Princess Health and Justice secretary, drug-policy chief and ex-health boss back needle exchanges but 'political rhetoric' can trump science. Princessiccia

Princess Health and Justice secretary, drug-policy chief and ex-health boss back needle exchanges but 'political rhetoric' can trump science. Princessiccia

drug abuse health departments hepatitis c heroin HIV legislation needle exchanges

Gusty 15:57 Add Comment

By Melissa Patrick
Kentucky Health News

CORBIN, Ky. � Local officials and legislators continue to debate and sometimes reject needle exchanges, but two state officials and a former state health commissioner voiced their strong support of them at a pubic forum May 17 in Corbin.

Dr. William Hacker:
"Needle exchanges work."

"Needle exchanges work," said Dr. William Hacker, chair of Shaping Our Appalachian Region's Health and Wellness Advisory Committee and former state health commissioner. "We would, as a public health role, encourage them to be extended."

Hacker spoke at the "Cumberland River Forum on Opioid Use Disorders: A Time for Community Change," one of three public forums on the subject in Kentucky in May.

The General Assembly authorized needle exchanges in the 2015 anti-heroin bill, as a way 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.

Kentucky's rate of hepatitis C is the highest in the nation, and a recent federal Centers for Disease Control and Prevention report said that of the 200 counties in the nation that are most susceptible to a hepatitis C or HIV outbreak, 54 of them are in Kentucky.

So far, only 14 counties in Kentucky have either approved or are operating needle exchanges: Jefferson, Fayette, Jessamine, Franklin, Clark, Kenton, Grant, Harrison, Pendleton, Carter, Boyd, Elliott, Pike and Knox.

Justice Secretary John Tilley:
"Real facts and real science"

Justice Secretary John Tilley, who was instrumental in getting the heroin bill passed when he was a state representative from Hopkinsville, encouraged communities to look at the evidence-based research that supports needle-exchange programs and to not listen to the political rhetoric.

"We've got to push aside this political rhetoric on topics like this one and talk about real facts and real science," he said. "These programs have been validated by meta-analysis. ... Those who seek out a needle exchange are five times more likely to enter treatment. These programs continue to beat back blood-borne illnesses like hepatitis C and HIV, at rates we cannot duplicate without these programs. They are universally successful at what they do."

Tilley said after the meeting that addiction is a chronic disease and should be treated as a public-health crisis, noting that other diseases are treated based on science and medicine, not opinion.

"When you go to the doctor, you don't ask him his political view of a particular health program," he said. "Well, this is no different. And for me to substitute my judgment for the science is dangerous."

Van Ingram changed his mind

Van Ingram, executive director of the Governor's Office of Drug Control Policy, said his opinion about needle exchanges changed after he researched them and learned how effective they are at decreasing the spread of hepatitis C and HIV. He also noted that these programs provide testing and treatment referral for these infectious diseases, and also help participants get treatment.

"Eleven years ago I left law enforcement, and if you had told me that I would end up being the poster boy for syringe exchange, I would have said you were crazy," he said. "But quite honestly, they do work."

Ingram also noted the CDC study and reminded the audience of the "enormous" HIV outbreak that occurred last year in Scott County, Indiana, 30 miles north of Louisville.

"So if a syringe exchange can keep us from having a rapid HIV outbreak, I think that is probably a good trade-off," Ingram said.

But evidence-based research isn't always enough to convince policy makers that needle exchange programs don't condone or perpetuate drug use.

The Georgetown newspaper answered its
question in its story. The answer is yes.

Last week it was reported that two Kentucky counties decided against needle exchanges. Boone County's Fiscal Court silently said no to a needle exchange by refusing to call up a resolution to support one, Mark Hansel reported for NKyTribune. And the Scott County Fiscal Court voted 5-3 against one, Dan Adkins reported for the Georgetown News-Graphic. Adkins followed up with a featured front-page story about the county's heroin problem.

A point of contention among Republicans in the General Assembly is that some of the exchanges don't require a needle-for-needle exchange, which they say was their intent.

