚÉä. With a population of 47,000, ÂÒÂ×ÄÚÉä is the largest city in the state. It also had the highest overdose rate per capita in the entire country in 2022.

The city health department started a syringe service program in 2015, but was open for just three years before public and political pressure forced the city to shut it down. Then-mayor Danny Jones, a Republican, called the program a “mini-mall for junkies and drug dealers.�

The program’s closure in 2018, however, had dire consequences for public health. HIV and hepatitis rates skyrocketed, eventually requiring CDC officials to travel to ÂÒÂ×ÄÚÉä in 2021 to help the city contain the outbreak.

Then-CDC HIV Prevention Chief Dr. Demetre Daskalakis called the outbreak “the most concerning HIV outbreak in the United States.�

The fight for evidence-based and person-first

Iris Sidikman, the harm reduction coordinator at Women's Health Center of West Virginia, said the reluctance to fund harm-reduction services has directly impacted organizations that go beyond providing syringe services.

“When you have a tool to give someone in a non-judgmental space, it can open a world of possibilities,� Sidikman said.

In 2024, Women's Health Center of West Virginia applied to the Kanawha County Commission for $250,000 in opioid settlement funds twice, first through an online application and again at a public commission meeting. The clinic intended to use some the funds to provide increased naloxone training and education, cover costs related to screening and treatment of HIV and Hepatitis C and to fund a portion of clinical and programmatic staff salaries for the Harm Reduction Program, Sidikman said. Their application was denied without explanation.

The Women’s Health Center also applied to the ÂÒÂ×ÄÚÉä City Council in August 2023 to create a syringe service program on ÂÒÂ×ÄÚÉä’s West Side, but was denied due to fear of an “increase in drug use and crime.â€�

Research on harm reduction by the Substance Abuse and Mental Health Services Administration has shown that these practices reduce disease transmission and overdose rates, and experts believe politicians should look at the numbers more often.

“What we want to do with data analysis ... is to be able to produce the evidence to show to political power that these interventions are working and capable, they are saving many lives,� said RTI International Research and Public Health Analyst Barrett Montgomery.

SOAR WV, another grassroots, ÂÒÂ×ÄÚÉä-based harm reduction group, works to promote the health, dignity and voices of individuals who are impacted by substance use disorders, according to their website. SOAR and other organizations picked up the task of providing new syringes until the state Legislature passed Senate Bill 334 in 2021, which included strict regulations for running a syringe service program, such as requiring a West Virginia state I.D. in order to participate.

The City of ÂÒÂ×ÄÚÉä also passed stipulations requiring that each syringe be uniquely labeled for tracking purposes.

As of June 2025, West Virginia Health Right operates the only syringe-service program in ÂÒÂ×ÄÚÉä, but according to one source, “doesn’t even begin to make a dent in the problem.â€�

The political appetite is lacking because of a lack of information around the subject, says Susan Margaret Murphy, president of the Drug Intervention Institute in ÂÒÂ×ÄÚÉä.

“Unfortunately, we are in a political climate where I don’t think research and scientific knowledge necessarily pleads the case. So sometimes it’s got to be kind of a heart-on-the-sleeve storytelling type of approach,� she said.

Stigma and the struggle for support

In neighboring Boone County, Commissioner Brett Kuhn agreed.

The county currently does not have any harm reduction services, and, so far, its three elected commissioners have not spent any of their $2.9 million in opioid settlement funds to provide them.

“I think in a rural setting, you’re going to see more pushback than you would in more of an urban setting,� Kuhn said. “I think with the syringes, it’s like people think we’re subsidizing the drug use, whereas with naloxone the attitude is more like, ‘well, we’re trying to help somebody that’s in trouble.’ And really, if you look at it, in both cases, is there any real difference between the two?�

Kuhn says that informing the public about how harm reduction works and its benefits to the community is key to fighting pushback.

“You’ve got to get out ahead of the curve. You’ve got to get out there and get the information out,� Kuhn said. “I sometimes think we don’t do a good enough job of that.�

Kuhn said his county experienced the brunt of the nation’s opioid overdose epidemic firsthand. Its opioid mortality rate in 2023 was 82 per 100,000, the second-highest rate in West Virginia, according to the West Virginia Department of Health and Human Resources.

Instead of harm reduction programs, the county spent its funds on paying off its regional jail bill, supporting a food pantry, a county arrest record-keeping system, a rapid response vehicle for EMTs, and a 25-bed expansion at Hero House, a faith-based sober living home in Madison.

Kuhn and officials in other counties say the vague nature of the state’s MOU which outlines how the money can be spent puts the duty of interpretation on local officials. The county did not hold special community meetings or town halls to gather input on how to spend the funds.

But Kuhn says it’s rebuilding a sense of community that could help garner support for harm reduction services.

“I think it’s sometimes the attitude is ‘well, those people don’t want to help themselves,’� Kuhn said, “[but] if they don’t want to help themselves, then what do I need to do to try to help? And I think in a certain sense, we’ve lost that sense of community, that we’re all in this together.�

Kuhn hopes that can change in the future.