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Homegrown Black Metal Smashes Stereotypical Appalachian Narratives

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In recent months, the media spotlight on Appalachia has resulted in complicated conversations about whose mountains we inhabit and who’s telling our stories and how. This conversation rapidly escalated from a slow boil to a forest fire. I met with Aaron Carey of the Apalači folk metal band Nechochwen — in the forests — to talk about his work as a musician and his life as a resident of West Virginia and the greater Ohio Valley.

Nechochwen joins the ranks of several metal-hybrid bands to make a project of telling the stories of Appalachian history and heritage with an unlikely assemblage of elements of traditional Appalachian music and ice cold black metal. You won’t see our mountain-metal darlings adorned in corpse paint, like their Norwegian predecessors, but you will catch them growing and canning their own food, just like their grandmothers taught them.

My best friend Will’s grandparents, lovingly dubbed Ma and Pap, lived in a small region in the northern part of the Ohio Valley, called Yellow Creek. They lived in a cabin in a holler next to the creek, with Will’s family’s cabin not far off, which was next to an old-fashioned treehouse that Will’s father and Pap built by hand. We’ve always joked that they were Appalachian legends, with the Foxfire series in their bookcase, waders hanging to dry on the porch and a log on the woodstove. Pap taught us how to roast weenies just right, tie a lure and catch quick minnows with our small hands in the shallow edges of the creek. He kept bees, maintained trails and raised ducks.

Nestled somewhere next to those Foxfire volumes on plain living was an out-of-print copy of a collection of regional histories called Tales and Stories of Yellow Creek. A few years have passed since Will’s grandparents passed away, with exactly a year between their deaths. Pap died on March 12, 2015, preceded by Ma who passed away on March 12, 2014.

We returned to the cabin this past holiday season to have a Christmas dinner party just for ourselves, where nothing had changed. Will had been living in New York City, working on finishing his master’s degree, and I had been away at college, with almost a year since my last visit home. I sat down with Ma’s quilt next to a kitschy statuette of a woodsman santa claus with a glass of Pap’s old Tennessee whiskey and read Schillings’ tales of Yellow Creek.

Almost six months later, I met Aaron, a music lecturer at Bethany College, who had also grown up in the Ohio Valley. We found it to be amusing that he lives in Wellsburg and I live in Wellsville, two small towns only twenty-some miles apart on different sides of the valley. Aaron has been writing music since he was in high school and founded the West Virginia Apalači folk metal band Nechochwen in 2005. Coincidentally, he had also been given a copy of Robert Schilling’s Tales and Stories of Yellow Creek by an older relative, leaving both of us stunned to learn that that we were two out of probably a handful of folks who were still living that had read its stories.

Following their 2015 release, “The Heart of Akamon,” Nechochwen plans to release a split with the Minnesota-based atmospheric black metal bluegrass hybrid band Panopticon featuring tracks that draw inspiration from a story of a granite boulder referred to as “Standing Rock” that Aaron originally learned of from a chapter in the book. The Standing Rock is sacred, once the site of meeting place for indigenous people, and was recently designated the site of a conservation project in Jefferson County, Ohio. The surrounding area is now protected, although it was likely to be sited for development by local industry, as it is one of the few remaining habitats of the American hellbender salamander. Aaron told me that he sees this as divine intervention.

I asked Aaron if we could meet up and talk about Nechochwen’s upcoming split. We decided on a hike. He drove us to a trail not far from his house and a stone’s throw from his office at Bethany, one he refers to as an “ancient forest,” never before deforested or modified. As we meandered the trail, we kept an eye out for wild ramps and morel mushrooms. I was taught as a child to choose only the largest ramps of the patch and to leave behind more than you take as to “save some for next summer,” by relatives who referred to them as “spring onions.” I didn’t know, at five or six, that my uncle was passing down good habits for sustainable harvesting, but I was thrilled to wiggle my fingers to the ramps’ roots to pluck them from the dirt. Careful and deliberate, Aaron plucked ramps for the both of us, and told me that he’s delighted for the forest patch to mature over the next few weeks of spring.

We settled on a place to pitch two hammocks and talk, and almost immediately after nestling in, Aaron drew my attention to the massive hydraulic fracturing drilling rig nearby that towered over the treeline of the forest. The low frequency hum of the machinery made it difficult to hear the sounds of spring. We struggled to speak over what may have been drilling or workers operating equipment. It was the several-hundred-foot elephant in the room: Aaron expertly chose these woods for our interview as they had been untouched and uncut for thousands of years, but we had to share a conversation about what it meant for him to be close to nature over the constant drone of manmade structures.

I asked Aaron if the natural gas industry encroaching on the untouched landscape of his home made him feel heightened anxiety to hurry to preserve the stories of his home and his indigenous lineage. Almost before I could finish my sentence, he answered, “Yes.” He told me that he first started to notice the larger trend of local industry “tainting wildlife,” as he describes it, when he was learning to become closer to nature to pray and connect with “the beyond.” This sent him on a personal journey to devise strategies to cope with the destruction of the spaces in nature he cherished so much.