Then-Attorney General Jack Conway said Dec. 18 that needle exchanges did not have to be one-for-one. It is also widely accepted that not requiring one-for-one is considered a best practice across the country to prevent the spread of HIV and hepatitis C and to stop intravenous drug users from sharing and reusing needles, Dr. Sarah Moyer, the interim director of the Louisville Metro Department of Public Health and Wellness, told Kentucky Health News in March.

Last session, as the Senate voted to amend House Bill 160 to require one-to-one exchanges, Senate Republican Floor Leader Damon Thayer of Georgetown threatened to file a bill to eliminate them altogether next session if they don't make this change during the upcoming year.

In its original form, HB 160 was a bill to educate the public about how to safely dispose of hypodermic needles in order to keep them out of landfills. The House let the bill die without another vote.

Tilley said after the meeting, "Culture and change takes a while," and noted that while he respected his colleagues differing opinions, he said it is likely that this topic is not in their "wheelhouse."

"So, I think the more they learn the more they will come along," he said. "What we should do is all come back to the table and talk about how the programs that are now in place in Kentucky are working and how the reliance on science and evidence based policy makes them work."

Princess Health and CDC finds health problems are common at public pools; state requires local health departments to inspect each one twice a year. Princessiccia

Princess Health and CDC finds health problems are common at public pools; state requires local health departments to inspect each one twice a year. Princessiccia

health departments swimming water safety

Gusty 18:44 Add Comment

By Melissa Patrick
Kentucky Health News

Thousands of public pools, hot tubs and water playgrounds are forced to close every year for serious health and safety violations, according to a new study by the federal Centers for Disease Control and Prevention.

Kentucky requires local health departments to conduct two full inspections of each public swimming pool during the operating season, once every six months for its continuous-operation indoor facilities, and monthly water chemistry inspections, according to the state Department for Public Health.

"The local health department environmentalists are the ones who do these inspections and monitors, so the records for these inspections are kept with each local health department, Beth Fisher, spokesperson for the Cabinet for Health and Family Services, said in an e-mail.

But you might want to do your own inspection if you go on vacation out of state, because that's not the case everywhere.

"Almost one third of local health departments do not regulate, inspect, or license public pools, hot tubs, and water playgrounds,� Michele Hlavsa, chief of the CDC's Healthy Swimming Program, said in a news release. �We should all check for inspection results online or on site before using public pools, hot tubs, or water playgrounds and do our own inspection before getting into the water.�

And even if states are checking their pools, that doesn't mean they are always safe.

A 2013 CDC study of inspection data from the five large states containing 40 percent of the nation's public aquatic venues found that almost 80 percent of them had at least one violation. It found that one in eight inspections resulted in immediate closure because of serious health and safety violations and that one in five kiddie or wading pools were closed due to violations. Most of the violations were related to improper pH (15 percent), lack of proper safety equipment (13 percent) and inadequate disinfectant levels (12 percent).

"Young children who are still learning their toileting skills are more likely to contaminate the water. They're more likely to swallow the water. Both of which can lead to outbreaks of diarrheal illness," Michael Beach, the CDC's associate director for healthy water, told Dennis Thompson at HealthDay News. He said pH levels are "critical because it determines how effective the disinfectant is killing germs."

The CDC recommends that parents change their infants' diapers often and in the bathroom, not poolside, to take children to the bathroom every hour, and to teach children to spit out any pool water they get in their mouth.

Beach said most contamination of public pools and hot tubs are the result of people swimming while suffering from diarrhea. He said adults should not swim while recovering from diarrhea, and if they do, should shower before getting in the water.

The CDC recommends individuals do a self-inspection of all public pools before getting in them and offers this checklist that identifies some of the most common swimming pool health and safety problems:

• Use a test strip (available at most superstores or pool-supply stores) to determine if the pH and free chlorine or bromine concentration are correct.
• Make sure the drain at the bottom of the deep end is visible.
• Check that drain covers appear to be secured and in good repair.
• Confirm that a lifeguard is on duty at public venues. If not, check whether safety equipment like a rescue ring with rope or pole is available.

If you find problems, do not get into the water and tell the person in charge so the problems can be fixed, says the release.

