By Mara O'Malley for Kent State News Lab.
Broadcast version by Nadia Ramlagan reporting for the Kent State-Ohio News Connection Collaboration.

Though it is now legal for Ohioans to use cannabis, the 2023 passage of Issue 2 does not prevent employers from drug testing job applicants and employees and instituting zero-tolerance policies. Employers in Ohio are still permitted to penalize workers who use, possess or distribute marijuana.

But the City of Cleveland announced in December that it would eliminate pre-employment drug tests for some city jobs.

"Pre-employment testing can oftentimes create obstacles in filling open positions by preventing otherwise qualified candidates from even applying," said Matthew Cole, director of human resources for the City of Cleveland, in an email. "These policy updates are more cost-effective and will ultimately help us widen the applicant pool for several City positions."

Katherine Mills, a Cleveland-based employment attorney at Fisher Phillips, says companies can still enforce pre-employment, random or reasonable suspicion testing of all employees.

"Each employer will have to evaluate their business needs and balance that against what employees may choose or opt to do outside of work," Mills said. "The bill language does specifically state, though, that employers do not have to permit cannabis use that impacts the workplace."

Cleveland says it intends to maintain a drug-free workplace by making it known that employees are required to be fit for work and will be prohibited to work while impaired, meaning that they must be free from any kind of alcohol and drugs, including marijuana.

"It's really going to be on a case-by-case basis for employers to evaluate their situation and then determine what is going to be the best course of action, both for the business and for their employees," Mills said.

The City of Cleveland has decided to only drug test for certain positions, like those identified as safety or security jobs or those that fall under the federal Department of Transportation.

"We are constantly evaluating our policies to ensure they align with the needs and desires of both our current and prospective employees," Cole said via email.

Whatever a company decides, Mills says it needs to update its employee handbook and published policies so that employees know that even though marijuana is legal, it may still be prohibited in their workplace.

The National Organization for the Reform of Marijuana Laws, or NORML, advocates for cannabis legalization. They say some states that have legalized marijuana go further and prohibit the firing or hiring of an employee based on a drug test.

Several states, including California, Connecticut, Minnesota, Montana, New Jersey, New York and Rhode Island, prohibit most employers from refusing to hire or from firing someone based solely on a positive drug test for marijuana, according to NORML. Three other states - Michigan, Nevada, and Washington - prohibit most employers from refusing to hire someone based solely upon a positive drug test.

"What good is this law allowing for the legalization for production, sale, and use of marijuana if these people who engage in that activity can lose their job?" said Paul Armentano, deputy director of NORML.

Armentano said many states around the country have had marijuana laws in place for years and have not seen occupational accidents or absenteeism skyrocket.

"There isn't a single state that has ever legalized marijuana for either medical purposes or adult use purposes that has ever repealed or even rolled back their legalization law," Armentano said.

Similar policies have been put in place around the country among multiple different states. Through studies that have been done the work-place performance has not been affected from after-work marijuana use.

Workplace policies will have to continue to evolve as Ohio figures out recreational marijuana, Mills said.

"All the regulations of things are still being developed," Mills said. "We're kind of in this gray space of, it's technically legal but there is no dispensary that adults can currently walk into and buy adult-use marijuana."

During this time, Fisher Phillips recommends that companies review and consider updating their drug testing protocols. Whether or not they make changes, employers should update their employee handbooks so that employees know the company's stance on cannabis use.

Beyond that, companies can have last chance policies - in which an employee agrees to seek substance abuse treatment and refrain from further use of alcohol or drugs in order to keep their job - and substance abuse programs. The law firm also suggests that employers offer training, stay up to date on changing regulations and clearly communicate their expectations to employees.

"We can definitely help find that sweet spot of, you know, respecting the ever-changing landscape that we exist in while also prioritizing both workplace needs and safety concerns," Mills said.


Mara O'Malley wrote this article for Kent State News Lab. This collaboration is produced in association with Media in the Public Interest and funded in part by the George Gund Foundation.


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By Taylor Sisk for KFF Health News.
Broadcast version by Nadia Ramlagan for West Virginia News Service reporting for the KFF Health News-Public News Service Collaboration

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."


Taylor Sisk wrote this story for KFF Health News.


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One popular New Year's resolution is to quit alcohol consumption.

Although easier said than done, one recovery center said there are modifications to try if previous attempts are not working. A good start is taking a hard look at what has worked and what has not.

Marissa Sauer, a licensed clinical addiction counselor at Avenues Recovery, a Fort Wayne recovery center, pointed out if there was a simple answer, everybody would use it. She added other influences are linked to alcohol and substance abuse.

"There's genetics. Were my parents and my grandparents struggling with substances? Does someone have maybe adverse childhood experiences that have led to substances being a coping mechanism of some kind?" Sauer explained. "Maybe there are these mental health diagnoses."

Sauer mentioned people, places, or things which could inhibit or enable someone to abuse drugs or alcohol, making it complicated to simply walk away. Medication, therapy or conversations with people who have beaten their addictions are all effective measures for recovery.

The U.S. Surgeon General's 2025 Advisory Report indicates alcohol consumption is the third leading preventable cause of cancer after tobacco and obesity and the public is taking notice.

There is a growing momentum of the "sober curious" movement, avoiding happy hours at bars, ordering a low or no-alcohol drinks known as mocktails, or completely abstaining from alcohol for 30 days for "dry January." Sauer said longtime substance abusers fear change and she wants them to know there is hope.

"Whether you're 21 or whether you're 51, that ability to heal is there," Sauer emphasized. "The best gift that you could give yourself for a healthy 2025 is to give your loved ones the absolute best version of yourself."

An Indiana State Epidemiological report from 2021-2022 revealed almost 24% of residents age 12 and older have participated in binge drinking, with the highest rate among young adults ages 18 to 25.


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A statewide program in Kentucky aims to provide credentialing and pathways to a career in social work for people in substance use disorder recovery. Advocates say the Career Ladders in Mental and Behavioral Health or CLIMB-Health program is vital for the state to boost the mental health and social services workforce.

Carl Wilson, senior fellow for healthcare development and initiatives with the Kentucky Council on Secondary Education, said it also provides opportunities for those in recovery to make a living and expand their career horizons.

"You can gain both occupation credentials and or employment all the way up through a professional level within this program. So the program offers individuals with lived experience a tailored pathway," he said.

Community colleges across the state serving more than 100,000 residents are now working with people who have been state-certified peer support specialists, to transfer their training toward Bachelor of Social Work degrees. The CLIMB-Health program began on Kentucky Community & Technical College System campuses in counties with the highest overdose deaths.

Wilson said residents in drug court programs in all 120 counties face barriers to employment.

"When they get to that employer interview, and that employer runs that background, and they see the addiction issue, they see in most cases, the justice involvement, they're locked out of opportunities," he added.

The goal is to fill urgent gaps in the state's healthcare system and boost long-term economic stability for people living in recovery.

"We have approximately 50,000 to 0,000 untapped workers for our workforce in Kentucky that have not been given that opportunity to have a specialized program which addresses them," Wilson continued.

While overdose rates in other states are declining Kentucky ranks among the top ten states in the nation for drug overdose deaths, according to the CDC.