In Oceana, the leaves were beginning to change, but the people weren't able or willing to.
In the meantime, Fred Cox and his team at the Wyoming County Health Department will be there.
On Friday afternoons, Cox, administrator of the health department, and other workers offer their services from the middle of a field next to a low-income housing complex, Oceana Apartments.
They just began offering those services in Oceana last month, but on a recent Friday, they welcomed back several familiar faces.
One man told the health workers there are no addiction recovery options in the local area, and people struggle with transportation.
He said in such a rural area, people are also afraid to be seen.
"There's no judgement here," said Teresa Hatfield, their part-time harm reduction coordinator.
The workers have set up a folding table outside of their van and provide new syringes, as well as condoms and HIV testing.
Using new needles to inject drugs decreases risk of spreading infectious disease, including Hepatitis C and HIV. West Virginia's hepatitis rates have skyrocketed along with its overdose rates.
Two years ago, Wyoming was one of the counties involved in an HIV outbreak in West Virginia that eventually spread to 57 people in 15 counties. Public health officials said, at the time, that it was spread mainly through male-to-male sex.
But the federal Centers for Disease Control Prevention also says that many counties in West Virginia are among the most susceptible to an HIV outbreak, largely due to injection drug use, in the country. And Cabell County is currently experiencing an HIV outbreak, primarily spread through sharing needles and including, so far, approximately 80 people.
"I'll be honest with you," Cox said.
The local outbreak woke them up, he said.
Several people arrived on foot. Hatfield explained that lack of transportation in the high-poverty area is why they developed a mobile program.
In a kindly voice, Cox teaches them to use naloxone, an opioid overdose reversal medication, as well as passes out the kits.
Oceana is the newest location for the Wyoming County Health Department's harm reduction program. It also operates in Allen Junction, near Mullens. They also plan a site for Pineville.
So, local residents are still feeling it out.
Hatfield said that in Allen Junction, they've developed relationships with repeat clients.
"They get a hug," she said. "We tell them we're happy to see them."
If those clients are ready, they'll point them toward recovery options as well.
"Our biggest goal is to try to get people into recovery," Cox says, "but in the meantime, we want to make sure we keep the associated issues at bay."
Cox says they have much-needed support from the police, the board of health, local mental health organization, local politicians, and the wider community.
He spearheaded the development of the program.
But, "This is not my baby," he said. "This is everybody's baby here."
Before they opened the mobile site, they door-knocked. They went to council meetings.
Cox said he told those concerned about needle litter in the community that their concerns were valid.
But not if they ran the program right, he said.
Research suggests that when syringe exchange closes, needle litter doesn't go away, and may even increase due to the lack of incentive to dispose of the needles properly.
Most people understood the need, Hatfield said.
DHHR recently announced that across the state, overdose deaths slightly declined in 2018, but increased in Wyoming County.
Robin Pollini, a substance abuse and infectious disease epidemiologist and associate professor at West Virginia University's School of Public Health, noted that harm reduction programs, which are supported by several decades of research, are fairly new in West Virginia, and that few programs operate in the southern part of the state.
"The absence of that program would be just – I'm just, I can't, I'm almost speechless, and I don't get that way very often," she said.
She said such programs involve a "steep learning curve" for health officials.
But Cox, and others at Wyoming County Health Department, recognized and accepted a community need, and genuinely care about meeting it, she said.
"They didn't have to start that program," she said. "It would have been easier for them not to start that program. But they did it because they know that people in their county need it.
"They also realize that they're serving people from the county in that program," she added. "Those people are their constituents and their patients too, and they need those services.
Still, starting the program took courage, she added.
Pollini sometimes travels from Morgantown just to volunteer.
"They really embody the heart of what it means to serve people who have substance use disorders and to meet them without judgement, and the fact that they have embraced that and really advocate for that, it gives me hope," she said. "It gives me hope about this state and they don't ask for credit, they just go about their work. And to me, that's a big deal."
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