Sunday, May 21, 2017

Ky. is a national leader in hepatitis C, but many counties at risk shun syringe exchanges that could prevent disease outbreaks

"Growing intravenous drug use by people sharing syringes to inject heroin and other substances" has helped make Kentucky a national hotbed for cases of hepatitis C, "which ultimately could mean a staggering cost to taxpayers to treat people with the disease," Bill Estep reports for the Lexington Herald-Leader.

"Giving addicts clean needles can help stem the spread of the disease, but many Kentucky counties considered at greatest risk for an outbreak have not approved such programs," Estep notes. His story has a map of syringe exchanges and the Kentucky counties that the federal Centers for Disease Control and Prevention considers most at risk for an outbreak of HIV or hepatitis C due to IV drug use. Of the 220 counties identified, Kentucky has 54, almost half its total number of counties.
Lexington Herald-Leader map
"The programs have only been legal in Kentucky since 2015, when the legislature authorized them in the face of mounting IV drug use," Estep notes. Now there are 33, nine of which are not in operation yet. They are run by local health departments with approval of the county fiscal court and the city where the exchange is located.

"Despite the documented problems, more than 30 of the counties the CDC identified as being at high risk for a disease outbreak have not set up needle-exchange programs," Estep reports. "Some local officials said they’ve faced concerns from residents of their culturally and politically conservative counties that giving needles to drug users condones or perpetuates drug abuse."

Russell County Judge-Executive Gary Robertson "said he had much the same reaction when the idea first came up but changed his mind after learning more," Estep writes. "Drug addicts will find needles and use drugs with or without a local needle-exchange program, but the program can help reduce the spread of expensive diseases, Robertson said."

Studies show that people who use exchanges are much more likely to get drug treatment, Estep notes. "Other studies have shown that exchange programs don’t encourage people to start taking drugs or increase how often users inject drugs; that they don’t increase crime; and that they help reduce the problem of drug users disposing of dirty needles improperly."

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The CDC said recently "that in 2015, Kentucky was among seven states where the incidence of new hepatitis C cases was more than twice the national rate," Estep reports. "Kentucky, West Virginia and Massachusetts had the highest rates, the May 12 report said. The problem has been building for years, according to the 2017 update to the Kentucky Department for Public Health’s state health assessment. The update, released in March, said Kentucky had the highest rate of new hepatitis C infections in the nation from 2008 through 2015, the last year with available data." Kentucky also has the second highest rate of babies born to mothers with the disease, trailing only West Virginia.

Those mothers need to be identified and treated before delivery, said Dr. Ardis Hoven, an infectious disease specialist with the state health department.“We have an epidemic, and we need to continue to deal with it,” she told Estep.

Treating hepatitis C is expensive, Estep notes: "In the last full fiscal year, Kentucky’s Medicaid program spent $69.7 million on pharmacy claims to treat 833 beneficiaries, or $83,735 apiece, according to the Cabinet for Health and Family Services."

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