Few WV families have not been affected by the disease of addiction.

A new report from the Center on Budget and Policy said treating and addressing drug addiction cost West Virginia an estimated $11.3 billion in one year.

For years, West Virginia has had the nation’s highest rate of opioid drug addictions and drug overdose deaths. Now the state is wrestling with another, not entirely unrelated health emergency: one of the nation’s highest spikes in HIV cases related to intravenous drug use.

The surge, clustered primarily around the capital of Charleston and the city of Huntington, is being attributed at least in part to the cancellation in 2018 of a needle exchange program that offered clean syringes to injection drug users not able to quit the habit altogether.

Needle exchange programs are included in the Centers for Disease Control and Prevention’s recommendations for controlling disease outbreaks among intravenous drug users. Such programs exist in dozens of states, but they are not without their critics, including in West Virginia, who say they don’t do enough to prevent or stop drug abuse.

The coronavirus has further complicated the problem. Local health officials have been in a bind partly because the resources required to fight the pandemic have made widespread testing for hepatitis, HIV, and other sexually transmitted diseases especially challenging, said Dr. Sherri Young, health officer of the Kanawha-Charleston Health Department.

“We couldn’t do big community events,” Young said. “We couldn’t do health fairs. We couldn’t connect the way we would have liked to have during the COVID response.”

As recently as 2014, only 12.5% of HIV cases in West Virginia were the result of intravenous drug use. By 2019, 64.2% were, according to state health department data. The increase was due primarily to clusters in Kanawha and Cabell counties.

Kanawha County, which includes Charleston and has 178,000 residents, had two intravenous drug-related HIV cases in 2018. The number grew to 15 in 2019 and at least 35 last year, said Shannon McBee, a state epidemiologist.

By comparison, New York City, with a population of more than 8 million, recorded 36 HIV cases tied to intravenous drug use in 2019, according to the CDC. Counties in other states with populations similar to Kanawha had an average of less than one HIV diagnosis among people who inject drugs, said Dr. Demetre Daskalakis, the CDC’s chief of HIV prevention.

In a recent presentation, Daskalakis called the outbreak in Kanawha County “the most concerning in the United States.” At a meeting of a Kanawha County HIV task force last month, he warned it could take years to address the surge.

“It is possible the current case count represents the tip of the iceberg,” Daskalakis said. “There are likely many more undiagnosed cases in the community. We are concerned that transmission is ongoing and that the number of people with HIV will continue to increase unless urgent action is taken.”

Health officials have said needle exchange programs have been shown to reduce the spread of communicable disease. But city leaders and first responders complained that such a program in Kanawha County led to an increase in needles being left in public places and abandoned buildings, and it was shut down.

The nonprofit organization Solutions Oriented Addiction Response, first founded to tackle the opioid epidemic, has stepped into the breach. In addition to providing addicts with clean needles in Charleston, the group shares information about HIV testing with residents, including the homeless, said SOAR co-founder.