INDIANAPOLIS — Despite research showing public health benefits of supplying clean syringes to intravenous drug users, Indiana has programs in only nine of 92 counties.
A bill in the General Assembly would enable counties to more easily establish a syringe exchange program by eliminating the need for a declared public health emergency while maintaining Indiana State Department of Health oversight. The bill, however, contains a provision that would require participants to register, a disincentive, experts say, to program use.
“This is just another tool in our toolbox,” Sen. Jim Merritt, R-Indianapolis, said Wednesday as he introduced his bill, SB 207 (http://iga.in.gov/legislative/2020/bills/senate/207). before the Senate committee on Health and Provider Services.
Madison Weintraut, program director of the Marion County Public Health Department’s Safe Syringe Access and Support Program, said syringe exchanges help reduce the spread of infectious diseases such as hepatitis C and HIV. Such programs across the state also offer free testing, peer recovery coaches and opportunities for rehabilitation.
“Syringe service programs are a vital component to addressing the drug epidemic,” Weintraut told the Senate committee. “Through these programs, we get people in the door to provide teachable moments and services that … reduce risky behaviors and open the door for rehabilitation.”
The Centers for Disease Control and Prevention reports that participation in syringe service programs increases the likelihood that an IV drug user will seek treatment by five times and reduces their injection use by nearly three times, compared to those who don’t have access to the programs.
“(There’s) a rapport that the personnel have with the people that come to the program,” said Eric Yazel, the Clark County health officer who oversees the area’s syringe service program. “They know them by name, they know where they’re at and whether they’re ready for recovery.”
The program educates IV drug users about health problems they might encounter, options for treatment and how to connect with a recovery coach, he noted.
COMMUNITY RELATIONSHIPSHealth officials seeking to start a syringe exchange program should establish relationships with area law enforcement agencies, elected representatives and the community, according to Yazel.
While Clark County Cares, an advocacy group, provides that support on the ground level, Yazel said that the 2015 HIV outbreak in neighboring Scott County provided impetus to start the local syringe program.
“That’s one thing that changed some perceptions and made people more receptive to us initially getting started,” Yazel said.
If people don’t understand the humanitarian aspect of syringe service programs, Yazel tries to win them over with a financial argument.
“Through our program we’ve diagnosed almost 100 cases of hepatitis. … We’ve identified cases of HIV, as well. Our skin and soft-tissue infections locally are down about 30%,” Yazel said. “On a low-end estimate, it saves our county about $2 million.”
The CDC and the Indiana Department of Health cite research showing that supplying clean syringes minimizes the spread of HIV, hepatitis B and hepatitis C, saving hundreds of millions of dollars in hospital care.
USER REGISTRIES
While making it easier for counties to establish syringe programs, SB 207 would also mandate the creation of a patient registry. Some advocates worry that the provision would turn patients away.
Indiana, like other states, criminalizes the possession of drug paraphernalia. Under SB 207, registered patients whose syringes come from a government program could be protected from prosecution.
But some states allow for patients to participate in programs anonymously, as recommended by Indiana University’s School of Public Health. SB 207 would require a full name and Social Security number.
Syringe service programs “should not require participants to provide any identifying information … (other) than their first name,” an IU report outlining the implementation and benefits of the programs states. “This helps to establish trust between participants and staff.”
Weintraut called the registry “well-intentioned” but said, “Fear of prosecution is one of the main reasons people do not participate.”
Early in the Clark County program, possession prosecutions hurt the program’s reputation, and rapport with patients had to be reestablished, Yazel said.
“You’ve got to come to the realization that people who are using IV drugs are going to use IV drugs whether clean syringes are available or not,” he explained. “Once you can wrap your head around that, the rest of the program starts to suddenly make a lot more sense.”
Arresting someone for paraphernalia doesn’t help the person with their recovery because patients leave jail within a few days and return to old patterns, Yazel said.
The law and the lack of access to syringe service programs can contribute to a particularly visible sign of IV drug use: syringes in public places and parks.
“(It) encourages them to dispose of those syringes inappropriately because they’re afraid of being caught with them,” Weintraut said.
In the 30 years of syringe service programs in the United States, Weintraut said, research shows that inappropriate syringe disposal decreases with the introduction of exchange programs
LOOKING FORWARD
The state Department of Health reports that more than 8,500 Hoosiers have participated in the nine county syringe programs, with an average syringe return rate of about 82%.
Most importantly, being in a “non-coercive environment,” such as a syringe service program, gives people a path to recovery, Weintraut said.
“Self-motivation is the greatest predictor of a person’s recovery success,” she explained, noting that the overarching goal of her program is eventually to “go out of business.”
“But the reality is that we are still seeing a lot of opiate use, and now what we’re seeing is a transition to methamphetamine use,” Yazel said.
He wonders whether rising use of methamphetamine, which causes fewer deaths and overdoses than opiates, might deter support for programs addressing secondary problems, such as infectious diseases.
“We have a lot of work to do, and we have to make sure that our programs are set up to kind of move with emerging trends,” Yazel said. “Anywhere that IV drug use is prevalent a syringe service program essentially has to be a part of (the solution) to be truly successful.”