Paul Ravenwood, of the Appalachian atmospheric black metal band Twilight Fauna, told me on another occasion that “black metal has a weird ability to represent a landscape, as well as pain and frustration. People here experience both of those.” As Paul has paid close attention to the ways that energy industries have changed our region, it has inevitably influenced his writing process. “We have to be political. It’s hard to drive past a place that used to be a mountain that is now a mudhole, or watch as people sit in trees to stop pipelines, and not be. It’s a part of me,” he said.

As Aaron and I drove into the hills of Bethany’s secluded campus, he pointed out, without relent, historic sites of where settlements used be nestled along the creekbends thousands of years ago, some protected and some altered. He showed me creekbeds he knows are rich with artifacts and fragments from the past, where he often wades to dig for flint and arrowheads.

Aaron seemed to know everything about the region, from its history to the varieties of plants underfoot. He is fiercely devoted to preserving the history of the region, using Nechochwen as a medium, and he sees this as a community project; he wants his music to help others envision what the regions he writes about may have looked like thousands of years ago.

He sees this project as reciprocal. Aaron cherishes the moments that unfold when others come to him to share stories of their own indigenous histories after hearing his music and reading his lyrics. Some read Nechochwen’s lyrics, learn where the stories fit in a broader history of the Appalachian region, and contact Aaron with their own local lore. He told me that he values their exchanges just as much as he does his own research process.

Nechochwen chooses metal as a home for this storytelling because they feel it’s one of the few avenues capable of telling the horrors of the forced removal of Native American people caused by westward expansion. Aaron feels that some of the stories he wants to tell might be “too grim” for some of the styles of acoustic music that he writes on his own. Paul sees a lot of the same elements in traditional folk music and black metal, although those parallels aren’t immediately obvious to others. He says that he’d rather be remembered for telling stories, rather than for writing black metal, as traditional folk and bluegrass musicians are widely recognized for their long-held storytelling tradition. Paul covets Montcalm, West Virginia’s Hazel Dickens as much as he values Kolbotn, Norway’s Darkthrone.

He and Paul see themselves as a part of a community, often driving more than five hours to spend time with one another. Paul shared that Aaron had taught him a lot about indigenous culture and history during his first visit to West Virginia, where they trekked the same trail where Aaron and I met. Many of the bands met for the first time at Shadow Woods Metal Fest, where several Appalachian folk metal artists performed. Paul shared with me that Austin Lunn of Panopticon performed a cover of Jean Ritchie’s song Black Waters at the fest that moved him to tears. Jean Ritchie’s harrowing ballad tells the story of witnessing the destruction of mountaintop removal mining in Kentucky. Aaron told me he feels “at home” with his recording label, Bindrune Recordings, as the outfits he shares the roster with have in common their intimate relationship with nature that is weaved through the lyrics and sound elements of each of their releases. Fittingly, the record label’s byword reads “Woodland Denizens… Unite!”

My conversation with Aaron was haunted by the reality that artists like Nechochwen have to struggle to “hold onto the thread” of what remains of their histories, as Aaron describes it. These stories and traditions have been persistently erased for centuries. Just like the destruction of the natural landscape, and subsequently, the life that inhabits it, the ongoing and systemic historical erasure of indigenous histories is violence.

Holler-casting blackened bluegrass to you from the Ohio Valley, Liz Price studies Appalachian regional policy by day and spins mountain-metal by night.

Appalachia

When Losing 14 to 1 is a Win — Sort Of

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Matthew Ferrence is a writer and college professor who ran a 14-day write-in campaign against an unopposed Pennsylvania state legislator. He got clobbered but finds something positive in the results. Photo: submitted by the author
A last-minute write-in campaign against an unopposed Pennsylvania state representative yielded 900 official votes. It wasn’t nearly enough to win, but it was enough to show that there’s more to Appalachia than the average TV pundit claims.
Well, I didn’t win. Let’s get that out of the way.But on the night of November 6th, 2018, after launching a last-minute zero-budget Green Party write-in campaign against an unopposed Republican incumbent, in a Pennsylvania district that perpetually votes at about a 70 percent clip for even Republicans who get absolutely blasted in statewide races (see: gubernatorial candidate Scott Wagner, soundly defeated by Tom Wolfe), I wound up making a nearly 5 percent dent.

The how isn’t quite as important as they why, I think, but in brief: exactly two weeks before the election, I announced on Facebook my intention to mount a write-in campaign for the Pennsylvania House of Representatives, disgusted that for the fourth time in seven elections, the local incumbent — Brad Roae — faced literally no competition. Nobody squared off against him in the Republican primary and nobody ran on the Democratic ticket. In fact, only twice in his tenure has he faced opposition from Democrats, each of them throttled to the tune of 60-40 or thereabouts in the general election.

As an even sorrier indication of the state of political engagement in the rural part of Northwestern Pennsylvania where I live, only once has a Republican ever challenged him in a primary. It’s smooth sailing every two years, which leads to a tepid, basic and uninspiring legislative track record. Taxes are bad, he says. And, oh, let’s have some laws to weaken environmental protections for gas well drilling. He has made public media posts that appear to equate school boards to Hitler, and he has argued that state funding shouldn’t support students who major in “poetry or some other pre-Walmart major.”

