Pubdate: Tue, 24 Jan 2017
Source: Courier-Journal, The (Louisville, KY)
Copyright: 2017 The Courier-Journal
Contact:  http://www.courier-journal.com/
Details: http://www.mapinc.org/media/97
Author: Morgan Watkins

NEEDLE EXCHANGES SPREAD IN HEROIN-RIDDLED KY.

One woman relied on old needles used by her friend's diabetic husband.
Another settled for whatever syringes she could find.

But for the first time since they started using drugs several years ago,
both women have access to fresh syringes. They are getting them through a
needle exchange in Frankfort.

"If you can have a new one every time, why wouldn't you?" asked the
younger of the two women, who both spoke to the CJ on condition of
anonymity for fear of being stigmatized or getting fired. "I think it's
awesome that they're doing this.

"It's going to happen either way, you know what I mean?" she explained.
"They can actually help instead of ignoring the problem."

Since state lawmakers decided in March 2015 to allow needle exchanges in
Kentucky, 21 have been established, some in cities like Bowling Green,
others in rural communities like Williamstown.

[photo] Items available to intravenous drug users in an RV in the parking
lot at the Franklin County Health Department. The exchange is open on
Friday from 1 to 3 but will soon move into a more permanent location.
October 14, 2016 (Photo: By Michael Clevenger, CJ)

Health officials say the exchanges are needed to help stem the spread of
Hepatitis C and HIV in Kentucky, which is particularly vulnerable to both.
The U.S. Centers for Disease Control and Prevention recently identified
220 counties that are especially vulnerable to the rapid spread of both
among people who inject drugs, and 54 were in the Bluegrass State.

Greg Lee, director of the state's HIV/AIDS continuing education program,
said Hepatitis C, which can be spread by drug users sharing needles, can
have ripple effects that impact other people who need medical care. For
example, people with Hepatitis C can't donate blood.

Meanwhile, some state lawmakers think new restrictions should be enacted
to ensure the exchanges give out only as many needles as they receive, but
the people running the programs say that kind of mandate could hurt their
ability to combat the spread of disease.

For a while, it seemed only urban areas like Louisville and Lexington
would welcome needle exchanges, Lee said. But rural counties warmed up to
them last summer, which is also when Frankfort's exchange opened.

"It seems to be kind of mushrooming," he said, especially over the last 10
months.

To set up a needle exchange in Kentucky, the local board of health and the
governing bodies for the county and city in which the program will be
located must approve.

[photo] Amber Carmack watches as an intravenous drug user drops off used
syringes in an RV in the parking lot at the Franklin County Health
Department. The exchange is open on Friday from 1 to 3 but will soon move
into a more permanent location. Sally Brunner, RN, left, and Ashton Veno,
right, look on in the background. October 14, 2016 (Photo: By Michael
Clevenger, CJ)

These initiatives are a "no-brainer" for many health departments, but
securing support from city and county officials takes longer, Lee said.
Community buy-in is vital to the initiative's long-term success, but it
takes time, he said.

Beyond the needle exchanges that have already opened in Kentucky, another
seven counties -- Kenton, Boyle, Garrard, Powell, Clay, Nelson and Owsley
- -- have secured all the necessary approvals, although they haven't
launched their own programs yet, Lee said. And some local boards of health
have backed an exchange but haven't won the support of county and city
officials yet.

Then there are communities like Hopkinsville, where Mayor Carter Hendricks
said needle exchanges haven't even been discussed.

"The need has not yet really surfaced," he said. "The drug that's really
been the greatest problem in our area for the past two to three years has
been meth."

Needle exchanges haven't gained much traction in Western Kentucky, where
meth reigns, Lee said. But the state is seeing opioid use grow slowly
there.

[photo] Sally Brunner, RN, shows the different size syringes available to
intravenous drug users in an RV in the parking lot at the Franklin County
Health Department. The exchange is open on Friday from 1 to 3 but will
soon move into a more permanent location. October 14, 2016 (Photo: By
Michael Clevenger, CJ)

Some health departments are in no rush to put the issue to a vote. The
Bullitt County Health Department, for example, is still in the "education
and awareness phase," public health director Andrea Renfrow said.

The health department's job is to educate people, she said. And research
shows that needle exchanges don't increase drug activity but do help keep
diseases from spreading.

Despite the research Renfrow and other health officials cite, many
communities remain wary of needle exchanges, which have existed since the
1980s but are new to the commonwealth.

"Northern Kentucky has been the most difficult by far," Lee said. The
Northern Kentucky Health Department has advocated for needle exchanges,
but some elected officials are still cautious.

The Boone County Fiscal Court considered the idea last year, but none of
its members "felt comfortable" making a motion to proceed with an
exchange, Commissioner Charlie Walton said.

