If you’ve been paying attention, you know by now that Appalachia is in the middle of an opioid addiction crisis. You may have seen suffering with substance abuse disorders in your own neighborhood.

But John Law, spokesman for the Kanawha-Charleston Health Department, says what isn’t as visible could be just as dangerous: blood-borne diseases like hepatitis and HIV.

So Law’s department set out to implement a needle exchange program in Charleston. Drug users could bring in a maximum of 30 dirty needles and exchange them for 30 new, clean ones. Programs like this are often part of what’s referred to as “harm reduction programs.”

“We often think of the people who use needles and the people who use drugs are those unfortunate individuals huddle doorways and those sleeping on the streets,” Law said. “But it’s also people who work in restaurants and secretaries and people who work in all facets of life who came through the harm reduction program and realized that they needed clean needles to stave off another health problem besides their addiction.”

While needle exchange programs have been proven to lower the rates of blood-borne illnesses like HIV and hepatitis, they are also designed to help people who are addicted to drugs find treatment, and provide them with basic medical care. They can also generate data to help medical practitioners track the program’s effectiveness.

The original program started with just five people in December 2015. Eventually 6,000 individuals visited 24,000 times. The health department distributed 650,000 needles and collected about 425,000 needles. That leaves about 225,000 needles unaccounted for. Law says these missing needles were never turned in — so when dirty needles were found on the streets, it was a mystery just where they came from.

First responders like the city police chief said needles were found in public places and accused drug users of leaving exposed needles in their clothing during pat downs.

“There were excess needles there, everybody realizes that,” Law said. “We are certainly not denying that. We went out on several times with city officials and there were needles on the street but there are needles on the street all over the country not because of the needle exchange but because we have an opioid epidemic.”

As a result of the outcry over the excess needles, the police chief issued a list of recommendations to address the program’s flaws. But because some of the suggestions were difficult to implement, the city decided to suspend the program altogether in March. One of the problematic recommendations was to require participants to show photo ID, which Law says is impractical.

“Many of the people we deal with are homeless or don’t have photo ID,” he said.

The police chief also wanted the program to only distribute retractable needles, but Law is concerned that distributing retractable needles is not the best practice. Retractable needles are meant to be used one time, once the needle is retracted, it can’t be used again. That’s how it’s supposed to work, but Law says this often isn’t realistic for drug users who shoot up several times per day. Without ready access to multiple needles, they’re likely to use the same one more than once.

“The experts in the field will tell you that retractable needles are probably not a good idea because one it can cause tissue damage,” Law said. “People usually won’t retract the needle totally and they’re more inclined to share it and that’s what causes the spread of disease.”

Law said the health department has a responsibility to take best practices seriously but is continuing to evaluate the recommendations to see if the department can successfully implement them.

Despite the public outcry and the program’s suspension, Law said he still considers it a success.

“We measure success because the hepatitis rate in Kanawha County declined, it was a slight decline but it declined,” he said. “We had more than 100, probably closer to 150 people, enter recovery so that was very gratifying.”

Law said the program was a national model that was used other places like Huntington, West Virginia.

“I think if we failed we were probably not quick enough to respond to concerns that were expressed because it was a nationally reviewed program,” Law said. “We were following best practices you need to listen very closely and you have to do what is right for your community at the time.”

Law said the exchange program is important to public health and the department will continue to look into implementing the Charleston police chief’s recommendations. Meanwhile, in May, the West Virginia Department of Health and Human Resource’s Bureau for Public Health confirmed 72 cases of hepatitis A in Cabell, Kanawha, Lincoln, Putnam, Wayne and Wyoming counties. Of those cases, 64 have occurred in Kanawha and Putnam counties. Additionally, there are possible cases still under investigation, but not yet confirmed by the state laboratory.

“There is certainly a sense of urgency knowing the potential out there with HIV and hepatitis C, but there is a same sense of urgency to be responsive to the community and really do what the community needs and wants,” Law said.

Shortly after our interview with Law, the West Virginia DHHR released results of an investigation into the program. The DHHR listed six items in the report that were problematic including missed opportunities for linking users with treatment, messy data entry, and lack of an oversight committee missing committee. They also concluded that the Charleston-Kanawha Health Department’s Harm Reduction Syringe Services Program certification be suspended until some of their recommendations can be implemented.

The Charleston police chief did not return our requests for comment. Current Mayor Danny Jones would not grant us an interview but he’s spoken out frequently against the program.

This article was originally published by West Virginia Public Broadcasting.