Showing posts with label needle exchanges. Show all posts
Showing posts with label needle exchanges. Show all posts

Wednesday, 8 June 2016

Princess Health and Official praises needle exchanges and medication-assisted treatment for addiction: 'Treatment works. Recovery is possible.' . Princessiccia

Scott Hesseltine
Scott Hesseltine, the new vice-president of addiction services at Louisville's Seven Counties Services, talked on Kentucky Educational Television about needle exchanges and a new model of addiction treatment that combines medication assisted treatment with an abstinence-based model of care.

"We are in the midst of a tragic public-health crisis and it's claiming the lives of our citizens at astronomical rates," he said, noting that more than 1,000 people die from drug overdoses in Kentucky each year and that the state has the highest rate of hepatitis C in the nation.

Seven Counties Services provides behavioral-health services, primarily for people on Medicaid, in Jefferson County and six neighboring counties: Henry, Oldham, Trimble, Spencer, Shelby and Bullitt.

The interview on "Connections with Renee Shaw" was part of KET's "Inside Opioid Addiction" initiative, which is funded in part by a grant from the Foundation for a Healthy Kentucky. It aired in June.

Hesseltine, who came to Seven Counties Services from the Hazelden Betty Ford Foundation, a nationally recognized drug and alcohol treatment center, commended Kentucky's "forward thinking" in passing an anti-heroin bill last year.

Among other things, the bill allows needle exchanges to decrease the spread of infectious diseases, like hepatitis C and HIV, that are commonly spread by drug users sharing needles. They require both local approval and funding and have met with some resistance because many think they condone or perpetuate drug use.

Asked about that, Hesseltine said research shows that needle exchanges do what they are meant to do -- reduce the incidence of infectious disease among intravenous drug users.

He noted that Justice Secretary John Tilley, who was instrumental in passing the heroin bill as a state representative, said at a recent community forum in Corbin that research found that addicts who are involved in needle exchange programs are five times more likely to enter treatment.

"And we know treatment works and recovery is possible, so any avenue to slow the spread of disease and to help more people find the solution in recovery is a positive thing," he said.

Another point of contention among some lawmakers is that some of the state's needle-exchange programs don't adhere to a needle-for-needle exchange, which they say was the intent of the law,but instead provide as many needles as the addict needs for a week.

Hesseltine said the needs-based model decreases needle sharing and thus disease, so "Needs-based is more appropriate; it is more evidence based."

Hesseltine told Shaw that while working at Hazelden, he was part of an initiative that completely "altered the way we provided care." The new program, called COR-12, combines medication-assisted treatment with the 12-step abstinence model, which had been the only accepted recovery treatment program at Hazelden.

Hesseltine brought the new model with him to Seven Counties Services and said he likes to call it "medicated assisted recovery." He said "It has to be done appropriately so we are helping to stabilize someone from their biological symptoms of addiction so they can then engage in the recovery process."

Hesseltine told Shaw that addiction isn't curable, but is treatable.

"I would say it is a chronic disease that can be put into remission with structure, support, accountability and behavioral interventions," he said. "Curable? No, but like diabetes -- not curable, but certainly manageable."

Shaw asked if any addict is beyond reach. "Only someone who is not alive," Hesseltine replied. "Treatment works. Recovery is possible." He said that is why access to naloxone, the overdose-reversal drug branded as Narcan, is so important.

Asked what policy changes he would like to see, Hesseltine listed increased funding for drug treatment, "high level" models of care that shift addiction services to local communities, and repeal of the Medicaid rule that doesn't allow any reimbursement for mental-health and substance-use-disorder residential treatment facilities with more than 16 beds.

With treatment, Hesseltine said, "People can go from a pitiful and incomprehensible demoralization, a state where they have no hope to one of having hope, to being a productive member of society and to really regaining a place where they feel good about themselves and they are leading a life full of joy and freedom."

