You’ve Got Questions? We’ve Got Answers!
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From Cucumbers To Kindles
Q: Where do I get cucumber extract?
A: You can buy it from BulkSupplements.com (who, despite their name, start at 100g packs)
Alternatively: you want it as a topical ointment (for skin health) rather than as a dietary supplement (for bone and joint health), you can extract it yourself! No, it’s not “just juice cucumbers”, but it’s also not too tricky.
Click Here For A Quick How-To Guide!
Q: Tips for reading more and managing time for it?
A: We talked about this a little bit in yesterday’s edition, so you may have seen that, but aside from that:
- If you don’t already have one, consider getting a Kindle or similar e-reader. They’re very convenient, and also very light and ergonomic—no more wrist strain as can occur with physical books. No more eye-strain, either!
- Consider making reading a specific part of your daily routine. A chapter before bed can be a nice wind-down, for instance! What’s important is it’s a part of your day that’ll always, or at least almost always, allow you to do a little reading.
- If you drive, walk, run, or similar each day, a lot of people find that’s a great time to listen to an audiobook. Please be safe, though!
- If your lifestyle permits such, a “reading retreat” can be a wonderful vacation! Even if you only “retreat” to your bedroom, the point is that it’s a weekend (or more!) that you block off from all other commitments, and curl up with the book(s) of your choice.
Q: Any study tips as we approach exam season? A lot of the productivity stuff is based on working life, but I can’t be the only student!
A: We’ve got you covered:
- Be passionate about your subject! We know of no greater study tip than that.
- Find a willing person and lecture them on your subject. When one teaches, two learn!
- Your mileage may vary depending on your subject, but, find a way of studying that’s fun to you!
- If you can get past papers, get as many as you can, and use those as your “last minute” studying in the week before your exam(s). This will prime you for answering exam-style questions (and leverage state-dependent memory). As a bonus, it’ll also help ease any anxiety, because by the time of your exam it’ll be “same old, same old”!
Q: Energy drinks for biohacking, yea or nay?
A: This is definitely one of those “the dose makes the poison” things!
- Caffeine, in and of itself, can be healthy in moderation for most people.
- Taurine has assorted benefits at safe dosages:
- Other ingredients often have health benefits too.
But… The generally agreed safe dose of taurine is around 3g/day for most people; a standard Red Bull contains 1g.
That math would be simple, but… if you eat meat (including poultry or fish), that can also contain 10–950mg per 100g. For example, tuna is at the high end of that scale, with a standard 12oz (340g) tin already containing up to 3.23g of taurine!
And sweetened carbonated beverages in general have so many health issues that it’d take us a full article to cover them.
Short version? Enjoy in moderation if you must, but there are definitely better ways of getting the benefits they may offer.
Q: Best morning routine?
A: The best morning routine is whatever makes you feel most ready to take on your day!
This one’s going to vary a lot—one person’s morning run could be another person’s morning coffee and newspaper, for example.
In a nutshell, though, ask yourself these questions:
- How long does it take me to fully wake up in the morning, and what helps or hinders that?
- When I get out of bed, what do I really need before I can take on my day?
- If I could have the perfect morning, what would it look like?
- What can evening me do, to look after morning me’s best interests? (Semi-prepare breakfast ready? Lay out clothes ready? Running shoes? To-Do list?)
Q: I’m curious how much of these things you actually use yourselves, and are there any disagreements in the team? In a lot of places things can get pretty heated when it’s paleo vs vegan / health benefits of tea/coffee vs caffeine-abstainers / you need this much sleep vs rise and grinders, etc?
A: We are indeed genuinely enthusiastic about health and productivity, and that definitely includes our own! We may or may not all do everything, but between us, we probably have it all covered. As for disagreements, we’ve not done a survey, but if you take an evidence-based approach, any conflict will tend to be minimized. Plus, sometimes you can have the best of both!
- You could have a vegan paleo diet (you’d better love coconut if you do, though!
- There is decaffeinated coffee and tea (your taste may vary)
- You can get plenty of sleep and rise early (so long as an “early to bed, early to rise” schedule suits you!)
Interesting note: humans are social creatures on an evolutionary level. Evolution has resulted in half of us being “night owls” and the other half “morning larks”, the better to keep each other safe while sleeping. Alas, modern life doesn’t always allow us to have the sleep schedule that’d suit each of us best individually!
