By Rice C. Leach, M.D., President, Lexington Medical Society
This brief note is to share general information about needle exchanges and the people it will serve. It is not intended to be a detailed analysis of SB 192 but it is an overview of what is happening at the Lexington-Fayette County Health Department (LFCHD) and it offers some insight into those who use drugs.
Senate Bill 192, the “heroin bill”, passed by the Kentucky General Assembly is in response to the rapidly increasing number of deaths from overdose in Kentucky and related issues. It authorizes health departments to operate needle exchange programs and to refer patients for help so the LFCHD and the Board of Health decided early on to act. The department has produced a preliminary design to operate an exchange at the health department and is reviewing it with the appropriate community partners. From the outset the department decided to focus on (1) a needle exchange as part of the communicable disease program, (2) a way to accept referrals from outside for the needle exchange and related services and (3) a way to develop a referral network for patients needing infectious disease or substance abuse services. The initial planning included consultation with the Kentucky Department for Public Health, national substance abuse experts and persons experienced in operating needle exchange programs in Cincinnati and other cities. We learned quickly that the take home message is: get started, get as many clean needles on the street as you can, keep it simple, don’t be overly prescriptive, be flexible and build trust with the people you serve.
Communicable disease control: The health department has expertise in communicable disease control and the problem is real. Kentucky has the worst statistics in the country for hepatitis (over 7 times the national average for the rate of hepatitis C and 4 times the rate of hepatitis B) and needle exchanges have been shown to be an effective way to interrupt their spread among drug users and into the general population as sexually transmitted diseases and they increase health care costs.
Referral for other services: Health departments are expected to accept referrals from emergency medical services and emergency departments and to expedite access to treatment for infections and for drug abuse. Part of the challenge in meeting these expectations is that health departments are expected to do these this without using any state or federal public health funds. That means that communities develop effective partnerships to manage the potential increase in cases.
In Lexington the preliminary design is being reviewed by law enforcement, hospitals, mental health organizations and others including heroin addicts to determine what needs to change before we start. The comments from partners have not been completed but we do have some input from drug users. We interviewed drug users incarcerated in Lexington on drug related charges and got very good advice. These men and women emphasized the need to make sure that the participants bring in their needles to be exchanged otherwise they will toss them somewhere in a park or some other public place. They told us to make sure that law enforcement officials won’t penalize them for taking part in the needle exchange program and to make sure that department staff can be trusted to maintain confidentiality. Some noted that many people in emergency departments talk down to them so they don’t come in for help with things like infections; instead they wait until we are so sick that they have to be admitted. They said that the lack of access to detoxification centers is a barrier to entering a drug rehabilitation program because the rehab programs won’t take them until they are ‘clean’. All of them wished they could kick the habit and all of them said that a needle exchange program will not increase the number of addicts–people who are going to be addicts will do so with or without needle exchanges.
One of the inmates, a young woman in her early twenties spoke about the human side of drug abuse—a side that rarely gets media attention. Her poem about her experience follows. She described drug abuse as she sees it so I share it with the reader. Perhaps needle exchange can be an entry in to treatment for some and that some of the participants join the ranks of those who have successfully quit. One has to hope so because this drug abuse problem is eroding our state’s future human capital.