Wednesday, 25 May 2016

Princess Health and Woman stuck by needle faces up to one year of testing for HIV and hepatitis; dirty needles becoming common in public places. Princessiccia

By Melissa Patrick
Kentucky Health News

A Monroe County woman was stuck by an insulin needle found in a pair of sweatpants she purchased at the Walmart in Tompkinsville and now faces up to a year of testing to make sure she hasn't been infected with HIV or hepatitis, Jacqueline Nie reports for WBKO-TV in Bowling Green.
Insulin syringes are commonly used by IV drug abusers

"I had to be tested for HIV and hepatitis and a drug screening," said Mary Crawford, who was stuck by the needle. "I have to go back from that in 30 days and be tested again, and again in 6 months from that 30 days."

"Crawford says through at least these next 7 months, she cannot share anything with her husband or children," Nie repports. Crawford warned others to be careful: "It could happen to anybody, anywhere."

The latest Kentucky Health Issues Poll found that 13 percent of Kentuckians said they knew someone with heroin problems. And insulin syringes and needles are commonly used to inject it.

Clark County Public Health Director Scott Lockard said that while this was the first time he had heard of a needle being placed in an article of clothing in a department store, he said it is not unusual for dirty needles to be found in public.

"Unfortunately it is becoming more common for used needles to be found by the public," Lockard said in an e-mail. "I have had reports of needles being found locally on streets, in parks, public parking lots, unoccupied buildings, and in restrooms in public venues."

The problem is so bad in Northern Kentucky, where 35 percent in the poll said they knew someone with a heroin problem, that they released public service announcements before Easter to remind children to look for needles before eggs. The Northern Kentucky Heroin Impact Response Taskforce organized police and egg-hunt organizers to search parks for needles prior to the hunts, and said it will continue to search public places for needles throughout the summer, Ben Katko reported for WXIX-TV (Fox 19).

One way to keep dirty needles off the street is through needle exchanges, which allow intravenous drug users to exchange dirty needles for clean ones. These programs were authorized in Kentucky by the 2015 anti-heroin bill, but require both local support and funding.

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. Some jurisdictions have rejected exchanges, saying they encourage drug use, despite pleas from experts who say that's not true and the programs lead users to treatment.

"Needle exchanges work," former state health commissioner William Hacker said. "It decreases the spread of infectious diseases. It takes dirty needles off the street. It is safer for the law enforcement and EMS. It also provides an opportunity to interact with people and divert them to effective treatment."



Sunday, 22 May 2016

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

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."

Friday, 6 May 2016

Princess Health and  Three more Kentucky counties get needle exchanges; several others discussing, some debating; most are in early stages. Princessiccia

Princess Health and Three more Kentucky counties get needle exchanges; several others discussing, some debating; most are in early stages. Princessiccia

By Melissa Patrick
Kentucky Health News

Harrison, Pike and Knox counties are the latest in Kentucky to approve a needle-exchange program, bringing the total number of counties to 14, and several more are getting close.

Needle exchanges were authorized by the 2015 anti-heroin bill 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.

The other counties that have either approved or are operating needle exchanges are Jefferson, Fayette, Pendleton, Carter, Grant, Jessamine, Franklin, Clark, Boyd, Kenton and Elliott.

Campbell County close, could have domino effect

The Campbell County Fiscal Court voted 3-1 May 4 to approve a needle exchange and now awaits the support of the City of Newport, Mark Collier of Fort Thomas Matters reports for WCPO-TV, its news partner.

If approved, the exchange will be be operated by the Northern Kentucky Health Department and paid for by a grant from the R.C. Durr Foundation. It also has a a sunset provision that would make it expire Dec. 31, 2018.

Commissioner Charlie Coleman, the only dissenter, said he opposed the exchange because Campbell County residents told him "overwhelmingly" that they didn't want one, Collier reports. He was also not comfortable with the proposed location in the Fiscal Court building.

While Kenton County has approved a mobile needle exchange and the City of Covington has also approved one, both programs are contingent on Boone or Campbell counties to join the effort.

The Fort Mitchell City Council passed a resolution April 18 supporting a needle exchange, making it the second Kenton County city to do so. Independence passed a similar resolution earlier this year, Melissa Stewart reports for The Cincinnati Enquirer.