Princess Health and Top deputy in state health department named commissioner of Lexington health department. Princessiccia

Princess Health and Top deputy in state health department named commissioner of Lexington health department. Princessiccia

health departments public health state government

Gusty 11:29 Add Comment

Kraig Humbaugh

Dr. Kraig Humbaugh, senior deputy commissioner of the Kentucky Department for Public Health, has been named the Lexington-Fayette County commissioner of health, starting in June. He will replace Dr. Rice C. Leach, who died April 1 following a battle with cancer.

�I am honored to serve and look forward to working with the Board of Health, the hard-working team at the health department and the community to make Lexington a healthier place to live, work and visit,� Humbaugh said in a news release. �It�s important that we build on Dr. Leach�s legacy and the already strong foundation that the health department has in the community.�

A pediatrician by training, Humbaugh has extensive experience in public health, including epidemiology of communicable diseases and emergency preparedness and response.

�We are very excited to have Dr. Humbaugh join us as the next commissioner of health,� Paula Anderson, chair of the Lexington-Fayette County Board of Health, said in the release. �In addition to his exceptional background in public health, he has widespread leadership experience on the state level. He also knows Kentucky and has worked closely with the Lexington-Fayette County Health Department on many previous projects. All of those attributes made him the right choice to lead our health department.�

Humbaugh earned his undergraduate degree from Vanderbilt University and his medical degree from Yale University. He was a Fulbright Scholar at the University of Otago in New Zealand and received a Master of Public Health degree from Johns Hopkins University.

Princess Health and Kenton County's approval of a needle exchange inches Northern Kentucky, hit the hardest by heroin, toward getting one. Princessiccia

Princess Health and Kenton County's approval of a needle exchange inches Northern Kentucky, hit the hardest by heroin, toward getting one. Princessiccia

county government county health boards county health departments health departments hepatitis c heroin HIV legislation local government needle exchanges public health

Gusty 16:40 Add Comment

The Kenton County Fiscal Court unanimously approved a mobile needle exchange program March 29, which moves the City of Covington's needle exchange program one step closer to fruition, Terry DeMio reports for the Cincinnati Enquirer.

The Fiscal Court's approval was one of several conditions required by the City of Covington to allow its exchange to move forward. Covington's plan also requires two other counties in the Northern Kentucky Health District to adopt exchanges (only Grant County has); limits access to only resident's of the district's four counties; and would move the exchange to St. Elizabeth Healthcare hospital.

In addition, it requires a one-for-one needle exchange and a mandate that all participants must be tested for hepatitis C, hepatitis B, HIV, and, where applicable, pregnancy. This condition is likely not legal and is being investigated by the Northern Kentucky's Health Board's legal counsel, DeMio reports.

Kenton County's plan differs from Covington's in that it mandates only the offering of these tests, DeMio reports.

Both plans will require the Kenton County Board of Health's approval.

Needle-exchange programs were authorized by the state anti-heroin law passed in 2015, and require both 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. Northern Kentucky has been hit the hardest in the state by heroin and its hepatitis C rates have been reported at 19 times the national rate.

The needle exchange would be funded by $250,000 from the R.C. Durr Foundation, and the health department would use its staff and already available testing to further pay for the exchange, DeMio reports.

The Fiscal Court also approved exploring the idea of building a community-wide addiction treatment center on the county jail grounds; putting $25,000 toward a heroin helpline; and approved a resolution to encourage the Northern Kentucky Board of Health to create a high-quality prevention and education program for the community.

The Northern Kentucky Area Development District has already put out proposals for the heroin helpline, DeMio notes. And County Judge-Executive Kris Knochelmann told him that Boone and Campbell counties were willing to consider putting $25,000 each toward it, and that St. Elizabeth had promised $75,000 toward its operation.

The other needle exchanges in the state that are either operating or have been approved are in Louisville and Lexington and in the counties of Pendleton, Carter, Elliott, Franklin, Grant and Jessamine.

