Coleman details $12 million in opioid grants, says his opposition to syringe exchanges is greater if they don't have one-to-one rule

Attorney General Russell Coleman talks to DV8 Kitchens
owners Rob and Diane Perez. DV8 Kitchens is getting
one of the prevention grants. (Photo by Melissa Patrick)

This story has been updated. 

By Melissa Patrick
Kentucky Health News

Attorney General Russell Coleman issued details Thursday of more than $12 million in grants from the state's opioid settlements for prevention, enforcement, treatment and recovery.

One of the grants will expand a syringe exchange, and was not supported by Coleman's appointees to the commission. He confirmed at an event Thursday that he opposes the exchanges.

"I'm extremely concerned that needle exchange further perpetuates drug use, and it will not be supported by me or this administration," he said in response to questions at an event he held to highlight the grants.

Coleman said the 51 grant recipients, chosen from 160 applicants, represent "bold ideas" aimed at trying to "save lives and tackle this crisis," with a focus on the three-legged stool of prevention, treatment and enforcement.

“We’re building programs and services that help Kentuckians for the next generation,” he said.

The announcement was made at DV8 Kitchens in Lexington, which employs people in recovery and is getting a $151,730 prevention grant to establish an employee-success mentorship program. 

“By connecting those in recovery with meaningful employment, we can give them a second chance at success,” DV8 owner Rob Perez said in a news release from Coleman's office. 

At the event, Perez stressed that while DV8 is "for people," its success is also good for the community. "Every time one person doesn't return back to addiction, we saved $37,000 as a community," he said.

Coleman's office oversees the Kentucky Opioid Abatement Advisory Commission, which the legislature created in 2021 to distribute the state's portion of the $900 million in settlements with opioid manufacturers and distributors, which are being paid in installments. The commission has awarded $55 million in 110 grants, including $10.5 million the legislature allocated in 2022 for behavioral-health treatment as an option to incarceration in 11 pilot counties. 

Coleman said its important to remember where this settlement money comes from. “This is blood money, purchased by pain and devastation of families across this commonwealth, which is why we must be such stewards of this money,” Coleman said. "We're honoring those we've lost by our stewardship and how we use this money effectively." 

Half of the settlement monies go to the state and the other half goes to cities and counties. The commission is housed in the attorney general's office and is headed by Chris Evans, a former chief operating officer for the U.S. Drug Enforcement Administration.

Syringe exchanges

Evans was one of the Coleman appointees who did not support a grant to the Boyle County Agency for Substance Abuse Prevention at at the June 4 commission meeting. In passing on the vote, he revealed Coleman's position on syringe exchanges.

The grant was approved by a majority vote. Coleman took office in January and has not yet made all of his five appointments; those members serve two-year terms. The other voting members are appointed by the University of Kentucky or serve by virtue of their office, including Coleman, who has designated Evans to hold his seat.

Two of the five positions that are appointed by Coleman were reappointed in June 2023, before he took office, with their terms expiring June 30, 2025. They included Karen Butcher and Von Purdy, both representing citizens at-large. Coleman appointed Darren "Foot" Allen, representing law enforcement, in February and that term will expire June 30, 2025. The other two positions to be appointed by Coleman expire at the end of this month. At this time Van Ingram, representing the drug treatment and prevention community, and Jason Roop, representing victims of the opioid crisis, fill those positions.

Asked if Coleman will make decisions about future appointments to the commission dependent on the person's view of syringe exchange programs, spokesperson Kevin Grout answered "No" in bold letters in an email.

Kentucky Health News asked Coleman if his lack of support for syringe exchanges for intravenous drug users, which are supported by research, could put a chilling effect on future applications for these programs.

He replied, "There's been no grant that has been blocked because of my personal opposition." He went on to say, "I don't support needle exchange. I support very robustly prevention, treatment and enforcement."

Asked if he had research to support his opinion, he said, "I'm a strong proponent of Narcan [an anti-overdose drug] and I'm a strong proponent of prevention. I'm very concerned that particularly when there's not a one-to-one ratio, a one-to-one return on needles that it is an enabler versus the harm reduction that we're actually seeking."

