Hospitalizations and deaths due to heroin overdoses are on the rise in Kentucky. According to the Kentucky Injury Prevention and Research Center, the number of Kentuckians hospitalized for heroin overdoses more than doubled from 2011 to 2012.
In addition, deaths from heroin overdoses among Kentucky residents have skyrocketed from 12 in 2008 to 215 in 2013. Kentucky also has some of the highest rates of drug overdoses and acute hepatitis C infection in the nation.
This year, the General Assembly enacted, and Gov. Steve Beshear signed into law, permissive legislation that enables local jurisdictions to establish needle exchange programs (NEP), also known as "harm reduction programs."
To some, a needle exchange may sound like a program that helps intravenous drug users feed their habit. To the contrary, the intent is to protect public health and create a path for heroin users to get treatment while preventing the spread of diseases through the sharing of needles.
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One critical role needle-exchange programs play is in reducing the number of HIV/AIDS and hepatitis cases spread within a community. The use or even the accidental stick of a dirty needle can lead to hepatitis, HIV/AIDS infection and other dangerous diseases.
For example, a recent outbreak of HIV/AIDS in a small community in southern Indiana was traced back to needle sharing. As of 2014, about 15 percent of all HIV cases that have occurred in Kentucky have been among injecting drug users. NEPs can assist in stopping transmission of HIV and acute hepatitis C among injecting drug users.
Another important role needle exchanges have is protecting the community at large from accidental sticks from dirty needles discarded in public places. Intravenous drug users submit dirty needles for proper disposal in exchange for clean needles. This arrangement provides an incentive not to leave dirty needles in parks, playgrounds or other public spaces where they could harm the general public.
National and international research studies show that NEPs do not encourage the initiation of drug use nor do they increase the frequency of drug use among current users. The presence of these programs in communities does not expand drug-related networks nor does it increase crime rates. On the contrary, the World Health Organization maintains "there is no convincing evidence of any major, unintended negative consequences" related to these programs.
Needle-exchange programs actually create a path for injecting drug users to get help because the programs offer information on how to find available treatment options. In fact, NEP participants are more likely to enter a drug treatment program than nonparticipants. Researchers have also found that injecting drug users who participated in an exchange were more likely to reduce or stop injecting than drug users who had not participated in a needle exchange.
Studies also show that NEPs provide opportunities for disease testing and education, leading to a decline of at-risk behaviors resulting in HIV incidence dropping as much as 80 percent within this population.
As of August 2012, there were 203 needle-exchange programs in 34 states in the U.S. and the District of Columbia. Kentucky's new law allows a local government to operate a program, but it does not require any community to do so. If the citizens of a community do not approve of a NEP, then local officials can certainly choose not to have one. These programs cannot be funded by federal dollars.
Currently, medical and substance-use disorder experts from the University of Kentucky, University of Louisville Medical Centers, state officials, local health departments and St. Elizabeth Hospital have prepared guidance for communities that wish to start a NEP to ensure the most effective and safe programs are developed. As these programs are implemented, more data can be collected on the effects on drug use and the spread of disease.
Arrest and incarceration of individuals suffering from substance-use disorders are costly and do not necessarily solve the problems created by addiction. NEPs provide communities the opportunity to try something that has been successful in other states. Many Kentucky communities are desperate for the ability to reach out to members who suffer from addiction, to help slow the spread of diseases and provide treatment referrals to people they might otherwise never have the chance to reach. This law gives them that opportunity.