Yeah, that’s who I lost to, my 900 votes or so to his 13,000. And that’s the guy who has gone to Harrisburg for more than a decade representing my home. Among the many things that gall me about his incumbency is the way that, outside of Appalachia, a lot of people would probably nod their heads and say, yup. Brad Roae is the kind of representative people think Appalachia embraces, is the kind of person so many non-Appalachians see as purely representative of who we are and what we stand for.

But here’s the thing. I’m finding hope in my two weeks as a candidate, and in the sudden flurry of interest and support. I ran because there had to be some opposition for democracy to have any chance at all, and when I did so I hoped I’d get 1 or 2 percent, not embarrass myself, shoot for the bar of 300 votes. That would be the same number of votes I would have needed as signatures to get on the ballot had I, say, planned ahead.

Then a funny thing happened. I started making videos introducing myself and my ideas, and put together a platform paper, and people started sharing these materials on Facebook, and I had to work through the anti-Russian Bot regulations the social media site now has so I could finally “boost” two of those posts on the morning of the election, and even before all that the organic sharing of an electorate dying for something, anything, that pushed against Appalachian political stereotypes meant 9,000 people had seen my stuff. Then, even though people had to first know I was running and then actually bother typing my name in, I fared okay. I earned about 65 votes for each day of my campaign. And I spent $50 on stickers, $20 on my Facebook ads.

Brad Roae poses in the Pennsylvania House chamber with Pennsylvania dairy princess LeeAnn Kapanick. Roae has represented the 6th House district since 2007. The district covers parts of Crawford and Erie counties in the state’s northwest corner. Photo: Pennsylvania State Legislature webpage

Official county returns compiled right before Thanksgiving gave me 851 votes. The Monday following, I reviewed the official computations and found another 60+, if I include misspellings like Matt Terrance and, Michael Ferrence, and Matthew Fetterman (for a voter who maybe confused me with our Democratic Lt. Governor candidate John Fetterman), and That Guy Whose Name Starts With F, as well as The Guy on Facebook Ask (name redacted), as well as a litany of close-but-no-cigar last names coupled with Matt or Matthew: Ferrer, Ferraro, Fetter, Farreah, Ferrenc, Ferrous, Ferris, Ferentz, Ferrick, and DeFerence. I got 14 votes in neighboring state districts, and four votes for the U.S. House Race. Among other write-ins, I beat a slew of names that received a single vote or a handful, tough competitors like Brad Roae (who a few people wrote in, even though he was on the ballot), Stephen Colbert, Anyone But Him, Anyone Else, Jesus, God, and Red Breasted Nuthatch.

Look, my day job is writing and teaching. I’m a professor at a small liberal arts college, chair of the Department of English, writer and teacher of creative nonfiction. I was born in southwestern Pennsylvania, among the played out coal fields and strip mines an hour east of Pittsburgh. I earned a Ph.D. at West Virginia University, where I specialized in Appalachian literature. I wrote a memoir about my brain tumor, and the geology of the Allegheny Plateau, and the curious exile of inhabiting the weird position of Northern Appalachian, which means you’re not quite normal American and not quite Appalachian. None of that adds up to politician, but all of it adds up to frustration. I’ve spent most of my life, other than brief adult stints in Arizona and France, living in a region that skews way right, even as that right continues to exploit and degrade the people and place. All Appalachia ever has been allowed to be is exploited. That’s it. And that’s all the rhetoric of the GOP offers, when you boil it down. Let’s Make America Great Again, like when black lung wrecked lives on the regular and, newsflash, is now roaring back to life since the unions have been busted, and the economy of the region stayed busted, so the people crawled down into mines without the protections hard fought with blood and love by the striking workers of Blair Mountain, and the striking workers of Pittsburgh steel, and the striking auto workers of the Rust Belt.

Ferrence knocked on some doors and created a Facebook page to promote his campaign. He did several short videos to explain why he ran and discuss issues. Photo: Matthew Ferrence for PA House, District 6 Facebook page

Public historian Elizabeth Catte gets it right (she’s the author of “What You’re Getting Wrong about Appalachia”) when she argues that Appalachians have been socialists all along. They just don’t know it. They gathered together. They fought the power of industrial dominion. They powered America with their coal, yes, but they also fueled the national movement for respect and dignity for labor. Then the GOP figured out how to weaponize hatred and fear, and there you go. You get Joe Manchin, alleged Democrat. And you get a region that votes more than 2/3 for Trump and Trump-esque troglodytes like Pennsylvania’s GOP gubernatorial candidate Scott Wagner, who claims that global warming is probably just accumulated body heat from a larger human population or happens because the earth is getting closer to the sun, and campaigns by saying he’ll dance on the governor’s face while wearing golf spikes.

It boils down to this: I am so tired of waking up on November Wednesdays in Appalachia, seeing election results and, worse, national punditry that says this is all we are and all we’ll ever be. The election map of my state is bright red, other than around a few urban centers, just like most of Appalachia. That seems to translate to the same conclusion we get over and over and over again: dumb hillbillies voting for the worst. That conclusion seems to be supported by the simple math of our state politics, where more than half of state legislators run unopposed in their general elections, and our incumbency rate is about 90 percent. Few candidates ever put up a fight to change that.