Some syringe exchanges have a one-for-one requirement, but regional health official Scott Lockard said in 2016 that most exchanges at that time used a "patient negotiation model," giving the user as many needles as they need for one week to assure they use a clean needle each time, often up to a capped amount.

"The goal is that they use a clean needle for each time they inject," Lockard said then. He said it is impossible to adhere to a strict one-for-one requirement. For example, he said users don't always keep up with their syringes or sometimes will tell you they are sharing them.

Coleman said he is a very strong advocate for wide distribution of Narcan, "given the nature of the threat we're seeing. . . . Narcan needs to be as ubiquitous as a fire extinguisher given this threat. But it always has to be Narcan plus a pathway to treatment, Narcan plus education. Because Narcan itself can be an enabler in some contexts. We want to make sure it's always coupled with treatment, coupled with prevention." 

Coleman also talked about his plans to build a statewide drug prevention program, with a goal of rolling it out this next school year. 

“We exist in a commonwealth where as little as one pill can and is taking our sons and our daughters,” he said. “But yet we lack a statewide prevention effort in our commonwealth. That will change.”

Coleman's office declined to release details of the grants until Thursday's event. Here's a summary of how the 23 new prevention grants will be used: 

Anderson County Agency for Substance Abuse Prevention, $171,100 for expansion of school-based prevention efforts and law-enforcement training.
Appalachian Research & Defense Fund (Legal Aid), $125,000 for legal support and wraparound services that help stabilize people in recovery by addressing employment barriers and other destabilizing civil legal issues.
Big Brothers Big Sisters of the Bluegrass, $185,301 for a high-school mentoring program, to empower high school students to become positive role models for younger students.
Boys and girls Clubs of Kentuckiana, $200,000 for an innovative program aimed at opioid prevention for youth aged 6-18.
Carter County Public Library, $101,500 to hire resource specialists to prtovide greater access to recovery-oriented programming.
Covington Partners, $225,450 for prevention programming that includes out-of-school-time programs, school-based health services, mentoring, drug and violence prevention and family engagement.
Cumberland Trace Legal Services (Legal Aid), $125,000 for legal support and wraparound services that help stabilize people in recovery by addressing employment barriers and other destabilizing civil legal issues.
DV8 Kitchen Vocational Training Foundation and DV8 Kitchens, $151,730 for the mentorship program, which will focus on removing barriers, supporting career-path development and job readiness while supporting recovery and wellness.
Girl Scouts of Kentucky Wilderness Road Council, $59,052 to launch the Building the Bridge to K-12 Girls Leadership Project, a community-based prevention program that focuses on increasing girls’ positive childhood experiences.
Jewish Family and Career Services, Louisville, $77,207 for enhancement of wraparound services for youth, to include opioid addiction screening and active prevention.
Legal Aid Society, $125,000 for legal support and wraparound services that help stabilize people in recovery by addressing employment barriers and other destabilizing civil legal issues.
Legal Aid of the Bluegrass, $125,000, same as above.
Mercy Health – Lourdes Hospital, $76,552 for a hospital-based, pharmacy-led tapering program, which slowly resudes doses of a drug over time to reduce withdrawal symptoms.
Operation Parent, $87,011 for prevention education of parents of 4th, 6th and 9th grade students in several Kentucky counties.
The Safety Blitz Foundation, $126,335 for a pilot version of The Coaches vs. Overdoses™ program, which addresses youth opioid misuse, the proliferation of synthetic opioids including illicit fentanyl, through prevention, education, awareness and community drug-disposal programming.
Scott County Sheriff’s Office, $91,847 for Drug Abuse Resistance Education in 5th and 9th grades.
Taylor County Schools, $208,824 for a school-based prevention program.
Three Rivers District Health Department, Owenton, $320,803 for a partnership with the Planet Youth program to implement a population-wide primary prevention process designed to take informed actions to increase protective factors, decrease risk factors and ultimately change the environment of children and youth.
University of Kentucky Research Foundation, $380,572 for development of prevention coalitions in Fayette County, educating 4th through 12th grade students and building community capacity and engagement around prevention efforts.
Operation UNITE, $751,850, for continuation and expansion of its Educate. Empower. Prevent. Program, which provides prevention training to students from 4th through 12th grades.
Wanda Joyce Robinson Foundation, Frankfort, $90,472 to start a youth substance intervention and prevention program that prevents substance use and abuse and promotes positive youth development and stronger families. The foundation helps children with incarcerated parents.
WestCare Kentucky, $100,404 for Camp Morilla, a free addiction prevention and mentoring day camp program for youth ages 9-12 and their families who have been impacted by family opioid use.
Young Men’s Christian Association of Greater Louisville, $248,487 for the YNOW Mentoring Program, which focuses on helping youth develop healthy drug-and violence-free lives.

