The Code of Virginia, Section 32.1-45.4, authorizes the State Health Commissioner to establish and operate local or regional comprehensive harm reduction (CHR) programs during a public health emergency. The purpose of this law is to interrupt transmission of Human Immunodeficiency Virus (HIV), hepatitis B virus, and hepatitis C virus by providing services such as testing, referral to substance use disorder treatment, and the provision of sterile and disposal of used hypodermic syringes and needles. The Virginia Department of Health (VDH) has provided health education and mobilization efforts to facilitate the development of CHR sites. VDH has also provided trainings to potential service providers and participated in community opioid taskforce and advisory boards to promote this initiative. VDH created protocols and standards for CHR sites to operate safely, with maximum public protections. VDH’s CHR strategy focuses on the reduction of both disease and overdose deaths and expedient entry into substance use disorder treatment programs.

From July 1, 2017 to June 30, 2018, the VDH Office of Epidemiology’s Division of Disease Prevention hired a Drug User Health Coordinator and participated in or hosted 46 community meetings and trainings. As of August 8, 2018, VDH has authorized the Lenowisco Health District to operate a CHR program in Wise County, and Health Brigade, a free clinic, to operate a CHR program in Richmond. VDH expects to authorize additional sites prior to June 30, 2019.

Barriers encountered include lack of support from some law enforcement entities, a three-year sunset provision in the law, developing suitable rural programs, and the stigma associated with programs that include syringe exchange services. To address these barriers, this report proposes recommendations to facilitate and improve CHR programs and outcomes.