Have a question you’d like answered? Reply to this email, or use the feedback widget at the bottom! We always love to hear from you
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Zuranolone: What to know about the pill for postpartum depression
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In the year after giving birth, about one in eight people who give birth in the U.S. experience the debilitating symptoms of postpartum depression (PPD), including lack of energy and feeling sad, anxious, hopeless, and overwhelmed.
Postpartum depression is a serious, potentially life-threatening condition that can affect a person’s bond with their baby. Although it’s frequently confused with the so-called “baby blues,” it’s not the same.
The baby blues include similar, temporary symptoms that affect up to 80 percent of people who have recently given birth and usually go away within the first few weeks. PPD usually begins within the first month after giving birth and can last for months and interfere with a person’s daily life if left untreated. Thankfully, PPD is treatable and there is help available.
On August 4, the FDA approved zuranolone, branded as Zurzuvae, the first-ever oral medication to treat PPD. Until now, besides other common antidepressants, the only medication available to treat PPD specifically was the IV injection brexanolone, which is difficult to access and expensive and can only be administered in a hospital or health care setting.
Read on to find out more about zuranolone: what it is, how it works, how much it costs, and more.
What is zuranolone?
Zurzuvae is the brand name for zuranolone, an oral medication to treat postpartum depression. Developed by Sage Therapeutics in partnership with Biogen, it’s now available in the U.S. Zurzuvae is typically prescribed as two 25 mg capsules a day for 14 days. In clinical trials, the medication showed to be fast-acting, improving PPD symptoms in just three days.
How does zuranolone work?
Zuranolone is a neuroactive steroid, a type of medication that helps the neurotransmitter GABA’s receptors, which affect how the body reacts to anxiety, stress, and fear, function better.
“Zuranolone can be thought of as a synthetic version of [the neuroactive steroid] allopregnanolone,” says Dr. Katrina Furey, a reproductive psychiatrist, clinical instructor at Yale University, and co-host of the Analyze Scripts podcast. “Women with PPD have lower levels of allopregnenolone compared to women without PPD.”
How is it different from other antidepressants?
“What differentiates zuranolone from other previously available oral antidepressants is that it has a much more rapid response and a shorter course of treatment,” says Dr. Asima Ahmad, an OB-GYN, reproductive endocrinologist, and founder of Carrot Fertility.
“It can take effect as early as on day three of treatment, versus other oral antidepressants that can take up to six to 12 weeks to take full effect.”
What are Zurzuvae’s side effects?
According to the FDA, the most common side effects of Zurzuvae include dizziness, drowsiness, diarrhea, fatigue, the common cold, and urinary tract infection. Similar to other antidepressants, the medication may increase the risk of suicidal thoughts and actions in people 24 and younger. However, NPR noted that this type of labeling is required for all antidepressants, and researchers didn’t see any reports of suicidal thoughts in their trials.
“Drug trials also noted that the side effects for zuranolone were not as severe,” says Ahmad. “[There was] no sudden loss of consciousness as seen with brexanolone or weight gain and sexual dysfunction, which can be seen with other oral antidepressants.”
She adds: “Given the lower incidence of side effects and more rapid-acting onset, zuranolone could be a viable option for many,” including those looking for a treatment that offers faster symptom relief.
Can someone breastfeed while taking zuranolone?
It’s complicated. In clinical trials, participants were asked to stop breastfeeding (which, according to Furey, is common in early clinical trials).
A small study of people who were nursing while taking zuranolone found that 0.3 percent of the medication dose was passed on to breast milk, which, Furey says, is a pretty low amount of exposure for the baby. Ahmad says that “though some data suggests that the risk of harm to the baby may be low, there is still overall limited data.”
Overall, people should talk to their health care provider about the risks and benefits of breastfeeding while on the medication.
“A lot of factors will need to be weighed, such as overall health of the infant, age of the infant, etc., when making this decision,” Furey says.
How much does Zurzuvae cost?
Zurzuvae’s price before insurance coverage is $15,900 for the 14-day treatment. However, the Policy Center for Maternal Mental Health says insurance companies and Medicaid are expected to cover it because it’s the only drug of its kind.
