CLARK COUNTY — Health officials in Indiana are moving forward with actions needed to implement the needle exchange that was approved Monday, and in the works for nearly a year.
The need for the program, now called The Exchange, comes after Clark County experienced a three-year upward trend of increasing deaths due to drug overdose, with cases of HIV and Hepatitis C higher than state average, according to the program application sent to the Indiana State Department of Health. Its proximity to Scott County, which has seen close to 200 positive cases of HIV in the past two years, brings concern that Clark county could follow.
In July 2015, Clark County declared a state of emergency and in September 2015, the county identified its first case of HIV associated with intravenous needle sharing. As of this week, 69 people have died in Clark County from drug overdose compared with 60 in all of 2015.
Last year brought 15 new cases of HIV and 200 cases of Hepatitis C to Clark County.
WHAT TO EXPECT
Once the program is off the ground, community members who actively engage in intravenous drug use will be able to safely and anonymously exchange their used needles for new ones at the health department clinic on Akers Avenue in Jeffersonville.
In the beginning, it will operate from 9 a.m to 3 p.m. Thursdays, staffed by trained volunteers.
Dr. Kevin Burke, Clark County health officer, said it's important to relate to those using the program with respect and empathy, without judgement.
“We need to make sure volunteers are properly trained so that people leave feeling like they've been respected, like they've been helped,” he said. “That it's something they'll continue to do and encourage their friends and other users they know to come to the exchange to get the needles.
“How these individuals are treated will determine the longterm success of the program.”
FIRST VISIT
When people visit The Exchange for the first time, they will go through an intake process, Burke said.
“We assess how they're doing mentally and physically, ask them what kind of services they think they might need and we can help set up referrals,” he said. This could mean immunizations all the way to help with addiction treatment if the person is looking for that.
They will be issued an ID card for future visits — this does not include their name, only a numerical code and a zip code. That way, if they are stopped by law enforcement, they can prove that the needles have been obtained legally and will also help with determining how many people use the program and what the community's needs are looking forward.
Burke said the idea will be to exchange one clean needle per one used, “although the first visit, they might come without syringes,” he said. “We need to know how many they use per day because that determines how many they get.”
Burke said the goal is that people have enough needles to use each one only once.
“If someone takes a new needle, shoots up and then passes it onto the next person, there's that risk of transmission of infection,” he said. “So one and done would be the goal of The Exchange.”
Dr. Carrie Lawrence, post-doctorate fellow of the Rural Center for AIDS/STD Prevention at Indiana University, has had extensive training in harm reduction practices and has been instrumental in implementing the needle exchange in Monroe County.
She will be working with Burke and others in Clark County to get the program up and running successfully, including working with trainers.
“We first want to assess the space they'll be using,” she said. “We want them to be successful so people will come.
“And since injection drug-use is highly stigmatized, and we still haven't decriminalized the syringe in the state, it's going to take a lot of trust-building and engaging processes to really get people comfortable in going.”
She said part of this really starts with the space the program will be using, making sure the hours are well-known, “making sure the space is somewhat private, but also low-barrier; creating the environment that will engage people to come and use it,” she said.
Training is usually two days and will be assisted by members of the Indiana Recovery Alliance, Lawrence said. It includes HIV prevention using harm-reduction methods.
“It's more than a needle exchange; it's having these strategic conversations with people who are interested in having testing or hooking up with different types of resources for mental health and addiction, as well as education to bring the needles back.”
Lawrence said the Monroe County program started off slowly, which is to be expected with a program like this. Much of the clientele come from people in the community letting others know.
“And it was slow-going [at first],” she said. “Because of the way individuals who inject drugs or use any illicit drugs have been treated for so long — building that relationship and making sure you have open streams of communication with all stakeholders is really important. It's not something you just want to jump into.”
Since last November, the county has referred about 40 percent of its visitors into other programs or to get help with physical or mental health issues.
“That's kind of the philosophy of harm reduction is meeting the person where they're at and walking with them,” she said. “Treating someone with dignity and respect goes a long way.”