Some counties in very early stages

The Whitley County Board of Health has unanimously voted in support of a needle exchange program, Mark White reports for the Corbin-Whitley News Journal. The county health department and the Whitley County UNITE Coalition, which works toward reversing the country's opioid epidemic, have held a public meeting to discuss the topic.

Mercer County will hold a community forum May 16 from 6 to 8 p.m. at the county Extension office to discuss a needle exchange, Kendra Peek reports for The Advocate-Messenger in Danville. Their program has been prompted by reports of two people stuck by discarded needles in public places in the county. County Judge Executive Milward Dedman told Peek he was "leaning in favor of it."

Nelson County is also considering a needle exchange, Randy Patrick reports for The Kentucky Standard in Bardstown. The public-health director for the Lincoln Trail District Health Department, Sara Jo Best, gave a presentation in support of the program April 19 at the Nelson County Fiscal Court meeting.

The Laurel County Board of Health is considering a needle exchange and will further discuss it at its June 9 meeting, Kelly McKinney reports for The Sentinel-Echo.

Ben Carlson of The Anderson News recently told what now reads like a familiar story about the exchange that occurs in an early needle exchange educational meetings. The Anderson County Health Department held such a meeting April 25.

At the meeting, health officials shared research showing that needle exchanges decrease the rates of HIV and hepatitis C caused by shared needle use; do not increase drug use; help connect users with counseling and treatment; and get dirty needles off the street.

It also included complaints from opponents who say that needle exchanges are "tacit approval of IV drug abuse." The foes included peace officers.

�The sheriff and I have over six decades of law-enforcement experience combined, and we�ve used those to teach children about the dangers of drugs,� said Chief Deputy Sheriff Joe Milam. �We�re not going to say don�t use drugs, but if you do, use this. We are not in favor of this.�

Exchanges get use, award

Lexington's needle exchange program is adding on-site referrals to rehabilitation programs to its needle exchange, which has been operating since September, reports the Lexington Herald-Leader. Since its opening, the program has received 10,297 used needles and given out 10,803 clean ones.

The Little Sandy District Health Department, which runs needle exchanges in Olive Hill and Grayson, recently received the Kentucky Public Health Association Commissioner's Award for its needle exchange. Since Feb. 4, more than 500 dirty needles have been exchanged in both Carter County locations, Joe Lewis reports for the local weekly, the Journal-Times.

Tuesday, 26 April 2016

Princess Health and More than 100 at SOAR Substance Abuse Roundtable committed to work on prevention and treatment efforts in region. Princessiccia

By Melissa Patrick
Kentucky Health News

More than 100 people attended the Shaping Our Appalachian Region Substance Abuse Roundtable April 7 to learn about current research and emerging opportunities associated with substance abuse and intravenous drug use in region, according to a SOAR news release.

SOAR is a bipartisan effort to revitalize and diversify the economy in Kentucky's 54 Appalachian counties. It has advisory councils for each of its 10 areas of focus, one of which is community health and wellness.

That council's chair, former state health commissioner Dr. William Hacker, facilitated the roundtable at Natural Bridge State Resort Park.

As part of the solutions-driven discussion, Susan Zepeda, CEO of the Foundation for a Healthy Kentucky, told the attendees that it is important to ask the right questions when gathering information about drug abuse to accurately depict what is going on in the region.

�When you ask people if they have a problem with prescription drugs they, of course, say no,� Zepeda said. �When you ask them if they know someone, like a family member or friend, that answer is very different.�

The group also discussed the importance of getting accurate data about substance abuse and overdose into the right hands to make progress on these issues.

�We want to get data into the hands of legislators and those who can do something about prescription-drug overdose,� said Dana Quesinberry, public-health-policy and program evaluator for the Kentucky Injury Prevention and Research Center at the University of Kentucky. �Sitting in a repository, it doesn�t do anything for anyone.�

The roundtable members also discussed needle-exchange programs, authorized under the state's 2015 anti-heroin law. The program is meant to slow the spread of HIV and hepatis C, which are commonly spread by sharing of needles among intravenous drug users.