Less than 1 percent of U.S. insurers have issued coverage guidelines so far, so it’s still unknown how much it will cost patients after insurance. Some insurers require patients to try another antidepressant first (like the more common SSRIs) before covering Zurzuvae. For uninsured and underinsured people, Sage Therapeutics said it will offer copay assistance.
The hefty price tag and potential issues with coverage may widen existing health disparities, says Ahmad. “We need to ensure that we are seeking out solutions to enable wide-scale access to all PPD treatments so that people have access to whatever treatment may work best for them.”
If you or anyone you know is considering suicide or self-harm or is anxious, depressed, upset, or needs to talk, call the Suicide & Crisis Lifeline at 988 or text the Crisis Text Line at 741-741. For international resources, here is a good place to begin.
For more information, talk to your health care provider.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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Is TikTok right? Are there health benefits to eating sea moss?
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Sea moss is the latest “superfood” wellness influencers are swearing by. They claim sea moss products – usually in gel form – have multiple health benefits. These include supporting brain and immune function, or protecting against viruses and other microbes.
But do these health claims stack up? Let’s take a look.
Plataresca/Shutterstock What is sea moss?
Sea moss is produced using a kind of seaweed – particularly red algae – that grow in various locations all around the world. Three main species are used in sea moss products:
- Chondrus crispus (known as Irish moss or carrageenan moss)
- Eucheuma cottonii (sea moss or seabird’s nest)
- Gracilaria (Irish moss or ogonori).
Some products also contain the brown algae Fucus vesiculosus (commonly known as bladderwrack, black tang, rockweed, sea grapes, bladder fucus, sea oak, cut weed, dyers fucus, red fucus or rock wrack).
Most sea moss products are sold as a gel that can be added to recipes, used in smoothies, frozen into ice cubes or eaten on its own. The products also come in capsule form or can be purchased “raw” and used to make your own gels at home.
Several kinds of red algae are used in commercially-available sea moss products. Nancy Ann Bowe/Shutterstock What’s the evidence?
Sea moss products claim a host of potential health benefits, from supporting immunity, to promoting skin health and enhancing mood and focus, among many others.
But is there any evidence supporting these claims?
Recent studies have reviewed the biological properties of the main sea moss species (Chondrus crispus, Eucheuma cottonii, Gracilaria and Fucus vesiculosus).
They suggest these species may have anti-inflammatory, antioxidant, anticancer, antidiabetic and probiotic properties.
However, the vast majority of research relating to Chondrus crispus, Gracilaria and Fucus vesiculosus – and all of the research on Eucheuma cottonii – comes from studies done in test tubes or using cell and animal models. We should not assume the health effects seen would be the same in humans.
In cell and animal studies, researchers usually administer algae in a laboratory and use specific extracts rich in bioactive compounds rather than commercially available sea moss products.
They also use very different – often relatively larger – amounts compared to what someone would typically consume when they eat sea moss products.
This means the existing studies can’t tell us about the human body’s processes when eating and digesting sea moss.
Sea moss may have similar effects in humans. But so far there is very little evidence people who consume sea moss will experience any of the claimed health benefits.
Nutritional value
Eating sea moss does not replace the need for a balanced diet, including a variety of fruits and vegetables.
Chondrus crispus, Eucheuma cottonii and Gracilaria, like many seaweeds, are rich sources of nutrients such as fatty acids, amino acids, vitamin C and minerals. These nutrients are also likely to be present in sea moss, although some may be lost during the preparation of the product (for example, soaking may reduce vitamin C content), and those that remain could be present in relatively low quantities.
There are claims that sea moss may be harmful for people with thyroid problems. This relates to the relationship between thyroid function and iodine. The algae used to make sea moss are notable sources of iodine and excess iodine intake can contribute to thyroid problems, particularly for people with pre-existing conditions. That is why these products often carry disclaimers related to iodine sensitivity or thyroid health.
Is it worth it?
So you may be wondering if it’s worth trying sea moss. Here are a few things to consider before you decide whether to start scooping sea moss into your smoothies.
A 375mL jar costs around $A25–$30 and lasts about seven to ten days, if you follow the recommended serving suggestion of two tablespoons per day. This makes it a relatively expensive source of nutrients.
Sea moss is commonly sold as a gel that can be eaten on a kitchen bench. April Sims/Shutterstock Sea moss is often hyped for containing 92 different minerals. While there may be 92 minerals present, the amount of minerals in the algae will vary depending on growing location and conditions.
