A bill went into effect in March which amended KRS 218A.510 to allow local health departments in Kentucky to operate needle exchange programs.
A needle exchange program is a substance abuse treatment outreach program which allows drug users to exchange used hypodermic needles and syringes for sterile, unused ones.
According to the statute, authority to operate an exchange is given to local health departments by the local board of health, county legislative body and city legislative body. The statute also allows for any one of these bodies to revoke the authority they grant for any reason.
The Kentucky Department for Public Health issued a “Guide for Local Health Departments Implementing Needle Exchange Programs” shortly after the statute went into effect. The guide calls needle exchanges “Harm Reduction and Syringe Exchange Programs” and says the goal is to supply clean needles to lessen the possibility of infection from shared needles, as well as help injection drug users find treatment and social services they may not be familiar with.
The guide says the public health benefits of HRSEPs are strong, because data has been collected since they began operating in the late 1980s. HRSEPs provide condoms, collect potentially infected syringes and issue new sterile syringes for users to use. That way users aren’t using contaminated needles, used needles are disposed of properly which decreases the spread of disease among users and risks to the public are minimized.
The average cost of a syringe is 97 cents and the average number of injections for users is 1,000 per year, so the cost of treatment is much less than the average cost of treatments such as HIV, which is over $600,000 and Hepatitis C, which is between $100,000 and $300,000 per person according to the guide.
The guide goes on to explain different types of delivery for services and registration guidelines for clients which provides accurate data on disease and drug use for the area. It allows for fixed and mobile installations as well as the types of exchanges allowed. A strict one for one exchange means users must have contaminated needles in order to obtain new ones. Needs based services focus on getting users sterile syringes regardless of whether addicts have needles to dispose of and a one for one plus exchange offers a set group of syringes to be issued, but users must dispose of at least some syringes to obtain new ones. First time visitors are given syringes regardless of whether they bring in any for disposal, but are required to turn in on the next visit.
Hepatitis and Harm Reduction Manager for the New Mexico Public Health Office Dominick Zurlo provided information on a county similar to Harlan County in size and population. Grant County New Mexico has about 30,000 residents. The location of the HRSEP in the county is in Silver City, and they use a one for one plus plan. Zurlo explained they offer packs of ten syringes. After clients are registered they receive a pack along with proper tests for HIV, Hepatitis and other infections commonly spread by injection drug use. He said after the initial pack is distributed, clients must turn in at least one used syringe to receive the next pack. The HRSEP also offers many treatment opportunities for clients and provides pat down gloves to police, so they aren’t stuck with needles provided by the program. In 2014 he said the Silver City PHO issued 29,590 sterile syringes and collected 28,500 contaminated ones.
Zurlo stressed the importance of anonymity while still allowing data collection and monitoring. To solve this contradiction he said they give clients an alias after they register for services. He said it makes clients feel at ease, while still allowing the PHO to collect vital data for the program.
Zurlo couldn’t comment on actual statistics regarding the spread of disease (Hepatitis C,B and HIV) due to HIPPA concerns, but he did say “the program has been very effective, and close to the national average in those areas,” and later added, “Our law has been in effect since 1998 and Grant County should offer a pretty good model for success that Harlan County can go by.”
According to a representative from the Harlan County Health Department there have been no talks of implementing a HRSEP in the county yet. The representative also added there had been no talks among the members of the local health board at the time of the interview. According to the statute only local health departments can operate a needle exchange in Kentucky. Reports from both the Louisville and Lexington HRSEPs say the programs in those cities have been effective in stemming the spread of disease among their IV drug users.
Reach Bradley Fields at 606-909-4146 or on twitter @bradley_HDE