Princess Health and Boyd, Clark counties approve needle exchanges; Boyd's is a limited, one-for one; Covington's proposed limits draw objections. Princessiccia

Princess Health and Boyd, Clark counties approve needle exchanges; Boyd's is a limited, one-for one; Covington's proposed limits draw objections. Princessiccia

AIDS county health boards drug abuse General Assembly health departments hepatitis HIV legislation legislature needle exchanges public health state government

Gusty 16:00 Add Comment

By Melissa Patrick
Kentucky Health News

Clark and Boyd counties are the ninth and 10th Kentucky counties to approve a needle-exchange program, and Madison and Anderson counties are talking about it. Meanwhile, the city of Covington has approved an exchange with conditions that don't match its health department's plan, and one of the conditions might not even be legal.

Needle exchanges were approved under the state's anti-heroin law passed in 2015, and require both local approval and funding. They are meant to slow the spread of HIV and the hepatitis C virus (HCV), which are commonly spread by the sharing of needles among intravenous drug users.

Clark County Health Director Scott Lockard noted that the federal Centers for Disease Control and Prevention has "identified 54 counties in Kentucky as being vulnerable to rapid dissemination of HIV or HCV infection among persons who inject drugs. Of the top 25 most vulnerable counties in the nation 16 of them are in our state."

Clark County

On March 23, the Clark County Fiscal Court approved on a 4-2 vote a needle exchange that will start on or before June 1, but the program will need re-authorization in January, Greg Kocher reports for the Lexington Herald-Leader.

"Both the Fiscal Court and the [Winchester] City Commission inserted a sunset clause in the orders requiring the health department to present data on our program in January 2017 in order to get re-authorization for a longer time period," Lockard told Kentucky Health News in an e-mail.

He noted that the CDC identified nearby Wolfe County as the most vulnerable county in the nation to rapid dissemination of HIV and HCV among drug users, with adjoining Powell and Estill counties 15th and 25th, respectively.

"Residents from all three of these counties frequently come to Clark County for medical services from our provider community and the health department," he said. "More must be done in the area of prevention if we are to avoid a situation similar to what Scott County, Indiana, encountered."

That county, about 30 miles north of Louisville, has drawn national attention for its high rates of HIV and hepatitis C, mostly caused by intravenous drug users who share needles. According to published reports, "from November 2014 to mid-June 2015, the Indiana county of 24,200 reported 170 HIV cases. It reported 130 new cases of hepatitis C in 2014," noted Bill Robinson of The Richmond Register.

According to Lockard, Clark County's program will use a patient negotiation model, which does not require a one-to-one needle exchange, during the initial visit, but will try to get close to a one-for-one model on subsequent visits.

"We will educate participants that they need to return needles to get needles," he said.

Boyd County

The Boyd County Fiscal Court voted 4-1 March 15 to approve a one-to-one needle exchange for one year, Lana Bellamy reports for The Daily Independent. 

The Ashland City Commission had already given its approval for the exchange, which may begin as early as July. Bellamy reports that the program will be paid for by special taxing districts, and all of the fiscal court members voiced concerns about the sustainability of the funding.

Ashland-Boyd County Health Department Director Maria Hardy told the court that syringes typically cost about 97 cents each, but the health department will be able to buy needles from a distributor for 9 cents each, Bellamy writes.

The Boyd County program will assign tracking numbers to its participants to protect their identities and allow a maximum of 40 needles to be exchanged each week.

County Commissioner John Greer, the only member to vote against the resolution, said he was concerned the program would encourage drug abuse and Sheriff Bobby Jack Woods agreed, Bellamy reports. This is a common concern among opponents of needle exchange programs, though evidence-based studies have proven otherwise.

Covington

During the same week, the City of Covington approved a needle-exchange program, but with conditions that could kill the program, Terry DeMio reports for The Cincinnati Enquirer.

The conditions are that all participants be tested for hepatitis C, hepatitis B, HIV, and, where applicable, pregnancy. That could be illegal, DeMio reports.

A Northern Kentucky Health Board spokeswoman told DeMio that they believe that they cannot require anyone to undergo any medical procedures, but said they were checking with legal counsel. Other health and harm-reduction officials told DeMio that this requirement is not legal, and that such a condition would likely prevent a program from getting off the ground.