The efficiency with which minerals from algae can be absorbed and used by the body also varies for different minerals. For example, sodium is absorbed well, while only about 50% of iodine is absorbed.
But sea moss has also been shown to contain lead, mercury and other heavy metals – as well as radioactive elements (such as radon) that can be harmful to humans. Seaweeds are known for their ability to accumulate minerals from their environment, regardless of whether these are beneficial or harmful for human nutrition. Remember, more doesn’t always mean better.
What else am I eating?
While you won’t get a full nutritional breakdown on the jar, it is always wise to check what other ingredients you may be eating. Sea moss products can contain a range of other ingredients, such as lime, monk fruit powder, spirulina and ginger, among many others.
These ingredients differ between brands and products, so be aware of your needs and always check.
Despite their health claims, most sea moss products also carry disclaimers indicating that the products are not intended to diagnose, treat, cure or prevent any disease.
If you have concerns about your health, always speak to a health professional for accurate and personalised medical advice.
Margaret Murray, Senior Lecturer, Nutrition, Swinburne University of Technology
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Protein: How Much Do We Need, Really?
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Mythbusting Protein!
Yesterday, we asked you for your policy on protein consumption. The distribution of responses was as follows:
- A marginal majority (about 55%) voted for “Protein is very important, but we can eat too much of it”
- A large minority (about 35%) voted for “We need lots of protein; the more, the better!”
- A handful (about 4%) voted for “We should go as light on protein as possible”
- A handful (6%) voted for “If we don’t eat protein, our body will create it from other foods”
So, what does the science say?
If we don’t eat protein, our body will create it from other foods: True or False?
Contingently True on an absurd technicality, but for all practical purposes False.
Our body requires 20 amino acids (the building blocks of protein), 9 of which it can’t synthesize and absolutely must get from food. Normally, we get those amino acids from protein in our diet, and we can also supplement them by buying amino acid supplements.
Specifically, we require (per kg of bodyweight) a daily average of:
- Histidine: 10 mg
- Isoleucine: 20 mg
- Leucine: 39 mg
- Lysine: 30 mg
- Methionine: 10.4 mg
- Phenylalanine*: 25 mg
- Threonine: 15 mg
- Tryptophan: 4 mg
- Valine: 26 mg
*combined with the non-essential amino acid tyrosine
Source: Protein and Amino Acid Requirements In Human Nutrition: WHO Technical Report
However, to get the requisite amino acid amounts, without consuming actual protein, would require gargantuan amounts of supplementation (bearing in mind bioavailability will never be 100%, so you’ll always need to take more than it seems), using supplements that will have been made by breaking down proteins anyway.
So unless you live in a laboratory and have access to endless amounts of all of the required amino acids (you can’t miss even one; you will die), and are willing to do that for the sake of proving a point, then you do really need to eat protein.
Your body cannot, for example, simply break down sugar and use it to make the protein you need.
On another technical note… Do bear in mind that many foods that we don’t necessarily think of as being sources of protein, are sources of protein.
Grains and grain products, for example, all contain protein; we just don’t think of them as that because their macronutritional profile is heavily weighted towards carbohydrates.
For that matter, even celery contains protein. How much, you may ask? Almost none! But if something has DNA, it has protein. Which means all plants and animals (at least in their unrefined forms).
So again, to even try to live without protein would very much require living in a laboratory.
We can eat too much protein: True or False?
True. First on an easy technicality; anything in excess is toxic. Even water, or oxygen. But also, in practical terms, there is such a thing as too much protein. The bar is quite high, though:
❝Based on short-term nitrogen balance studies, the Recommended Dietary Allowance of protein for a healthy adult with minimal physical activity is currently 0.8 g protein per kg bodyweight per day❞
❝To meet the functional needs such as promoting skeletal-muscle protein accretion and physical strength, dietary intake of 1.0, 1.3, and 1.6 g protein per kg bodyweight per day is recommended for individuals with minimal, moderate, and intense physical activity, respectively❞
❝Long-term consumption of protein at 2 g per kg bodyweight per day is safe for healthy adults, and the tolerable upper limit is 3.5 g per kg bodyweight per day for well-adapted subjects❞
❝Chronic high protein intake (>2 g per kg bodyweight per day for adults) may result in digestive, renal, and vascular abnormalities and should be avoided❞
Source: Dietary protein intake and human health
To put this into perspective, if you weigh about 160lbs (about 72kg), this would mean eating more than 144g protein per day, which grabbing a calculator means about 560g of lean beef, or 20oz, or 1¼lb.
