ASTORIA, Ore. – Syringe exchange programs are opening up access to health care for some Oregonians.

Exchanges provide clean needles to prevent the spread of disease, and a Clatsop County program that started in October 2017 has made a big impact.

County Public Health Director Michael McNickle says the program has provided 250,000 needles since it began.

Just as important, he says, is distribution of naloxone, a drug used to fight overdoses.

The county estimates naloxone handouts have saved at least 36 lives.

McNickle says the program plays another important role.

"We're the gateway for the users who have no other alternative,” he explains. “And after the trust is built, they know that we're going to be there every week, and we're still there trying to help them recover and get into recovery.

“So, at some point if they take advantage of that, then we'll help them get to that point in their life where they're ready to take on that next challenge."

The Public Health Department facilitates the program in collaboration with the addiction support group Jordan's Hope for Recovery, with funding from the Columbia Pacific Coordinated Care Organization.

A recent National Safety Council study confirms the U.S. still is deep within the opioid crisis.

Americans are more likely to die from accidental overdoses than car crashes. On average, 130 people die of a drug overdose every day, according to the Centers for Disease Control and Prevention.

Tanya Phillips is health promotion manager for Jackson County Health and Human Services, which runs a syringe exchange program with an estimated 300 to 400 visits a month.

Phillips says exchanges are a proven way to stop the spread of diseases such as Hepatitis C and HIV. She says Jackson County's program also increases folks' access to care on the spot.

"We're able to provide health education and resources and if anyone does, after their test, show that they are positive for HIV or Hep C, we're able to make referrals for them to get further testing, but also treatment as well, which is really important," Phillips states.

Phillips points out that the stigma surrounding opioid addiction can prevent treatment.

"It's a chronic health condition, and so how can we change the care that we offer and the mindset that we have around that, to kind of support individuals who do suffer from this addiction in getting help?" she states.


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The Iowa House has passed a measure to establish a licensing board for midwives. Iowa is one of 15 states currently without such a program, often leaving rural residents without access to critical medical care when it is time to deliver their babies.

House File 265 would create a board to certify midwives have completed 2,000 hours of training before they are licensed, and are held to the same medical standards as nurses who deliver babies in hospital settings.

Rep. Monica Kurth, D-Davenport, the bill's co-sponsor, said Iowa ranks 49th in the nation for its doctor-to-patient ratio for OBGYN care.

"So, we are somewhat considered a OBGYN 'desert,' and it leaves a lot of people without close access to a major hospital for childbirth," Kurth pointed out.

The measure would allow exemptions for midwives practicing in 'culturally traditional' populations, such as Native American and Mennonite communities. Like other states, Iowa faces a critical nursing shortage. It is especially acute in maternal health care, which supporters say the bill will help address. It heads next to the Senate.

Kurth noted the bill also requires the registered midwife to come equipped to any birth with what is called a "transfer plan," in case something goes wrong during the delivery. Right now, she added, there is too much left to chance, especially in rural communities where midwives are in high demand and often develop a clientele through word-of-mouth.

"Some people are practicing without this certification," Kurth stressed. "If someone is looking for a midwife, they may hear about this person or that person, and might not realize that they don't have extensive training. And so, that's where some of the alarming situations can come in."

Medical providers have opposed similar legislation in the past, saying it offers rural Iowans a false sense of security, and they have expressed concerns over midwives' abilities to handle complicated births.

March is Sleep Awareness Month and health experts say Americans are not getting enough of it.

United Health Foundation data found more than 32% of those surveyed said they got fewer than seven hours of sleep, although the rate was slightly better in Oregon at about 28%.

Dr. Kimberly Hutchison, associate professor of neurology and sleep medicine at Oregon Health and Science University, said our culture devalues sleep, with the perception people who get the sleep they need are lazy or not working hard enough.

"Because we live in this accomplishment-driven culture, it results in people sacrificing sleep in order to get other things done," Hutchison explained.

Hutchison pointed out sleep is as important for our health as the food we eat or exercising. The recommended amount of sleep for adults is seven to nine hours in a 24-hour period. For teens and adolescents, it can be as much as 10 hours. For older adults, the number is closer to seven.

Dr. Ravi Johar, chief medical officer for UnitedHealthcare, said one of the best ways to ensure you are getting enough sleep is to have a regular schedule.

"That's something that's really important, just having a routine, whether it's brushing your teeth, changing into pajamas, doing some kind of activity before you go to sleep," Johar outlined. "Yoga, listening to music, reading, things of that sort, setting your alarm for the same time every day."

Johar added people should see a health professional for medical issues such as insomnia or sleep apnea.

"Sometimes there may be underlying medical problems that are making it difficult for you to sleep," Johar noted. "The other thing that's really important that people don't realize is how much stress and behavioral-health issues can factor into their sleep."

It's been 13 years since more than 156,000 West Virginians gained health insurance coverage through the Affordable Care Act.

As sweeping and sometimes controversial as the ACA has been, its longer-term effects are still being felt today at the state level.

Gary Zuckett, executive director of the West Virginia Citizen Action Group, pointed to a new West Virginia law capping insulin copays at $35 per month. The law goes into effect January 1.

"I think we now have the best insulin copay cap legislation in the country that we just helped get passed in a very 'red' legislature," Zuckett noted. "Which does show you that health care is not partisan."

Federal data shows since the launch of the federal health insurance exchange, enrollment in health insurance plans has doubled from 8 million to more than 16 million nationwide.

According to the West Virginia Center on Budget and Policy, the Medicaid expansion included in the ACA allowed more than 200,000 West Virginians to gain access to health coverage.

Zuckett cautioned when the "continuous coverage" rules enacted during the pandemic expire April 1, the state will begin re-evaluating people's eligibility, which could signal a setback in progress.

"A lot of people won't qualify or won't fill out the paperwork, and they'll lose their health insurance in West Virginia," Zuckett explained. "That could be as many as 50 or 100,000 people. So, that's going to be a step backwards."

According to America's Health Rankings, around 6% of West Virginians were uninsured in 2021, far fewer than the nearly 16% of the state's population who lacked coverage prior to the Affordable Care Act.