So what’s an Appalachian creative writing professor to do? You run a last-ditch campaign. You tilt against the windmills in a manner that is both impotent (because you get crushed at the polls) and, at least for me, hopeful. Because having a choice, any choice, other than the incumbent mattered to the 2,000 people who either voted for me or tossed in a symbolic protest write-in. Because people stopped me when I walked by, and messaged me on Facebook, and were angry when they learned about the campaign only after they voted because, damn it, they couldn’t vote for the incumbent, and leaving it blank is just what the GOP has wanted for so long. The story of Appalachian politics has been about that blankness, a cultivation of the sense — and you can read this in almost every national outlet at some point in the last two years, usually with a quote from that faux-Appalachian pseudo-pundit J.D. Vance — that there’s nothing but right-wing fools in these hills and hollers. Appalachia is given up for dead again, this time just as a tarnished example of the hatred and backwardness of politics in this strange, strange land.

That’s just not how it is. That’s not the Appalachia I know nor the one I saw in my brief campaign. Heck, I ran this mini-campaign focused specifically on lefty sustainability, as in ecology and tree-hugging, as well as economies that stop repeating the boom-bust cycles of our past, and I drew a mighty good swipe of votes all at once, in the end. There are a lot of people in my county who believe in the value of the environment, and the necessity of fine educations, and the rightness of universal healthcare, and the imperative of social justice, and the glory of love in all its forms. There are progressives in these hills, you know. And a lot of them, but also a lot who hear those same old stories and worry about what the neighbors will think, so they don’t vote, or accept the inevitability of political monoculture. Thus the slam happens again. And again. And again. Unopposed Republican. Platforms of no taxes. Tacit acceptance of the Confederate Battle Flags that flutter on too many once-Union farmhouses.

Yeah, I got creamed. But I think we also won something that night. And we’ll keep coming back for more, riding a blue wave tinged with green, fighting for a change in the rural center of America that so many figure is lost forever. You know the joke, about Philadelphia and Pittsburgh and a lot of Alabama in between. Well, Alabama has a Democratic Senator, and so does Pennsylvania. We can do more, do better, push against the dogged stupidity of a right-wing cultural war that makes us all weaker and worse off. We can step into these races, and we can square off and say, hit me, and we can get hit, and eventually we can win. I know I’ll give it another shot – with my name printed on the ballot next time. I’ll need at least a couple of months next time, to get enough votes to be competitive, if history holds. But I’ll vow, and I hope others will too, that no one gets to run unopposed anymore. No one gets to spit out tired political bullshit and not get called out. This is our Appalachia too.

This article was originally published by the Daily Yonder

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Appalachia

There’s a Tool that Claims to Predict Potential for Criminal Behavior. Should PA Judges Use It?

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Allegheny County Courthouse in downtown Pittsburgh. Photo: Connor Mulvaney/PublicSource

The Pennsylvania Commission on Sentencing is considering a “risk assessment” tool, which, according to social justice activists, would reinforce existing bias in the criminal justice system. But the tool’s designers say it would give judges more data to base sentencing decisions on as opposed to primarily relying on uniform guidelines.

The commission is hearing public feedback about the risk assessment tool on Thursday, Dec. 13, from 10 to 11:30 a.m. at the Allegheny County Courthouse (436 Grant St., Pittsburgh).

How would the “risk assessment” tool work? Say you’re facing a criminal charge. In addition to the usual information about your present and past — as in the crime for which you are on trial and your prior record, if any — the judge also has a report trying to predict your future. On a scale from 0 to 18 points, an algorithm has indicated how likely you are to reoffend, based on data about recidivism rates.

Read more about how the risk assessment tool is used to calculate sentences from PublicSource.

This story was originally published by PublicSource based in Pittsburgh.

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Diving Deep into Harm Reduction

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Medicine worker disposing medical waste into plastic containers with protective glove. Photo: Adobe stock.

Part 1: Why W.Va.’s Largest Needle Exchange Closed

In December  2015, with support from the city of Charleston, the Kanawha-Charleston Health Department launched a harm-reduction program that included a needle exchange. The primary goal was to reduce the risk of diseases commonly spread by sharing needles.

Now, only thing that remains of the harm reduction program is a syringe kiosk where people can deposit used hypodermic needles.

At its peak  the program served more than 400 people a week,mostly from Kanawha County. But some came from surrounding counties as well,a factor that became a point of contention for many in the city.

“It became basically, a line of people just to line up to get needles between 10 and 4 on any given Wednesday,” said outgoing Charleston mayor, Danny Jones who been an outspoken critic of the program.

In the months before it closed, Jones publicly called the program a “needle mill” and “mini-mall for junkies.”

“On any given Wednesday, they might have given out 12,000 needles,” he said during a recent interview.

In reality, the average number of needles given out during the weekly Wednesday exchange was about 5,000 serving about 190 visitors, according to data obtained from the health department. That’s about 26 needles per person, per week. The highest number of  needles the program ever gave out in a single week was just over 11,000 to 417 people.

While 5,000 seem like a lot, the average heroin user injects several times a day. So 26 needles a week gets a person about three injections a day with a clean needle.

“A syringe exchange program should really be called a harm reduction program,” said Dr. Artis Hoven, an infectious disease specialist with the Kentucky Department of Health.