If you’re eating quarter-pounder burgers though, that’s not usually so lean, so you’d need to eat more than nine quarter-pounder burgers per day to get too much protein.
High protein intake damages the kidneys: True or False?
True if you have kidney damage already; False if you are healthy. See for example:
- Effects of dietary protein restriction on the progression of advanced renal disease in the modification of diet in renal disease study
- A high protein diet has no harmful effects: a one-year crossover study in healthy male athletes
High protein intake increases cancer risk: True or False?
True or False depending on the source of the protein, so functionally false:
- Eating protein from red meat sources has been associated with higher risk for many cancers
- Eating protein from other sources has been associated with lower risk for many cancers
Source: Red Meat Consumption and Mortality Results From 2 Prospective Cohort Studies
High protein intake increase risk of heart disease: True or False?
True or False depending on the source of the protein, so, functionally false:
- Eating protein from red meat sources has been associated with higher risk of heart disease
- Eating protein from other sources has been associated with lower risk of heart disease
Source: Major Dietary Protein Sources and Risk of Coronary Heart Disease in Women
In summary…
Getting a good amount of good quality protein is important to health.
One can get too much, but one would have to go to extremes to do so.
The source of protein matters:
- Red meat is associated with many health risks, but that’s not necessarily the protein’s fault.
- Getting plenty of protein from (ideally: unprocessed) sources such as poultry, fish, and/or plants, is critical to good health.
- Consuming “whole proteins” (that contain all 9 amino acids that we can’t synthesize) are best.
Learn more: Complete proteins vs. incomplete proteins (explanation and examples)
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Why Psyllium Is Healthy Through-And-Through
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Psyllium is the powder of the husk of the seed of the plant Plantago ovata.
It can be taken as a supplement, and/or used in cooking.
What’s special about it?
It is fibrous, and the fiber is largely soluble fiber. It’s a “bulk-forming laxative”, which means that (dosed correctly) it is good against both constipation (because it’s a laxative) and diarrhea (because it’s bulk-forming).
See also, because this is Research Review Monday and we provide papers for everything:
In other words, it will tend things towards being a 3 or 4 on the Bristol Stool Scale ← this is not pretty, but it is informative.
Before the bowels
Because of how it increases the viscosity of substances it finds itself in, psyllium slows stomach-emptying, and thus improves feelings of satiety.
Here’s a study in which taking psyllium before breakfast and lunch resulted in increased satiety between meals, and reduction in food-related cravings:
Satiety effects of psyllium in healthy volunteers
Prebiotic benefits
We can’t digest psyllium, but our gut bacteria can—somewhat! Because they can only digest some of the psyllium fibers, that means the rest will have the stool-softening effect, while we also get the usual in-gut benefits from prebiotic fiber first too:
The Effect of Psyllium Husk on Intestinal Microbiota in Constipated Patients and Healthy Controls
Cholesterol-binding
Psyllium can bind to cholesterol during the digestive process. Why only “can”? Well, if you don’t consume cholesterol (for example, if you are vegan), then there won’t be cholesterol in the digestive tract to bind to (yes, we do need some cholesterol to live, but like most animals, we can synthesize it ourselves).
What this cholesterol-binding action means is that the dietary cholesterol thus bound cannot enter the bloodstream, and is simply excreted instead:
Heart health beyond cholesterol
Psyllium supplementation can also help lower high blood pressure but does not significantly lower already-healthy blood pressure, so it can be particularly good for keeping things in safe ranges:
❝Given the overarching benefits and lack of reported side effects, particularly for hypertensive patients, health care providers and clinicians should consider the use of psyllium supplementation for the treatment or abatement of hypertension, or hypertensive symptoms.❞
Read in full: The effect of psyllium supplementation on blood pressure: a systematic review and meta-analysis of randomized controlled trials ← you can see the concrete numbers here
Is it safe?
Psyllium is first and foremost a foodstuff, and is considered very safe unless you have an allergy (which is rare, but possible).