Here is a summary of how the 28 new treatment and recovery grants will be used: 

Appalachia Regional Healthcare, $94,572 for expanding its peer recovery team so peer recovery coaches can be placed in four more hospitals.
Backroads of Appalachia, $167,025 for women in recovery with workforce training and employment opportunities.
Boyle County ASAP, $282,610 for expansion of its harm reduction program (including a syringe exchange), resilient-kids programming and case management efforts.
Celebrate Recovery Fairdale, $30,004 for weekly recovery meetings.
Center for Employment Opportunities, $255,109 for expansion of employment services for justice-impacted individuals in treatment or recovery.
Chrysalis House, Lexington, $227,273 for treatment for pregnant and parenting women.
Comprehend, Inc., $426,087 for opening a buprenorphine clinic in a community mental health center.
Eastern Kentucky Concentrated Employment Program, $450,000 for career and support services for people who are in recovery and comorbid polysubstance use who are interested in entering or re-entering the workforce.
Family Nurturing Center of Kentucky, $221,937 for services to children impacted by their caregiver’s opioid use and provides needed support to parents in recovery.
Family Scholar House, $245,110 for a five-step approach revolving around wrap-around services during and post-treatment to progress individuals from ‘crisis to stability’ targeting single parents, foster alumni, individuals facing reentry and post-secondary students.
Grin Grant, Lexington, $361,251 for expansion of dental restoration scholarships and peer support services and launch of a new recovery program.
Hope Center, $680,280 for in-patient, residential treatment for men.
Hope Springs Church, $50,462,Supports regular recovery support meetings and events.
Horsesensings, Inc., Bagdad, $115,219 for therapeutic job training in the horse industry and housing for those in recovery.
Isaiah House, $250,000 for recovery housing and job training aftercare opportunities for those in long-term recovery.
Kentucky Hospital Research and Education Foundation (Ky. Hospital Assn.), $250,000,Supports expansion of a program that ensures patients have 24/7 access to care.
Lake Cumberland Area Development District, $277,552 for case management and supportive services to individuals in recovery seeking to re-enter the workforce.
Life Learning Center, Covington, $498,500 for "a cutting-edge, technology-enhanced system designed to fill existing gaps in recovery services by providing continuous, real-time data, support and accountability."
Mercy Health-Marcum and Wallace Hospital, Irvine, $179,834 for recovery services for individuals with criminal justice involvement.
Natalie’s Sisters, $88,356 for expansion of services for women who have been sexually exploited or trafficked.
Northeast Kentucky Regional Health Information Organization, $331,997 for the Career Ready Workforce Project, which will focus prevention efforts on high-school students preparing to enter the workforce, individuals struggling with addiction ,and local agency staff members seeking to increase employable skills.
Ramey-Estep Homes, Rush, $222,801 for teen prevention-education programming, expansion of first-responder trauma-treatment programming and expansion of treatment and recovery access.
Recovery Café Lexington, $276,278 for expansion of recovery support model to a third location in Frankfort.
Transitions, Inc., Covington, $156,000 for expansion and enhancement of treatment services, as well as expansion of community education and prevention activities in the African American community.
Voices of Hope-Lexington, $538,021 to increase the quantity and quality of recovery support services for people in or seeking recovery.
Volunteers of America Mid-States, $664,587, for two recovery community centers in Lincoln and Pulaski counties.

