Legislators need ask only one question as they consider tightening requirements on needle-exchange programs in Kentucky:
Would they like to increase or decrease the rate of hepatitis C and HIV in Kentucky?
This question arises in light of an opinion issued this month by the attorney general’s office about the programs, approved as part of the heroin legislation in the last legislative session, that allow local governments to establish programs to provide drug users with clean syringes. Commonly called needle exchanges, they reduce the spread of blood-borne diseases through sharing dirty syringes.
They are called exchanges because, ideally, drug users will bring in dirty needles and exchange them for clean ones. Dirty needles can infect anyone who touches them, including a child on a playground where one has been discarded, and police and other first responders called to help someone who has overdosed.
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In Lexington, which began its program in September, people must bring in dirty needles to receive clean ones. Louisville, which established the first program in Kentucky in June, does not require a one-to-one exchange of a dirty needle for a clean one.
Louisville’s approach, although considered a best-practice nationally, raised concern among some legislators. As a result, Senate President Robert Stivers, R-Manchester, asked the attorney general whether the legislation required people to bring in dirty needles as a condition of receiving clean ones. The resulting opinion found that the language of the legislation does not require an actual exchange.
It’s that decision that now has legislators muttering over enabling drug use and considering legislation to require an actual exchange.
Distributing clean needles, even if dirty needles aren’t returned, will reduce the awful health consequences — not just for the drug users — that stem from use of dirty needles.
Hepatitis C is found seven times more often in Kentucky than in the rest of the country, and the rate of infection is growing very rapidly among young adults. Health officials figure that might be a low count because in early stages the disease has few symptoms and so might be undetected.
Chronic hepatitis C is a deadly and expensive condition that can lead to liver damage or failure, liver cancer and death. In 2014 about 7 percent, or $50 million, of Kentucky’s Medicaid budget went for drugs for treating hepatitis C.
Whether Medicaid or a private insurer is paying the bill, the cost for a 12-week course of treatment can be $80,000 to $100,000, The New York Times reported this year. So, every clean needle offers the hope of significant savings in health and money.
It’s important to note that needle exchanges offer more than just syringes. They also distribute kits for sterilizing needles and safe containers for disposing of used needles. Drug users also have access to testing for hepatitis C and HIV, and access to information about drug treatment options.
Health officials reported that in the first few months of the Louisville program, 55 of the 822 participants had been referred for drug treatment. Initially, about eight clean needles were handed out for every dirty one that came in, but after about two months that rate dropped to less than 2-to-1 and is expected to drop further.
Kentucky has many real problems that need legislative attention. This is not one of them.