Yet Northern Kentucky, as well as Eastern Kentucky, have a greater need
for these programs right now than other parts of the state do because they
have counties that are at greater risk for an HIV outbreak like the one
that rocked Scott County, Ind., last year, Lee said.

[photo] Sally Brunner, RN, prepares items available to intravenous drug
users in an RV in the parking lot at the Franklin County Health
Department. The exchange is open on Friday from 1 to 3 but will soon move
into a more permanent location. October 14, 2016 (Photo: By Michael
Clevenger, CJ)

Lynne Saddler, district director of health for the Northern Kentucky
Health Department, said that region's high Hepatitis C rates are still
rising.

"This is just a tool that we need to do our jobs in controlling diseases,"
she said of needle exchanges. "That's all it is, and if we can help people
get into treatment and get on a better path in life, all the better for
everyone."

Grant County launched a needle exchange last spring and all the necessary
approvals for one in Kenton County have been secured, Lee said. But
elected officials in Kenton want an exchange in Campbell or Boone County
to be fully authorized before opening their own.

Needle exchanges are supposed to stymie the spread of diseases like HIV
and Hepatitis C by reducing people's reliance on sharing syringes.

But some state lawmakers, as well as Gov. Matt Bevin's administration,
have expressed support for a controversial mandate that might make it
difficult for health departments to eradicate needle sharing.

This "one-for-one" mandate would require needle exchanges to receive one
dirty syringe for every clean one they dole out.

Republican state Sen. John Schickel, who represents Boone County, opposes
needle exchanges but said he doubts they could be eliminated now. He hopes
a one-for-one requirement is approved, at least.

"To have the government provide someone who is taking illegal drugs the
means to do it is wrong," he said. "It sends a mixed message, especially
to our young people."

Now that the Republicans control Kentucky's legislature and its executive
branch, a one-for-one requirement may be reconsidered during this year's
legislative session. The Bevin administration already requires needle
exchanges funded through state grants to stick to a one-to-one ratio.

[photo] A sign alerting participants about the syringe exchange program
hangs on an RV in the parking lot at the Franklin County Health
Department. The exchange is open on Friday from 1 to 3 but will soon move
into a more permanent location. October 14, 2016 (Photo: By Michael
Clevenger, CJ)

Bevin believes a "true one-for-one needle exchange will get us closer to
the goal of reducing the number of needles on the street," an emailed
statement from the Governor's Office said.

But health officials say a one-for-one requirement could hamper the
effectiveness of the exchanges, where some people who inject drugs are
still afraid to go. "You're not really providing enough clean syringes to
keep sharing from happening," Lee said.

A one-to-one ratio is a good goal but not good policy, said Wayne
Crabtree, who oversees the Louisville Metro Department of Public Health
and Wellness's needle exchange operation.

"We can be bold," he said. "Or be 'safe' and find ourselves back in the
hole."

Building trust with the people who would be helped by needle exchanges
takes time.

"It's very humiliating and humbling to come here," said a woman wearing
bright tights who frequents the exchange in Frankfort. She said she has
tried to get friends to visit the exchange, which doesn't ask for names,
"but they're afraid to be marked."

For her, Frankfort's program has been a godsend. "It does no good to have
people reusing needles over and over again," she said. "You have to make
it as safe as you can."

And though she's repeatedly said "no" when asked if she's interested in
substance abuse treatment (which she's tried before), she said it's a
question the staff needs to keep asking.

For most people who go to needle exchanges, the employees they meet there
are the only sober people in their lives, Crabtree said. The stigma
associated with addiction keeps people from treatment, but forging those
personal connections can have an impact. Someone who uses a needle
exchange is five times as likely to enter treatment as someone who
doesn't.

Last fall, a middle-aged couple visited Frankfort's exchange for the first
time. Their friends were "too scared" to come, said the woman, whose
copper hair was pulled back in a ponytail.

[photo] Amber Carmack watches as an intravenous drug user drops off used
syringes in an RV in the parking lot at the Franklin County Health
Department. The exchange is open on Friday from 1 to 3 but will soon move
into a more permanent location. October 14, 2016 (Photo: By Michael
Clevenger, CJ)

"Tell your friends: No IDs, no problem," an employee told them. They
promised to spread the word.

The couple said they appreciated that the staff didn't treat them like
junkies. Medical problems propelled them toward pain pills, but they
planned to be off them soon, the woman promised, for their son's sake as
well as their own.

"We're getting ready to get into a program to get some help. I've just
seen too many people die," she said. "I'm going to do it. I'm not going to
give up."

Reporter Morgan Watkins can be reached at 502-875-5136  ---
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