Four Rivers Behavioral Health, Paducah, $232,251 for a mobile recovery support vehicle program that provides services to adults.
Young People in Recovery, Louisville, $301,440 for peer-led chapter and life-skills curriculum programs for people seeking recovery and a youth prevention program for middle- and high-school-aged children and their parents in five communities.

There is no vaccine for hepatitis C, so all adults should get tested

Photo by jarun011, iStock/Getty Images Plus

By Takako Schaninger

University of Kentucky  

The hepatitis vaccines you receive as a child don’t protect you from getting hepatitis C, a serious disease that can have fatal consequences including liver damage, cirrhosis and liver cancer.

Hepatitis is an inflammation of the liver most often caused by three viruses: hepatitis A, hepatitis B and hepatitis C. There is a vaccine for hepatitis A and hepatitis B, but not for hepatitis C. . 

Most people who get hepatitis C develop a chronic, long-lasting infection that sometimes doesn’t present symptoms for months or even years, meaning they can unknowingly spread the virus to others.

Millions of Americans have hepatitis C, yet many don’t know they are infected. The only way to know for sure is to get tested.

The infection is transmitted mainly by blood-to-blood exposure. Today, most people become infected with hepatitis C by sharing needles, syringes, or any other equipment used to prepare and inject drugs.

The Centers for Disease Control and Prevention estimates that 2.4 million people in the U.S. have chronic hepatitis C, with Kentucky having some of the highest infection rates in the country.

The CDC recommends that all adults get tested for hepatitis C. Getting tested is important to find out if you are infected and get lifesaving treatment. Treatments are now available that can cure most people with hepatitis C in eight to 12 weeks.

Hepatitis C is easily preventable. 

For people who inject drugs, the best way to prevent hepatitis C is to stop injecting. Drug treatment including buprenorphine can lower your risk for hepatitis C since there will no longer be a need to inject. 

If you are unable or unwilling to stop injecting drugs, there are steps you can take to reduce the risk of becoming infected including using new, sterile equipment for each injection and avoiding sharing equipment with others.

Kentucky has 82 syringe exchange programs in 63 counties. Click here to find their locations and hours. Here's a map:

Kentucky Cabinet for Health and Family Services map

Ky. study shows syringe exchange programs decrease infections associated with IV drug use, could result in 'big money saved'

By Melissa Patrick
Kentucky Health News

A new analysis of Medicaid claims data suggests that Kentucky counties with syringe-service programs have slightly lower rates of diseases associated with intravenous drug use, such as HIV and hepatitis C.

The analysis estimated a progressive reduction of 0.5 percent per month, adding up to a 6% increase over a year. That can add up to savings, not only in lives, but money. So said Dr. Connie White, deputy commissioner of clinical affairs for the Kentucky Department for Public Health, at the Kentucky Harm Reduction Summit Aug. 20. 

White said, "As a public-health person, I think of all the emotional tragedy for the patient and for the family with one of these co-morbidities," diseases and conditions that occur together. "But if you're trying to sell this program to a bunch of politicians and legislators, you're talking about money saved, we're talking big money saved."

Kentucky has more syringe-service programs than any other state in the nation, but 56 of the state's 120 counties still don't have one -- and 20 of those are considered highly vulnerable to an HIV or hepatitis C outbreak among IV drug users, according to the Centers for Disease Control and Prevention. Thirty-four of the state's most vulnerable counties have operational syringe exchanges. 

The vulnerable counties without an exchange include Bell and Clinton, which rank sixth and 11th on the national list of 220; Cumberland, Casey, Edmonson, Harlan, Johnson, Lawrence, Lewis, Menifee, Monroe, Rockcastle and Wayne, also in Appalachian Kentucky; and eight in the rest of the state: Carroll, Gallatin, Green, Breckinridge, Grayson, Green, Allen and Hickman. 

Kentucky has 74 operational syringe-service programs in 63 counties, with one more in Christian County approved but not operational. Bracken County's exchange is marked on the state's map as not yet operational, but it started operating July 8. 