She said harm reduction is an all-encompassing idea to reduce the risk of many things associated with addiction such as “provide naloxone, provide referral to care for people with substance use disorder, they do HIV and Hepatitis C testing.”

And in Charleston, it seemed to work.

While the Charleston program was open, the city did not see an HIV outbreak, according to interviews conducted by Charleston-Gazette Mail. During that same time period, 15 counties in southern West Virginia did have a small HIV outbreak — none of the three counties where the outbreak started had a harm reduction program, according to a Centers for Disease Control and Prevention Report.

Recorded incidents of Hepatitis C rates in West Virginia did increase — by a lot — during the course of the program, but so did efforts to test more people.

But in Charleston, reports of discarded needles in the community began to skyrocket and people were alarmed.

Firefighters reported having to crawl over them while putting out fires in abandoned structures; a local elementary school requested a biohazard container from the city so they could clean up an alley before school; and police officers reported finding huge numbers of syringes on people who were arrested.

Both the Fraternal Order of Police and the Charleston Professional Firefighters Association wrote letters to City Council expressing major safety concerns for first responders.

Concerns might have been exacerbated because the program grew really fast. In the two years the program was open, more than 651,000 needles were distributed. Only about 66 percent of those needles were returned.

According to the Centers for Disease Control and Prevention, the risk of contracting HIV is nominal for for healthcare professionals stuck by needles on the job — around .3 percent — with some studies suggesting even less. Outside experts like Peter Davidson from the University of California San Diego say needle litter is an annoyance but not the major public health concern an HIV or Hepatitis C outbreak would be.

“No one in the world has ever obtained HIV from stepping on a needle in the street,” said Davidson. “Needles in the street are a piece of trash. It’s not something you want seeing laying in the gutter, but they’re not actually a very hazardous object.”

In some ways, it doesn’t matter what the risk is. If someone finds a dirty needle on a playground or in a shopping mall bathroom, public reaction is strong. And for non-users, any risk of contracting HIV or hepatitis from a dirty needle is too much.

But closing a harm reduction  program in the biggest city in the state could have huge public health implications for the region, according to former state Commissioner for Public Health Rahul Gupta. Gupta said it’s “not in the best interest of the community” when needle exchange programs like this one are shut down “reactively.”

“It plays into that stigma and is more harmful long-term than it is beneficial,” he said in an interview shortly before he left his job.

Gupta said it’s more harmful because not only are you removing your best tool for preventing needle-born illnesses, but, as we’ll hear later in this series, the closure may impact public perception and support for other harm reduction programs across the state that are trying to open or stay open.

Part 2: Public Safety and Public Health

Best practices for harm reduction programs call for flooding a community with clean hypodermic syringes. Research shows that in addition to reducing the prevalence of blood-borne pathogens in the community, well-run programs help remove potentially infectious syringes from the community. But some people say that wasn’t happening in Charleston.

Photo: Todd Huffman via Flickr [CC BY 2.0]

Reports of needles found in public places in Charleston began to escalate in early October 2017.

Mayor Danny Jones said the city tried numerous times to complain and the Kanawha-Charleston Health Department didn’t do anything to address their concerns.

Then city health officer Michael Brumage took issue with that accusation,pointing to efforts, such as the founding of the statewide harm reduction coalition. He said one of the objectives of the coalition was to bring needles into other communities so there wouldn’t be such a burden on the city.

But in October 2017, the city public safety office established a code for needle pickup calls to help the city accurately collect data on locations, numbers and types of needles to be picked up.

About a week later, the city proposed running a pilot program with retractable needles. The idea was that if the needles could only be used once and then retract into a plastic chamber, it would reduce the risk of needlestick injuries to the community and first responders.

At the time, Brumage was all for the idea. He wrote an an email, which was part of documents released to West Virginia Public Broadcasting through a Freedom of Information Act request, to city attorney Paul Ellis.

“[T]he limitations … are acceptability and cost. Should we get support or donated supplies, I am all in for a pilot with evaluation. This could be a very interesting trial. We would like to bring in some researchers for this as well. Let’s do it! It’s worth a shot.”

Over the next few weeks, the Charleston Fire Department found a manufacturer willing to donate the needles in exchange for tracking how well they worked. After consulting with Brumage and his staff, the city requested 250,000 needles from the manufacturer for a six-month trial.

Everything seemed to be on track to start a pilot project using retractable needles in early spring 2018.

At least that’s what the city thought. Meanwhile, Brumage was in communication with a researcher at Johns Hopkins University in Baltimore, Maryland. The researcher reinforced something with him that  he said he already knew — that “retractables were unpopular among people who used IV drugs.”

In 2010, the national Harm Reduction Coalition issued a statement against auto disable syringes. They said the syringes do little to help control epidemics of HIV, hepatitis C, and other blood-borne viruses among people who inject drugs because many people inject drugs a half dozen times a day. Without needles you can use more than once, users revert back to sharing equipment.

“So, at that point I was kind of in a bind since I told the city we would implement the retractable syringe program. But now knew if I did, we’d actually be putting the public at risk,” said Brumage.

So given the current recommended practices, Brumage and the Johns Hopkins researcher decided to reduce the pilot instead to about 10 to 12 people. In meeting minutes from a call, also released in the FOIA,, Brumage’s staff appeared to confirm the new plan with the company that had agreed to donate the syringes.