"The Covington commission's resolution includes other conditions that differ from the health board's model program, too, and would require passage from the Kenton County Fiscal Court and the Board of Health before it's approved," DeMio writes.

These conditions include a requirement that two other counties in the Northern Kentucky Health District also adopt a needle-exchange program (only Grant County has); restrict use of the program residents of the district's four counties; and moving the exchange to St. Elizabeth Healthcare hospital.

The city also wants a one-for-one exchange, Michael Monks reports for The River City News.

The health department says its plan is "need-based," not one-for-one, because studies show that is the best way to reduce the risk of community exposure and spread of HIV and HCV. This is the main goal of the program, although needle-exchange programs also provide HIV and HCV testing and access to drug treatment.

The health department's plan is to initially provide clients with the number of syringes they would use in a week, along with a safe container for their return with instruction to return the used needles for new ones. Participants who don't return dirty needles after three trips would not receive new syringes, DeMio reports.

The department has been trying to establish needle-exchange programs in the district since the law passed one year ago. The Kenton County Fiscal Court is expected to discuss a needle exchange plan March 29, DeMio reports.

Dr. Lynne Saddler, the health department's director, told the Enquirer "that the Covington resolution was a start and that more discussion is planned by the health department."

Other counties

Madison County Health Department officials are also worried about becoming another Scott County, Indiana, as they face an epidemic of heroin use in their county, Bill Robinson reports for The Richmond Register.

Thus they have begun the process of educating their public officials, Robinson writes. Public Health Director Nancy Crewe presented her detailed findings to support a needle exchange at a quarterly joint meeting of the county Fiscal Court, Richmond City Commission and Berea City Council, noting that they were just beginning the long process of educating the public.

A needle exchange program was also brought up at the March meeting of the Anderson County Fiscal Court meeting, and was met with some disparaging remarks, Ben Carson reports for The Anderson News.

"What jackass thought of that idea?" asked Magistrate David Montgomery. "We might as well give them the dope, too."

Despite these comments, Montgomery did volunteer to be on a committee to explore a needle exchange program along with members of the health board, Lawrenceburg City Council, law enforcement, EMS and county jailer.

Robinson also reports that the Bourbon County Fiscal Court has voted to reject an exchange.

The other needle exchanges in the state that are either operating or have been approved are in Louisville and Lexington and in the counties of Pendleton, Carter, Elliott, Franklin, Grant, and Jessamine.

Princess Health and Bill to keep dirty needles out of landfills hijacked with amendment to require needle-exchange programs to be one-for-one. Princessiccia

Princess Health and Bill to keep dirty needles out of landfills hijacked with amendment to require needle-exchange programs to be one-for-one. Princessiccia

health departments legislation needle exchanges public health public safety

Gusty 11:38 Add Comment

By Melissa Patrick
Kentucky Health News

A House bill to educate the public about how to safely dispose of hypodermic needles easily passed was hit with a surprise amendment that would require a one-for-one needle exchange at needle exchange programs.

Rep. Mike Denham

The amended bill, which passed at the March 9 Senate Health and Welfare Committee meeting and now goes to the Senate floor, didn't set well with its sponsor, who said the amendment took him by surprise.

"At first blush, I have real problems with it," Rep. Mike Denham, D-Maysville, said in an interview. He said the amended bill would likely not pass in the House, but said he would review it and then decide whether to concur or not. He said he had already received emails and texts from his constituents telling him they did not support the committee substitute.

The original bill, House Bill 160, would require the state Department for Public Health to establish guidelines for disposal of hypodermic syringes, needles and other sharps used for home medical purposes and disseminate educational materials to pharmacies and the public. It was written to increase the safety of landfill workers who are at constant risk of being stuck by improperly disposed of needles.

Sen. Denise Harper Angel, D-Louisville, while supporting the original bill, voted no on the substitute and told the committee that the Louisville needle exchange program does not have a one-to-one requirement and is working well. "The effort here is to diminish disease," she said.