Syringe-service programs are more broadly referred to as harm-reduction programs and are designed to prevent outbreaks of HIV and hepatitis C, which are commonly spread by needle sharing among IV drug users. They also provide health screenings and vaccines, and connect drug users to treatment. 

They are allowed by a 2015 state law that requires approval by the county health board, the fiscal court and the city where the exchange is to be located.

Syringe exchanges reduce disease

The Kentucky Office of Health Data and Analytics did the analysis at the request of the Department for Public Health.

One reason the study is so important is that it helps to root the debate about such programs in empirical data, said Mathew Walton, a researcher with the office. 

Walton pointed to a national study that shows a person's political affiliation, income, and amount of stigma they feel about addiction and syringe-service programs are significant predictors of whether or not someone supports these programs -- not the facts.

The study looked at Medicaid claims from January 2015 through June 2019 in any county that had implemented a syringe-service program during that time.

It looked for six infections largely connected to IV drug use and minimally associated with other activities: HIV, hepatitis C, endocarditis, osteomyelitis, and, in people diagnosed with opioid-use disorder, skin and soft-tissue infections. The researchers only included new infections in their analysis. 

The study looked at infection rates before and after the syringe exchange was established in 42 counties. Recognizing that results might not be seen immediately, included lag times of one month, three months and six months. It also adjusted for a list of variables, many related to demographics.

Cameron Bushling, a statistician with the office, said each of the lag-time scenarios showed a decrease in infections after the syringe exchange was established. 

"The infection rate in your county will go down by roughly half a percent each month after you implement a syringe service program," he said. "So some, some may think this is a small number, but it's important to keep in mind that our infection rates were very low. . . . So half a percent is still a pretty big find."

In conclusion, Walton pointed out that most of the counties in the study were rural, outside metro areas. 

"There's an evidence of an association that they were successful in reducing infection, new infections," Walton said. "These do seem to be an effective use of resources for preventing costly and harmful infectious disease." 

He said the savings would come with even small reductions in infections caused by IV drug use.

"While this analysis revealed that this set of infectious-disease diagnoses was rare, even preventing a small percentage of them can have a significant effect on the Medicaid program," he said. "A single course of treatment for hepatitis C can be as much as $85,000 or more, so even a small outbreak prevention can be both a sort of economic benefit as well as a humanitarian and medical population health benefit."

Advice for resistant counties

Van Ingram, executive director of the Kentucky Office of Drug Control Policy, after a separate presentation, was asked what advice he would give counties that have been resistant to syringe exchanges. 

"I realize these can be controversial in some communities," said Ingram, who was Maysville's police chief before taking the drug-control job, and back then opposed syringe exchanges. Many law-enforcement officers do, believing, that they encourage drug use, despite research to the contrary.

"Well, first, just don't give up," he said. "Second, do everything you can to get the public on your side, the voters on your side. . . . and continue to keep raising this issue."  

He also suggested identifying the thought leaders in a community, those who have influence, and then educating them on why it's important to have one. His last bit of advice was to reach out to public health departments that have already fought this fight successfully and learn from their strategies.

Asked the same advice question, Frankie Haynes, the harm reduction coordinator for the Barren River District Health Department, stressed that educating the public is the key. 

"I can't tell you how many times we went into different entities and just explained to people what harm reduction was, or what needle-exchange services are, what are we doing," she said during a panel discussion about exchanges, "And once you give them a whole rundown on what it looks like to be a part of our program, what to expect within the program, you really start seeing eyes opening to the need for these programs across the state." 

The Bowling Green-based Barren River department is working to expand syringe services into Logan County, which has received approval from its Board of Health, but still needs the approval of the Russellville City Council and the county Fiscal Court. Two of the district's eight counties (Warren and Barren) have exchanges. 

Jennifer Twyman, health-education specialist with the Louisville Metro Public Health and Wellness syringe exchange program, agreed with Haynes. She said discussions with the public put a face on the program: "Talking to people in the community, so that they know what we're doing, makes just a huge difference."