�We�ve seen a switch from using pills as an opioid to using intravenous methods,� said Greg Lee, the HIV/AIDS continuing-education program director for the state Cabinet for Health and Family Services.

Clark County Health Director Scott Lockard said the federal Centers for Disease Control and Prevention issued a "wake-up call" with its report identifying 54 Kentucky counties as being among the 220 most vulnerable in the nation for the rapid spread of HIV and hepatitis C infection among intravenous drug users. Most of the counties, and eight of the top 10, were Appalachian.

"We are potentially on the leading edge of one of the biggest public health crises to hit our state," Lockard said in an e-mail to Kentucky Health News. "It will take a combined effort across sectors to prevent an HIV outbreak in the SOAR region such as the one that occurred in Scott County, Indiana," just north of Louisville.

Although many Kentucky county officials are talking about needle-exchange programs, so far only Louisville and Lexington and the counties of Boyd, Carter, Clark, Elliott, Franklin, Grant, Harrison, Jessamine, Knox, Pendleton and Pike are either operating or have approved such programs. Of these, Boyd, Carter, Clark, Elliott, Knox and Pike are part of SOAR.

The news release noted that participants left the discussion with a commitment to continue the conversation and to build a strategic plan to address substance abuse issues in the region, with a focus on clinical practices, health systems, drug screenings and other best practices.

Thursday, 31 March 2016

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

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.

Thursday, 24 March 2016

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

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.

Thursday, 10 March 2016

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

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.

Friday, 12 June 2015

Princess Health and Louisville opens first needle exchange in state; officials predict rural counties will be slow to follow.Princessiccia

Photo by Scott Utterback, The Courier-Journal
Louisville Metro Public Health & Wellness opened its mobile needle-exchange program Wednesday, June 10, making Louisville the first place in Kentucky to implement such a program.

Lexington and Northern Kentucky are expected to follow soon, but officials say that establishing needle exchanges in much of Kentucky will be "more politically complex," Mike Wynn reports for The Courier-Journal.

"We're going to see some parts of our state where this is available and others where it is not," Scott Lockard, president of the Kentucky Health Departments Association, told Wynn. "Rural areas are opting for a slow and deliberate approach, heavy on education and dialogue," he said, and some communities won't even consider a exchange because of "seemingly endless hoops to jump through."

Bullitt County, south of Louisville, is a prime example. There, officials told Wynn that they plan to do a needs assessment and host a community forum with input from law enforcement and mental health experts.

"It's a work in progress," Public Health Director Andrea Renfrow told Wynn. "We are not able to go as quickly as Louisville Metro."

One critic, Magistrate Joe Laswell, told Wynn that he had talked to many voters who are against the exchanges and want to know why police wouldn't arrest addicts when they show up to swap out dirty needles. "I believe in charging and incarcerating," he said, apparently unaware that the addicts would need to have drugs in their possession to be charged.

Lockard, who heads the Clark County Health Department, told Wynn that he won't ask his board to take a vote until August and that he can't predict the political outcome when it goes to city and county officials.

In three other Bluegrass counties, Scott, Harrison and Nicholas, the board of the Wedco District Health Department wants to start a needle exchange, reports The Cynthiana Democrat, but can't proceed in any of the counties without approval of the fiscal court.

So, despite the two-year debate that just ended in Frankfort over the law, it's not really over.

Democratic state Rep. John Tilley of Hopkinsville, the legislature's biggest proponent for needle exchanges, told Wynn that giving city councils and fiscal courts final authority over the programs was necessary to sooth critics and pass a comprehensive heroin bill this year.

Opponents of the law say the exchanges promote drug use, while proponents cite evidence that doesn't support those claims, but instead "help prevent the spread of deadly and expensive diseases and pull addicts into treatment programs while keeping dirty needles out of parks and off the streets," Wynn writes.