Brumage said he thought the needle manufacturer then told the city about the change. But no one did. So city officials said they felt blindsided several weeks later when they learned the pilot program no longer included the entire patient population.

“They refused retractable needles,” Jones said in an interview.

It was more complicated than that, but it probably felt like a refusal to the city because of the  change in plan wasn’t communicated. And I mean, remember, law enforcement, emergency responders and some members of the community were now expressing a lot of concern about needle litter and felt like they had to do something.

“I want to protect the public. I want to protect the law abiding public,” said Jones.

In late March of this year, Charleston Police Chief Steve Cooper decided — as he was legally empowered to do — that the health department may only give out retractable needles.

Essentially, Brumage said, the police were “ directing the health department to adopt — what appeared to be from the medical literature to be dangerous and unethical practices.”

But other public health experts said making a harm reduction program fit the needs of the community takes a lot of compromise.

“Public health has never been and will never be about my way or your way. It will always be what’s the best way to input science and marry it with art and put it into practice,” said former public health commissioner Rahul Gupta.

From a public health perspective, harm reduction programs are still the best tool the city a city? has to prevent the spread of needle born illnesses. But politically — at least in the state’s largest city — it’s closed indefinitely.

Part 3: Community Acceptance, Perception and Stigma

A girl is telling her friend a secret. Photo: Adobe Stock.

Less than two years after it began, the Kanawha-Charleston Health Department shut down it’s harm reduction program. Among other things, the program provided thousands of clean needles to drug users with the goal of reducing needle borne diseases, but faced significant pushback from some in the community.

As the state continues to grapple with the drug epidemic and its impact to public health, those running harm reduction programs in other West Virginia communities say the closure of the Charleston program, and the narrative that the needle exchange program was destroying the city, is having a negative impact on public perception of harm reduction efforts.

“Everyone understands that this drug epidemic is the biggest public health issue that we have dealt with,” said Terry Harlin, administrator of the Fayetteville harm reduction program. “I feel like what happened in Charleston hurt us a little bit.”

Harlin said when the Charleston program closed in [insert when here], members of the community began questioning the necessity of the Fayette County program.

“We definitely started hearing people locally, ‘well it didn’t work in Charleston so why would you continue doing that here?’” she said. “Even though there’s lots of evidence and research out there that show that harm reduction does help to prevent the spread of disease and does help to get people the help that they need.”

A Shifting Narrative

The trickle effect to other programs like Fayetteville’s likely happened in the last six months the Kanwaha-Charleston program was open, when the narrative around the program shifted. Outgoing Charleston Mayor Danny Jones was especially outspoken critic of the program.

“Needles were everywhere and our property crimes went through the roof,” he said.

No study has been done quantifying whether the harm reduction program caused an increase in needle litter, making it hard to confirm the veracity of the claim. But we do know, according to data from the health department, that during the two years the program was open, more than 650,000 needles were distributed and only about 66 percent of them were returned.

West Virginia University public health researcher Robin Pollini said that doesn’t mean the unreturned needles ended up on the street. In West Virginia it is legal to dispose of sharps in the trash if you package them and label them in a certain way, she said.

“And so the Charleston program, just like many programs across the state, gives out puncture proof containers and information on how to dispose of those safely,” said Pollini. “And so we don’t have any idea how many of those ended up properly disposed of in household trash and how many didn’t.”

Dr. Susan Gardner, assistant dean of the University of Charleston School of Pharmacy, said she has seen little evidence of widespread needle litter.  The school of pharmacy was one of the volunteer groups very involved in the Kanawha-Charleston Harm Reduction Program.

“There are times where I just took a walk on the East End looking — looking!,” she said. “[I say to myself] ‘ok, if it’s this bad surely I’ll see it.’ And the only time I’ve ever come across a needle in Charleston is doing a syringe cleanup.”

Us Versus Them

But without a study of Charleston’s needle litter, there’s also no way to prove that the 200,000 unreturned needles didn’t end up on the streets.

Members of the Charleston police department said they’ve observed much less needle litter since the program closed, but the department also has reams of photographs from first responders and community members of needles found in public spaces.

Comments on news articles and Facebook posts seem to paint a community drowning in needles.

On some level, needle litter itself, isn’t the issue.

“So part of the narrative that was built around the Kanawha program was this us and them of like ‘we’re the community and those people are drug users,’” said Pollini, from WVU. “Those people are part of our community they’re West Virginians right?”

In Wyoming County a Different Narrative

Wyoming County launched its needle exchange program in May. Executive Director Fred Cox said their program has been relatively well-received — he guesses because they had a small HIV outbreak prior to the program opening.

“A picture’s worth a thousand words I’d guess you’d say,” Cox said. “So, that picture was really clear to us here and I really do think that help changed some minds.”

He said if they hadn’t had the outbreak he doesn’t think they would have had to support to open the program as a prevention measure.

Some speculate that may be another reason Charleston’s program struggled in the end.

Outgoing Charleston mayor Jones said there were no reports of outbreaks of hepatitis C or the AIDS virus prior to the launch of the city’s harm reduction program.

“It’s not up to us to ruin a town over the fact that people have communicable diseases,” he said.