Kentucky Public Health Association honors 10 public-health leaders, two health departments and a racetrack

Public health promotes and protects the health of people and their communities, largely through surveillance and prevention programs, and much of what people in public health do often goes unnoticed. But once a year the Kentucky Public Health Association honors outstanding contributors to public health. Here are the award winners for 2018, honored during the association's 70th annual conference on April 27 in Covington.

Sue Thomas-Cox, a nurse administrator with the Chronic Disease Branch of the state health department, won the Outstanding Public Health Nurse Award. Among other achievements, Thomas-Cox was instrumental in obtaining a multimillion-dollar Centers for Disease Control and Prevention grant to increase colorectal cancer screening in the state. Due in large part to her work, the state has moved from 49th to 19th in colorectal cancer screening, annual cases of such cancers have declined more than 25 percent, and mortality from them has fallen more than 30 percent.

Melinda Carey, an administrative specialist with the department's Division of Epidemiology and Health Planning, won an award for her contributions in the area of administrative support. Carey's nomination came with 26 letters of support, several of which described her as "the go-to person" who "goes the extra mile and makes the workplace enjoyable."

Robert Slaton of Georgetown, who has served in various health leadership capacities for more than five decades, was honored for his lifelong contribution to the improvement of public health. He was state health commissioner,  Gov. Brereton Jones' special assistant for health reform, external affairs director for the former Trover Clinic in Madisonville, and held several positions with the University of Louisville. He was a founding member of the group that developed Passport Health Plan. He is chair of the Community Advisory Council of the Foundation for a Healthy Kentucky and the national advisory board of the Institute for Rural Journalism and Community Issues, which publishes Kentucky Health News. “His contributions to improved health outcomes in the commonwealth will long outlive his numerous years of service to the people,” a nominator wrote.

Jennifer Hunter, director of clinical services at the Northern Kentucky District Health Department, received a career achievement award. Hunter has worked as a public-health nurse for 28 years. A few highlights: leading a team of six nurses in relief efforts in Mississippi after Hurricane Katrina in 2005; and her work around the heroin epidemic, including a hepatitis C testing pilot that has since gone statewide, advocating for syringe exchange programs, and her work with women with substance-use disorders.

Doraine F. Bailey, who works with the breastfeeding support services at the Lexington-Fayette County Health Department, was honored for her "exceptional contribution to the health and well-being of mothers and children in Kentucky."  Bailey was described as a "tireless champion for breastfeeding and maternal education," going beyond her job requirements to promote breastfeeding at community events and by serving as a guest lecturer in the University of Kentucky nutrition and dietetics program.

John Q. Moses, an HIV linkage navigator with the Lexington health department, was honored for his "significant contribution to benefit our most vulnerable population -- the indigent and uninsured." Moses has spent his career serving those at risk for and affected by HIV and STDs and was instrumental in launching Lexington's syringe exchange program.

The Christian and Todd County Health Departments were honored for their work on the August 2017 solar eclipse, which required several years of "hard work and planning to prepare for the influx of people and potential dangers." Visitors from over 47 states and 25 countries attended events in the area.

Nancy Merk, a board-certified lactation nutrition supervisor and regional breastfeeding coordinator with the Northern Kentucky Health Department, was honored for her 30 years in public health. Merk's leadership was instrumental in the health department receiving the Loving Support Award of Excellence Gold Level Award for Exemplary Breastfeeding Support and Practices from the U.S. Department of Agriculture.

Shana M. Peterson, a health educator at the Jessamine County Health Department, was awarded for her exceptional contribution in health education. Peterson has implemented many evidence based health education prevention programs in schools and has been a strong advocate for local smoke-free policies.

Lorrene Rawlins, nursing director at the Wedco District Health Department in Bourbon, Harrison and Scott counties, was honored for her exceptional home health services. Through her leadership, Rawlins was able to reduce costs in other areas of her department to create a budget to directly care for indigent patients.

Jody L. Schweitzer, a state epidemiologist, won the first-ever Outstanding Epidemiologist of the Year award. She was honored in large part for her work in implementing the state's immunization information system, the Kentucky Immunization Registry, which has been recognized on the state and national level.