However, it is still recommended to start at a low dose and work up, because anything that changes your gut microbiota, even if it changes it for the better, will be easiest if done slowly (or else, you will hear about it from your gut).
Want to try some?
We don’t sell it, but here for your convenience is an example product on Amazon
Enjoy!
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How To Unchoke Yourself If You Are Dying Alone
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The first things that most people think of, won’t work. This firefighter advises on how to actually do it:
Steps to take
Zero’th step: he doesn’t mention this, but try coughing first. You might think coughing will be a natural reaction anyway, but that tends only to happen automatically with small partial obstructions, not a complete blockage. Either way, try to cough forcefully to see if it dislodges whatever you’re choking on. If that doesn’t work…
Firstly: don’t rely on calling for help if you’re alone and cannot speak; you’re unlikely to be able to communicate and you will just waste time (when you don’t have time to waste). Even if you call emergency services and they trace your location, chances are that, at most, a cop car will show up some hours later to see what it was about. They will not dispatch an ambulance on the strength of “someone called and said nothing”.
Secondly, it is probable that will not be able to perform an abdominal thrust (also called Heimlich maneuvre in the US) on yourself the way you could on another person, and hitting your chest with your hand will produce insufficient force even if you’re quite strong. Nor are you likely to be able to slap yourself on the back to way you might another person.
Instead, he advises:
- Find a sturdy object: use a chair, table, countertop, or another firm surface that has an edge.
- Use gravity to perform self-Heimlich: position yourself with the edge of the object just below your sternum (he says ribcage, but the visuals show he clearly means the bottom of the sternum, where the diaphragm is, not the lower ribs). Fall onto the object forcefully to create pressure and dislodge the obstruction. This will not be fun.
- If it doesn’t work indoors: move to a visible outdoor location like your yard or a neighbor’s lawn. Falling visibly on the ground will likely alert someone to call for help.
While doing the above, remain as calm as possible, as this will not only increase the length of time you have before passing out, but will also help avoid your throat muscles tightening even more, worsening the choking.
After doing the above, seek medical attention now that you can communicate; you’ve probably broken some ribs and you might have organ damage.
For more on all this plus visual demonstrations, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
How To Survive A Heart Attack When You’re Alone ← very different advice for this scenario!
Take care!
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Syringe Exchange Fears Hobble Fight Against West Virginia HIV Outbreak
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CHARLESTON, http://w.va/. — More than three years have passed since federal health officials arrived in central Appalachia to assess an alarming outbreak of HIV spread mostly between people who inject opioids or methamphetamine.
Infectious disease experts from the Centers for Disease Control and Prevention made a list of recommendations following their visit, including one to launch syringe service programs to stop the spread at its source. But those who’ve spent years striving to protect people who use drugs from overdose and illness say the situation likely hasn’t improved, in part because of politicians who contend that such programs encourage illegal drug use.
Joe Solomon is a Charleston City Council member and co-director of SOAR WV, a group that works to address the health needs of people who use drugs. He’s proud of how his close-knit community has risen to this challenge but frustrated with the restraints on its efforts.
“You see a city and a county willing to get to work at a scale that’s bigger than ever before,” Solomon said, “but we still have one hand tied behind our back.”
The hand he references is easier access to clean syringes.
In April 2021, the CDC came to Charleston — the seat of Kanawha County and the state capital, tucked into the confluence of the Kanawha and Elk rivers — to investigate dozens of newly detected HIV infections. The CDC’s HIV intervention chief called it “the most concerning HIV outbreak in the United States” and warned that the number of reported diagnoses could be just “the tip of the iceberg.”
Now, despite attention and resources directed toward the outbreak, researchers and health workers say HIV continues to spread. In large part, they say, the outbreak lingers because of restrictions state and local policymakers have placed on syringe exchange efforts.
Research indicates that syringe service programs are associated with an estimated 50% reduction in HIV and hepatitis C, and the CDC issued recommendations to steer a response to the outbreak that emphasized the need for improved access to those services.
That advice has thus far gone unheeded by local officials.
In late 2015, the Kanawha-Charleston Health Department launched a syringe service program but shuttered it in 2018 under pressure, with then-Mayor Danny Jones calling it a “mini-mall for junkies and drug dealers.”
SOAR stepped in, hosting health fairs at which it distributed naloxone, an opioid overdose reversal drug; offered treatment and referrals; provided HIV testing; and exchanged clean syringes for used ones.