Sen. Ralph Alvarado

Needle exchanges were approved as part of an anti-heroin bill in 2015. Republican Sen. Ralph Alvarado, a Winchester physician, who voted for the substitute, said in an interview that the intent of the law was to only allow a one-to-one needle exchange. He said many senators would have voted against that measure if they had known exchanges did not have to be one-for-one.

The Office of the Attorney General released a formal opinion Dec. 18 that said needle-exchange programs in the state do not have to have a one-for-one exchange. The opinion was requested by state Senate President Robert Stivers of Manchester, who along with other Republicans, also say that the intent of the law was a one-for-one exchange.

Alvarado criticized then-Attorney General Jack Conway's opinion: "That wasn't how it was presented originally to the state." He added, "The one-for-one encourages more interaction, more opportunity for involvement for the provider to provide treatment for their disorders, to test them for communicable diseases and that sort of thing."

Dr. Sarah Moyer, the interim director of the Louisville Metro Department of Public Health and Wellness, said in an e-mail that not requiring a one-to-one exchange has been proven to reduce the spread of HIV and hepatitis C, which is the intent of the program. Kentucky leads the nation in hepatitis C and suffers more than 1,000 drug overdose deaths a year.

�A one-to-one syringe exchange implies that no needle sharing is occurring," Moyer wrote. "We know that is not the case. The �needs-based negation model� is a best practice across the country. Our goals are to prevent the spread of HIV and hepatitis C in our community and to stop intravenous drug users from sharing and reusing needles. The program is working! Participants continue to return used and potentially infected syringes for sterile ones."

She added, "Our latest figures indicate that one syringe is being returned for every 1.3 syringes distributed among returning clients. Overall the rate is 1 to 1.7. We have more than 2,000 participants and the number continues to grow. We�ve tested approximately 500 for hepatitis C and HIV and referred those who test positive to medical treatment. We�ve also referred 143 individuals to drug treatment."

Alvarado said, "Even if the health departments want to do it this way now, that is not how the law was intentionally meant to be passed."

Needle-exchange programs operating or approved in the state are in Jefferson, Fayette, Grant, Pendleton, Carter, Elliott, Franklin and Jessamine counties.

Princess Health and Lake Cumberland District Health Department using polls in an effort to get school boards to make campuses tobacco-free.Princessiccia

Princess Health and Lake Cumberland District Health Department using polls in an effort to get school boards to make campuses tobacco-free.Princessiccia

education health departments polls schools smokeless tobacco smoking smoking ban smoking bans tobacco tobacco prevention youth

Gusty 17:48 Add Comment

Countywide smoking bans are unlikely to pass anytime soon in most of rural Kentucky, but more county school districts are making their campuses tobacco-free. Now a multi-county health department is trying to get rural school boards to do that, with public-opinion polls showing that county residents overwhelmingly favor the move.

Department logo has been altered to
show Clinton County in yellow.

The Lake Cumberland District Health Department conducted the poll in Clinton County, and said it found that 86.55 percent were in favor and 7.16 percent were opposed. The rest had no opinion.

Making a campus tobacco-free means that members of the public are not free to smoke at school athletic events, so the poll also asked, �Would you like to see our school become tobacco-free at all events?� The results were virtually the same: 85.3 percent answered yes and 8.7 percent answered no, even though one-fourth to one-fifth of the county's residents smoke and it has a long history of raising tobacco.

"The results are perhaps surprising to some, considering the rate of tobacco usage in the county," reports the Clinton County News. The poll of 749 residents has an error margin of plus or minus 3.6 percentage points.

The department also surveyed 100 teachers in the school system and found that 77 percent would "definitely" support making the schools 100 percent tobacco-free.

The health department presented the survey and other findings to the Clinton County Board of Education June 15, but the board took no action. The department noted that a recent survey found that 28 percent of the county's students in eighth through 12th grades had used smokeless tobacco in the previous 30 days. "That level was the highest in the Lake Cumberland District," the Clinton County News reports.

The Casey County Board of Education adopted a smoke-free policy after a poll by the health department showed 70 percent of the county's residents favored it, the Casey County News reported.