Kentucky Speedway was honored "as an industry who has demonstrated exemplary leadership for the commonwealth's health. "

Ky. has 54 counties at high risk for spread of HIV and hepatitis C among IV drug users but only 6 of them have needle exchanges

By Melissa Patrick
Kentucky Health News

Why, if 54 of Kentucky's 120 counties are among the nation's most vulnerable to outbreaks of HIV and hepatitis C among intravenous drug users, do only a few of them allow users to exchange used syringes for clean one to avoid spreading the diseases?

That question was asked, implicitly, by a national expert who spoke at the 2016 Viral Hepatitis Conference in Lexington July 26.

"I think it is very interesting to compare the counties we believe are at risk, based on our modeling, and then where are prevention services, such as syringe-service programs," said Dr. John Ward, director of the Division of Viral Hepatitis at the federal Centers for Disease Control and Prevention. "You can see there is a big disconnect, that there is a big gap in syringe service availability and other powerful prevention interventions, such as medication-assisted therapy."

Syringe exchanges were authorized in Kentucky under a 2015 anti-heroin law and require local approval and funding. They are meant to slow the spread of HIV and hepatitis C, which are commonly spread by the sharing of needles among intravenous drug users.

So far, 14 counties have approved syringe exchanges, according to the Cabinet for Health and Family Services, with 11 of them operating. But only six (Carter, Boyd, Pike, Knox, Mercer and Grant) are in the most-vulnerable group.

A spokeswoman for the state Department of Public Health said the agency supports the exchanges and is available to provide support, share best practices, offer technical guidance, and provide information on their effectiveness and benefits.

"In addition, DPH has hosted several statewide conference calls with local health department directors to discuss setting up syringe exchange programs," spokeswoman Beth Fisher said. "We have also coordinated several trainings for syringe-exchange staff members as well as administrators. We also work to provide education and training regarding harm reduction related to syringe use to communities."

Dr. John T. Brooks, senior medical adviser for CDC's Division of HIV/AIDS Prevention, pointed out the HIV outbreak that occurred in Scott County, Indiana last year, which drew national attention because of its high rates of HIV and hepatitis C.

He said Scott County isn't that different from many rural Kentucky counties because of its high poverty and unemployment rates, low education and life expectation, lack of HIV and hepatitis C care, insufficient addiction services and no needle exchange when the outbreak began. The CDC found that 18 Kentucky counties were more vulnerable to a hepatitis C and HIV outbreak among IV drug users.

"If we don't pay attention to history, we are doomed to repeat it at some point in the future," Brooks said. "You want to prevent this from getting introduced and recognize it the moment it is introduced so that you can do what you can to prevent it from continuing to spread."

Ward said multiple approaches are needed to stop the spread of hepatitis C. Using the Scott County outbreak as a model, he said a syringe-exchange program would decrease hepatitis C by 27 percent; adding medication-assisted therapy would make the decrease 41 percent; and adding a robust testing and treatment program would get it to 71 percent.

Brooks said syringe exchanges and medication-assisted therapies would reduce the potential spread of new HIV infections by 64 percent and 56 percent, respectively.

He encouraged Kentucky counties to gather their own data to determine the prevalence of IV drug use in their communities; to test people with substance-use disorders in jails and prisons, and those who frequent emergency rooms, for HIV and hepatitis C; and to create a countywide plan for a potential HIV or hepatitis C outbreak.

Referring to resistance to syringe exchanges, Wayne Crabtree of the Louisville exchange asked, "When has judgement, stigma or shaming ever made a difference in someone's life? When did it ever change behavior? I would say never. And we in public health know it is the hand reaching out to someone in need lifting them up and making them realize their self-worth that elicits change."

Dr. Ardis Hoven, a state infectious-disease expert, said "Stigma continues to exist everywhere around many of the issues we are discussing today and I think it is our responsibility and our challenge to begin to open up the dialogue in a way that goes to minimizing it. Because as stigma is sitting out there, we are not going to be able to get the job accomplished as well as we should."

Hoven said establishing a syringe exchange requires local data and local allies, especially local police, who can "make or break a syringe-exchange program."