Saturday, January 14, 2017

Ky. has 25 approved syringe exchanges to reduce risk of HIV and hepatitis C outbreaks; other counties debate proposals

By Melissa Patrick
Kentucky Health News

A minister, a nurse and a physician assistant joined forces in Powell County to educate its citizens about a syringe-exchange program, which should open up this month -- but the decision to support an exchange didn't come easily for any of them, Mary Meehan reports for Ohio Valley ReSource, a regional journalism collaborative of public broadcasters.

Van Ingram, executive director of the Kentucky Office of Drug Control Policy, told Meehan that rural counties like Powell are leading the way in changing the perception of how addiction is perceived in the state, shifting the focus toward treatment and public health initiatives and away from the criminal justice system. So far, syringe exchanges have been approved in 25 of the state's 120 counties; several others are having debates like the one that went on in Powell County.

Pastor Brad Epperson of the Clay City First Church of God, who also drives a school bus, told Meehan that the many funerals he has officiated for people too young to die, and the stories he hears from the children on his bus, made him realize that something had to change. He now considers syringe exchanges the first place for addicts to get the help they need.

Nurse Mandy Watson
(Photo by Mary Meehan)
Mandy Watson, a nurse for the Powell County Board of Health, told Meehan that she changed her mind about syringe exchanges after realizing what an HIV or hepatitis C outbreak could do to the community.

The federal Centers for Disease Control and Prevention ranks Powell County 15th in the U.S. for risk of an HIV or hepatitis C outbreak from IV drug use, and the county borders Wolfe County, which is ranked No. 1 in the nation.

"Almost anybody you ask has some kind of family member who does use or (has) some type of trouble with addiction," Watson said of the county, where 13,000 people live.

Physician assistant Troy Brooks, who is on the county health board, initially opposed a syringe exchange. "He said it seemed like a way to let addicts keep using their drug of choice without consequence," Meehan reports. But then local police showed him how bad the problems is by taking him to the Clay City playground, where they collected 41 dirty needles, and he saw the need to protect children and first responders.

Tosha Baker of the Clay City Times did a story June 2 about needles in the park and elsewhere, and the discussion of a syringe exchange.

The state legislature authorized syringe exchanges in the 2015 anti-heroin bill, but in an effort to decrease the spread of HIV and hepatitis C, which are commonly spread by the sharing of needles among intravenous drug users. They require both local approval and funding.

Six of the 25 syringe exchanges approved so far aren't operational yet. Thirteen are in counties deemed most vulnerable counties by the CDC, which identified 54 Kentucky counties as among the 220 most vulnerable in the nation to a rapid spread of HIV and hepatitis C infection among persons who inject drugs. Sixteen of the state's counties ranked in the nation's top 25.

Cabinet for Health and Family Services map; updates at
The Madison County Board of Health supports a syringe exchange, but was met with "mixed feelings" about the program at the August fiscal court meeting, with some members concerned that the program condoned intravenous drug use, Ricki Barker reports for The Richmond Register.

The county will host several forums to educate local citizens about the cost and benefits of the program and answer any questions that the public may have about it. Health officials told Barker that the department sees about eight to 10 patients a day with hepatitis C.

Woodford County has received a $6,860 grant from the Kentucky Agency for Substance Abuse Policy that will be used to seed a syringe exchange program if approved by the local governments.

Securing a needle exchange in Northern Kentucky continues to depend on what Campbell County decides to do, Chris Mayhew reports for

The Northern Kentucky Health Department wants to put a needle exchange program in the Campbell County Health Center in Newport, but Newport hasn't yet approved an exchange, despite a strong push from health officials since 2015 to do so. Mayor Jerry Rex Peluso, who supports an exchange, told Mayhew that the four city commissioners remain divided on this issue.

Intravenous drug use is so bad in Northern Kentucky that the health department created a "story map" to utilize "big data" to help combat the heroin epidemic in the area, noting that one person in Northern Kentucky died from a drug overdose every 40 hours last year. The map shows the areas with the highest number of opioid-related arrests since 2011, opioid related medical runs and where naloxone was administered; where you can get naloxone, among other things, Jay Warren reports for WCPO-TV in Cincinnati.

Several exchanges are newly approved or just getting started

Boyle and Whitley counties started their syringe exchanges Jan. 13.

Boyle County's program is open 1 to 3 p.m. Fridays in the basement of the health department in Danville, Kerry Steinhofer reports for The Advocate-Messenger. The program is initially being funded by a $20,000 ASAP grant, which will pay for supplies, but not salaries. Health officials said the hope is that the city and county will eventually fund the program.

Whitley County's exchange is open from 2 to 4 p.m. Fridays at the health department's main office in Williamsburg. Whitley County is ranked the 14th most vulnerable county in the nation for a rapid outbreak of HIV or hepatitis C infections, Mark White reports for the News Journal, the local weekly newspaper.

“Needle exchanges are the only thing they have shown that truly decreases hepatitis. Hepatitis C has become the number one killer in the state,” Public Health Director Martha Steele told White.

Mike James of The Daily Independent in Ashland reports that Greenup County recently approved a syringe exchange. The program will cost about $8,000 per year, including materials and will be funded by the local health department and a grant from Pathways Inc., a behavioral-health nonprofit. The program will be operated out of the health department one day a week for three hours a day. James reports that "users also will get counseling from a Pathways Inc. professional."

Floyd County will also begin offering its program in January as well, Andrea Saddler reports for The Floyd County Times. The county health department is conducting a survey to determine the best day to operate its exchange.

Nelson County approved its program in December, but it's not operating yet, Jim Brooks reports for the Nelson County Gazette. This exchange will be one-for-one and will be funded by the health department.

Warren County's excahnge opened in September and reports that it is off to a good start, seeing about a dozen people each week, Alyssa Harvey reports for the Bowling Green Daily News. It is open Thursdays from noon to 4 p.m. at the Barren River District Health Department.

Brad Stacy of The Morehead News reports that "the city, county and board of health approved a harm-reduction program that focuses on limiting the risks and harms associated with unsafe drug use, including needle exchange" after a standing-room-only crowd at a community forum discussed the heroin problem in the county.

Click here for a list of operating needle exchanges and their hours of operation.

Louisville's program grows, make case against one-for-one rule

The Louisville syringe exchange opened its fourth location in December at the Redeemer Lutheran Church in the Shawnee neighborhood. It will be open every Tuesday from 9 a.m. to noon, Joe Sonka reports for Insider Louisville.

"Statistics provided to Insider Louisville by the city health department show that from the program’s inception through the end of this October, a total of 5,347 individual clients have received 454,989 free syringes, with 267,746 used syringes returned," Sonka reports. He also notes that 295 clients in the exchange have been referred to drug treatment programs, two have tested positive for HIV and 182 have tested positive for hepatitis C.

Sonka reports that Louisville's exchange is the only one in Kentucky that uses a needs-based model, which is considered best practice by leading health experts to prevent the spread of disease. Other programs in the state place some limits or follow a one-for-one policy, as the state is requiring for exchanges that get state grants.

Stat, the science-and-medicine supplement to The Boston Globe, reports, "Needle exchanges, once met with fierce resistance, are working" and notes that public-health experts say that one of the challenges in decreasing infections is "that exchanges do not provide as many clean syringes as people who use drugs need."

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