Rahul Gupta, formerly the head of the state’s public health department, said harm reduction is a multifaceted idea that encompasses not just needle exchange, but testing and family planning and treatment of diseases.

“And other issues that come across that are consequential in some ways like needle litter and other things there have to be plans in place to address those — what we can’t afford to do is ignore them,” he said.

There often are demands, Gupta said, to do things differently. But he believes there’s always a middle ground you can get to with negotiation. And you do that, he said, because “people’s lives are at stake.”

Part 4: Best Practices vs. Community Acceptance

Current best practices for harm reduction programs include a couple provisions: No retractable needles should be distributed, patients should get as many needles as possible regardless of how many they bring back, and barriers to accessing needles should be as low as possible. But sometimes those recommendations are at odds with community acceptance for the practices.

Photo: Ashton Marra, 100 Days in Appalachia

In late March, shortly after the Kanawha-Charleston Health Department closed its harm reduction program, Mayor Danny Jones wrote a letter to Rahul Gupta, then state commissioner for public health, asking that the West Virginia Bureau for Public Health audit the program.

“The review provided very specific recommendations that needed to be met in order to restart the program,” Gupta said.

These included improving data collection and analysis about exactly how many people were using the program and what services they were using; putting in place a plan to deal with needle litter; improving communication with community stakeholders and requiring that people pick up needles they need in person.

After the audit came out, the Kanawha-Charleston Health Department requested a review of the audit from seven harm reduction experts around the country, including Dr. Peter Davidson from the University of California San Diego. All seven letters were critical of the audit.  

“I think the best way to describe it was that the people who wrote the audit had a very particular idea in mind about what a syringe distribution program should look like,” said Davidson.

In his letter Davidson wrote that “almost all of the recommendations in the audit represent severe, and in some cases unconscionable, barriers to effective, evidence-based, primary prevention of blood borne virus transmission.”

“You know one of the reasons syringe distribution programs exist in the way they exist at all is because is because the sort of traditional public health clinic model hasn’t served people who use drugs very well at all,” Davidson said. “And it hasn’t been very good at providing them with the basic tools they need in order to prevent the transmission of infectious disease and prevent overdose.”

Davidson said ideally, harm reduction programs have as low a barrier of entry as possible so the maximum amount of people will participate. And the recommendations made in the audit would raise the threshold of how easy it was to access resources, but he also says there’s room to adjust programs to fit the communities they serve.

“I wouldn’t expect a needle exchange in rural Appalachia to look the same as a needle exchange in San Francisco for example,” he said. “That would likely lead to a program that didn’t serve the population very well at all.”

And in Charleston, there were actually two harm reduction programs being held simultaneously: the one at the health department and a much smaller, clinic-based program operated by Health Right, the biggest free clinic in the state.

“Back in 2011 we noticed an increase in patients that were coming in with various stories, histories of being diabetic, they would pick up the needles for the program but not the insulin,” said executive director Angie Settle.

She said they began to suspect an increase in IV drug use among their patient population.

“So we kind of quietly started the program with the needle exchange it was mainly internal not something we broadcasted, but those patients that needed it knew of the service and as they came in we were screening every patient for IV drug use,” Settle said.

Because Health Right is a clinic working with a limited number of patients with whom they already have close relationships, they could run their program differently than the health department, which was trying to do a mass public health push, serving the whole city.

Health Right is also a one for one exchange — you bring a needle back, you get a fresh one — which for most harm reduction experts is not considered best practice. But since patients can come as many times a week as they want, Settle said it seemed to be the best choice for her program.

They also require every patient to meet with a counselor when they come in for needles. Basically, participation in Health Right’s program requires a lot more effort from patients, which means not everyone will use it, but Settle said that running a conservative program is preferable to not having a program available at all.  

“You know the reality here is you’ve got a drug-using population that, in fact, is going to keep using drugs whether or not you have a syringe exchange program or not,” said Dr. Artis Hoven, an infectious disease specialist with the Kentucky Department of Health.

But without a program, she said, the community is just opening itself up to the easier spread of communicable diseases.

“There is something called the art and science, if you will, of risk or harm reduction,” said Hoven. “And for many of us we are still learning what that art is and what that science is. We’re trying to make it better and to make it something that is effective.”

But if Charleston were to consider harm reduction again, a lot of community healing, conversations, and compromise would likely have to occur. And the biggest barrier may be one of the most intangible ones — addressing stigma.

Part 5: A Community Divided

When the Kanawha-Charleston Health Department closed its harm reduction programs, one of the biggest criticisms of the program was that it led to an increase in crime, vagrancy and homelessness. Those claims are not without merit.

Photo: Adobe stock

“I mean, that’s some of the stuff that people don’t really think about,” said Sgt. Matt Webb, who has been on the Charleston Police force for 20 years. During a ride-along, Webb was tracking a case of a man who was stealing vehicles and using them in other crimes. He pulled into an office parking lot where about eight cars were parked around a side-by-side ATV – effectively making it impossible to access the off-road utility vehicle.

“It’s the bigger picture of the drug issues. Guys out stealing somebody’s side-by-side … those people probably work hard every day to try to take care of their families and have things like that, and here he’s trying to support his drug habit and he goes and steals a side-by-side.”

