Kentucky needs more needle exchanges to stem spread of infectious disease

Providing drug users with clean, new needles is a necessary public health strategy.
Providing drug users with clean, new needles is a necessary public health strategy. Pablo Alcalá palcala@herald-leader.com

A member of the board that oversees his county’s health department, Carter County Judge-Executive Mike Malone had worries when health department officials brought up the idea of giving clean needles to IV drug users.

Like many people, especially politicians, he worried that handing out needles might appear to be encouraging illicit drug use. But now he supports the program. “The more you learn about it, the more you’ll understand it’s the right thing to do,” Malone, a Republican, told reporter Bill Estep.

Carter County is one of 13 locations in Kentucky that have either approved or begun operating needle exchanges since they were legalized last year by the General Assembly in a wide-ranging effort to address heroin abuse in the state.

That’s a lot of progress in a short time but as Estep’s story Sunday explained, to avoid an epidemic of HIV and hepatitis C more Kentucky communities need to get on board, quickly.

The way exchanges work is that drug users bring in used needles and get clean ones in exchange. This gets dirty needles out of circulation where they are a danger to anyone who encounters them, including police searching subjects and children on playgrounds. At exchanges drug users can also be tested for and educated about infectious diseases. And, of course, it’s a way to reach out to those who want to get into treatment.

But the most fundamental motivation for the exchanges is to fight the spread of dreadful and costly blood-borne diseases, like HIV and hepatitis C, through needle sharing. Kentucky has the nation’s highest incidence of hepatitis C, a dreadful disease that can lead to liver failure and liver cancer. The drugs alone for treating one case of hepatitis C cost $86,000, Jennifer Hunter, the director of clinical services at Northern Kentucky District Health Department, told Estep. As much as 7 percent of Kentucky’s total annual Medicaid budget, $50 million, is spent on two drugs used to treat hepatitis C.

Needle exchanges have operated in other countries and in major cities of the United States for decades. Researchers have found over and over that not only do they not encourage drug abuse but that users who participate in the programs are much more likely to seek treatment. Still, the politics for allowing them in more rural areas only recently began to shift.

In this region the change happened quickly after Scott County, Ind., close by Louisville, gained national attention when the HIV infection rate there soared. Between November 2014 and October 2015, 181 new cases of HIV were diagnosed in the county of 24,000 which had reported only five new cases in the previous decade.

Researchers from the Centers for Disease Control drilled deep to find out what was going on. They found that some drug users there injected themselves as often as 15 times a day and shared needles with as many as six other people, a recipe for spreading disease. CDC also looked at the demographic profile and found a county that matched so many in Kentucky: rural and poor, with a high incidence of unemployment, prescription painkiller sales and overdose deaths. In fact, the analysis found 54 counties in Kentucky that were vulnerable to a disease outbreak among IV drug users, 18 of them more vulnerable than Scott County, Ind.

“I think a lot of health departments in Eastern Kentucky looked at it and said, ‘That easily could have been us,’” Kristy Bolen, an epidemiologist at the Ashland-Boyd County Health Department told Estep.

But Boyd and neighboring Carter counties are among only a handful of the at-risk Kentucky counties that have needle exchange programs.

That has to change or soon Scott County will be us.