A Lexington Herald-Leader editorial wrote about needle exchanges: "Congressional critics rely on a gut feeling that providing needles endorses drug use, but 20 years of research argues otherwise." Listing that where there are syringe exchange programs:
  • Participants are five times more likely to get treatment.
  • HIV and hepatitis C declines among drug users.
  • Participants can get referrals to substance abuse treatment, disease prevention education, vaccinations, condoms, counseling and testing for communicable diseases.
  • Costs are more than recaptured. A 2011 European study found that $1 spent on needle-exchange programs yielded $27 in health-care cost savings, prompting an international report to call needle exchanges "one of the most cost-effective public health interventions ever funded."
The federal Centers for Disease Control and Prevention recently reported that new cases of hepatitis C more than tripled in Kentucky, Tennessee, Virginia and West Virginia between 2006 and 2012, mainly from the use of dirty needles. Officials fear an outbreak of HIV and AIDS will follow.

Sunday, 7 June 2015

Princess Health and Hepatitis C is on the rise in Appalachian Kentucky, and dirty needles are to blame; officials predict surge of HIV to follow.Princessiccia

Kentucky has the highest rate of acute hepatitis C in the nation and public officials predict it could get much worse, Claire Galofaro and Dylan Lovan report for the Kentucky bureau of The Associated Press.

Dirty needles shared by drug users is the primary cause of this upsurge in hepatitis C, a contagious liver disease that destroys the liver, often leads to cancer or cirrhosis, and is the leading cause of liver transplants. It is spread primarily through contact with the blood of an infected person.

Patton Couch talks about his troubles.
(AP photo by David Stephenson)
Patton Couch, 25 and one month sober, is one of thousands of young Appalachian drug users recently diagnosed with hepatitis C. Galofaro tells the story of how one night four years ago, Couch said �he plucked a dirty needle from a pile at a flophouse and jabbed it into his scarred arm� even though he knew most of the addicts in the room probably had hepatitis C.

"All I cared about was how soon and how fast I could get it in," he says. "I hated myself, it was misery. But when you're in the grips of it, the only way I thought I could escape it was one more time."

Public-health officials are also concerned that Kentucky or part of it will become the next Scott County, Indiana, which is dealing with one of the worst American HIV outbreaks among injection drug users in decades, Galofaro notes. She says Scottsburg is much like many Appalachian towns � which have poor and/or few treatment options, and have long been seized by an epidemic of prescription drug abuse.

"One person could be Typhoid Mary of HIV," said Dr. Jennifer Havens, an epidemiologist at the University of Kentucky's Center on Drug and Alcohol Research, who has studied Perry County drug users for years as the hepatitis rate spiraled through small-town drug circles there. Of the 503 drug users she has tracked since 2008, 70 percent have hepatitis C.

�An explosion of hepatitis C, transmitted through injection drug use and unprotected sex, can foreshadow a wave of HIV cases,� Galofaro writes.

In Scott County, 160 people have tested positive for HIV in five months, compared to just 49 drug users testing positive in New York City in all of 2013, Greg Millett, director of public policy for the Foundation for AIDS Research, told Golofaro. �This is a canary in the coal mine for other places with high rates of hepatitis C,� he said.

In a study released last month, the federal Centers for Disease Control and Prevention found that hepatitis C cases across four Appalachian states � Kentucky, Tennessee, West Virginia and Virginia � more than tripled between 2006 and 2012.

Kentucky leads the nation in the rate of acute hepatitis C, with 4.1 cases for every 100,000 residents, more than six times the national average, according to the CDC.

Officials in Appalachian are �scrambling to figure out how to stop it, whether through needle exchange programs, drug treatment or jail,� Galofaro writes.

Kentucky passed a law in March allowing local health departments to create needle-exchange programs. The guidelines have been set, but it is up to the counties to decide whether they want one.

Louisville and Lexington plan to launch needle exchange programs this summer, but �few rural communities have expressed interest,� possibly letting the larger cities work out the details first, Van Ingram, executive director for the Kentucky Office of Drug Control Policy, told Galofaro.

Even with the law in place, the debate about the needle-exchange programs persist. Proponents maintain that �we have to change the way we think� about treatment and that doing nothing is not an option, others told her that in small communities, the �fear of being exposed as a drug user may keep users away,� and others objected on a moral ground, �claiming they facilitate drug use rather than prevent it,� Galofaro reports.