But in April 2021, the state legislature passed a bill limiting the number of syringes people could exchange and made it mandatory to present a West Virginia ID. The Charleston City Council subsequently added guidelines of its own, including requiring individual labeling of syringes.
As a result of these restrictions, SOAR ceased exchanging syringes. West Virginia Health Right now operates an exchange program in the city under the restrictions.
Robin Pollini is a West Virginia University epidemiologist who conducts community-based research on injection drug use. “Anyone I’ve talked to who’s used that program only used it once,” she said. “And the numbers they report to the state bear that out.”
A syringe exchange run by the health department in nearby Cabell County — home to Huntington, the state’s largest city after Charleston — isn’t so constrained. As Solomon notes, that program exchanges more than 200 syringes for every one exchanged in Kanawha.
A common complaint about syringe programs is that they result in discarded syringes in public spaces. Jan Rader, director of Huntington’s Mayor’s Office of Public Health and Drug Control Policy, is regularly out on the streets and said she seldom encounters discarded syringes, pointing out that it’s necessary to exchange a used syringe for a new one.
In August 2023, the Charleston City Council voted down a proposal from the Women’s Health Center of West Virginia to operate a syringe exchange in the city’s West Side community, with opponents expressing fears of an increase in drug use and crime.
Pollini said it’s difficult to estimate the number of people in West Virginia with HIV because there’s no coordinated strategy for testing; all efforts are localized.
“You would think that in a state that had the worst HIV outbreak in the country,” she said, “by this time we would have a statewide testing strategy.”
In addition to the testing SOAR conducted in 2021 at its health fairs, there was extensive testing during the CDC’s investigation. Since then, the reported number of HIV cases in Kanawha County has dropped, Pollini said, but it’s difficult to know if that’s the result of getting the problem under control or the result of limited testing in high-risk groups.
“My inclination is the latter,” she said, “because never in history has there been an outbreak of injection-related HIV among people who use drugs that was solved without expanding syringe services programs.”
“If you go out and look for infections,” Pollini said, “you will find them.”
Solomon and Pollini praised the ongoing outreach efforts — through riverside encampments, in abandoned houses, down county roads — of the Ryan White HIV/AIDS Program to test those at highest risk: people known to be injecting drugs.
“It’s miracle-level work,” Solomon said.
But Christine Teague, Ryan White Program director at the Charleston Area Medical Center, acknowledged it hasn’t been enough. In addition to HIV, her concerns include the high incidence of hepatitis C and endocarditis, a life-threatening inflammation of the lining of the heart’s chambers and valves, and the cost of hospital resources needed to address them.
“We’ve presented that data to the legislature,” she said, “that it’s not just HIV, it’s all these other lengthy hospital admissions that, essentially, Medicaid is paying for. And nothing seems to penetrate.”
Frank Annie is a researcher at CAMC specializing in cardiovascular diseases, a member of the Charleston City Council, and a proponent of syringe service programs. Research he co-authored found 462 cases of endocarditis in southern West Virginia associated with injection drug use, at a cost to federal, state, and private insurers of more than $17 million, of which less than $4 million was recovered.
Teague is further concerned for West Virginia’s rural counties, most of which don’t have a syringe service program.
Tasha Withrow, a harm reduction advocate in bordering rural Putnam County, said her sense is that HIV numbers aren’t alarmingly high there but said that, with little testing and heightened stigma in a rural community, it’s difficult to know.
In a January 2022 follow-up report, the CDC recommended increasing access to harm reduction services such as syringe service programs through expansion of mobile services, street outreach, and telehealth, using “patient-trusted” individuals, to improve the delivery of essential services to people who use drugs.
Teague would like every rural county to have a mobile unit, like the one operated by her organization, offering harm reduction supplies, medication, behavioral health care, counseling, referrals, and more. That’s an expensive undertaking. She suggested opioid settlement money through the West Virginia First Foundation could pay for it.
Pollini said she hopes state and local officials allow the experts to do their jobs.
“I would like to see them allow us to follow the science and operate these programs the way they’re supposed to be run, and in a broader geography,” she said. “Which means that it shouldn’t be a political decision; it should be a public health decision.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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This article first appeared on KFF Health News and is republished here under a Creative Commons license.
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