During the 2018 mayoral election, crime and safety related to the drug epidemic became a political theme.

“One of the issues we have in our downtown area and is not just perception — it’s become reality unfortunately — is there is a belief that there is a public safety issue in downtown Charleston,” said mayoral candidate J.B. Akers during a fall debate between him and then-candidate Amy Goodwin televised by WCHS.

Akers was publicly critical of the syringe exchange component of the Charleston harm reduction program during his campaign. In the months leading up to the election, the program increasingly became a politically charged, divisive issue.

This fall, the City of Charleston completed a $100 million renovation on the Charleston Civic Center. The Civic Center overlooks the Elk River and abuts the Charleston mall. On other side? The Kanawha-Charleston Health Department.

“That health department shouldn’t be there,” said outgoing mayor Danny Jones.

The Charleston harm reduction program happened once a week. And as the program grew, that meant up to 400-some patients were coming through in a six-hour period for needle exchange as well as getting vaccinations, testing for diseases and accessing family planning services, among other services. This volume was a big deal for the downtown community.

“Having a program that was outside the city limits or at least within the city limits but in a less trafficked place by regular business people and people doing shopping in the city of Charleston would be an important thing to do as well,” said former city health officer Michael Brumage. Brumage said one of the lessons learned from the program was that they’d likely rethink the location.

Over the last couple of years, complaints of vagrancy and a rise in a criminal transient population have increased — a change Jones attributes to the harm reduction program and the geography of the state.

“It’s the confluence of the interstates,” he said.

Charleston is at the intersection of two major interstates — 64 running east to west and 77 running north to south, which Jones said made it easy for people outside of the city to come in and utilize resources meant for residents.

“I know it’s been a long time since I’ve started this profession, but when I first began this profession, I knew of two homeless people in town,” said Sgt. Webb. “And now, I mean, they’re all over the place.”

Sgt. Webb said that addiction and a bad economy go hand-in-hand.

“I’m pretty certain that the addiction aspect of what we’re dealing with has a lot to do with the economy,” he said. “You know, when you’re down on yourself you look for ways to make yourself feel better. I’m far from a doctor, but I’m sure a lot of people who are out here addicted to drugs had some kind of traumatic experience or they’re trying to fix something.”

A few months after the program closed, a Facebook group started, called “Charleston Has Had Enough!”, where members post photos of other people using drugs, stealing packages, panhandling, etc. Now, almost one of every 10 Charleston residents is a member.

None of the ten administrators or moderators returned requests for an interview, but in a Sept. 16 post, one of the founders wrote: “Word is going around that this group is all about shaming junkies. Anyone who believes that is an idiot. No. This is a group about shaming the so-called leadership that got us in the mess, namely the Kanawha County Health Dept. who convinced the city that free needles were a great idea.”

Danny Jones is a member.

“It was a really bad situation for our city. Needles were everywhere. Property crimes went through the roof. And now that it’s over, our property crimes have gone way down,” Jones said.

That’s a slightly misleading assertion. Larceny — meaning theft of personal property — has actually fallen considerably from 2014-2017, according to data obtained by West Virginia Public Broadcasting from the Charleston Police Department.

Burglary/breaking and entering spiked in 2016 (the first full year the program was in operation) but then fell to pre-program levels the second full year the program was in operation.

Breaking and entering into a car has risen continuously since 2014. And there was a massive spike in auto crimes in 2016 and no decline during the program’s second year of operation. But data like this does not prove why some crime went up after the harm reduction program opened and some went down. And speculations only seem to divide community.

In an off-the-record conversation, a member of the Charleston Fire Department said the closure of the Charleston program had set the city back 10 years in terms of acceptance of harm reduction. How to move forward is a subject incoming mayor Amy Goodwin addressed in the October debate televised by WCHS.

“Leaders lead,” she said. “Leaders don’t take the blame or cast the blame on someone else. They look at what they’ve done wrong and they say, ‘let’s improve it.’ They look at something that may be a problem in the city and they work with everyone; they bring everyone to the table. They don’t villainize; they don’t marginalize folks.”

At this point, bringing everyone to the table is going to take a lot of work, but it’s not impossible.

“I would be interested in being on some kind of board where they hold discussions about trying to find answers to these questions,” Sgt. Matt Webb said. He said it’s really challenging working with a population struggling with addiction.

“It’s frustrating,” he said. “If we go to somebody’s house and they’re having a heart attack, we send them to a doctor and the doctor can hopefully fix their heart. They give them a heart cath, they give them open heart surgery, they’ll do bypass – whatever. When it comes to somebody who is addicted to opioids – a lot of times, I know it’s not true, but they give off the impression that they don’t want help but it’s because the addiction is so great they feel like they don’t want help.”

And if someone does want help, he said, it doesn’t get much easier.

“Are there beds available in rehab places? How are they going to pay for it? Those are sometimes hard answers to get.”

But whether a board is created to discuss these issues like Webb mentioned — or even if enough people are willing to sit down and really listen to one another to address the still present public health risk of needle borne diseases — remains to be seen.

This series was originally published by West Virginia Public Broadcasting. Read them individually: Part 1, Part 2, Part 3, Part 4 and Part 5

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