Syringe exchange one option in Boone County's opioid drug war

No application to the Indiana State Department of Health has been made to approve the exchange, County Health Department administrator Cindy Murphy, RN, said Wednesday at the monthly meeting of the Boone County Healthy Coalition.

The meeting’s second half focused on an update of steps taken since an Aug. 4 symposium in Lebanon sponsored by the Boone County Substance Abuse Task Force. Many of the 116 people who attended the event broke into nine subcommittees, grouped under five themes, tasked with selecting a priority action within those themes for immediate or as-soon-as-possible action to reduce drug abuse here.

Since the symposium, the groups have collected information on a vast range of substance abuse issues, including the number of Narcan saves made by local police, fire and EMS agencies, the number of hepatitis C cases, and deaths caused by heroin overdoses, Murphy said.

In 2014, according to the Indiana State Department of Health, Boone County had 26 confirmed cases of hepatitis C. Cases of hepatitis C are considered an indicator of injection drug abuse levels, according to the National Institute on Drug Abuse, because it is transmitted through blood. Drug abusers commonly share needles.

“We are currently looking at counties that do a syringe exchange program,” Murphy said. “We want to know what are the lessons they have learned.”

Also being studied are strategies used in Ohio and in Northeastern states where abuse of opiates, including heroin and synthetic drugs such as fentanyl, has caused hundreds of deaths.

The five themes at the Aug. 4 symposium were education and prevention, mental health and medical treatment, recovery and support, enforcement and rehabilitation, and community engagement.

At Wednesday’s meeting, chairpersons of those groups reported on progress made toward the actions each group had selected as a best-use of community resources.

Spenser Rohler, an attorney with Taylor, Chadd, Minnette, Schneider & Clutter, chaired the enforcement and rehabilitation subcommittee, which recommended an awareness and education effort on tip lines and other resources, to educate the public on how to relay information to law enforcement.

That group found, “There are so many different areas” to explore, Rohler said.

The Boone County Jail has a “great drug program,” he said. But many of his clients are hesitant to participate in those programs. “It works for some, and the ones it works for, they will be the leaders,” he said. “Hopefully the others will see that success and buy in to the program.”

“One of the biggest problems I’ve seen with clients is that their care navigator is the probation department — and they are overworked,” Rohler said.

It is “very, very difficult” to find persons who can walk probationers through the process, he said. The probation department understands the issue, but is handcuffed by a lack of funding, he said.

“We know the needs,” said Penny Rader, the county probation department’s alcohol and drug director. “We’ve got to look for funding for any of these pieces to work.”

Assembling those pieces must be preceded by planning, Rader said.

“We have to have a plan in place before we start asking for money,” she said.

Some of that money could come from a $255,000 annual grant the federal Substance Abuse and Mental Health Services Administration gave Indiana recently, although no formal application has been made at the county level. The five-year grant will cover the expansion and enhancement of behavioral health care services for children, teenagers and young adults, the Associated Press reported.

Heroin had been replacing methamphetamine as the abused drug of choice in Boone County, in part because it was cheaper to buy and easier to find than methamphetamine, local police have said. Restrictions on prescription cold medicines that contain a necessary ingredient in the manufacture of meth had cut the number of quick, simple and dangerous “backpack” meth labs found in homes, motels and vehicles. Meth produced in Mexican “factories” was also cheaply available, suppressing the amount of homemade meth.

Now, Rader said, meth seems to be making a comeback.

In the last two months, she has not seen a positive heroin test among probationers.

She has, however, “had a ton of positive methamphetamine screens.”

The education and prevention group, chaired by Lisa Hutcheson, recommended a “take-back” program for disposal of unused drugs, to be conducted at festivals and programs throughout the county. The group wants to focus on educating the public about existing take-back programs.

Local doctors have said they want to be more educated about prescription medicine abuse, said Jeff Byrum, executive director of medical practice management at Witham Health Services.

“We’ve had a good lead on prescriber information,” Byrum said. Witham physicians who specialize in pain management “are helping to lead the charge,” he said.

Witham also plans to hire a psychiatrist, Byrum said.

“We realize our two emergency rooms (in Lebanon and Whitestown) are a funnel for patients with a heroin overdose,” he said. “They get treated and go home.” Many times, though, “these patients come back and back and back.”

Overdose victims who are revived with Narcan, should be treated the same as heart attack victims who are revived with an AED, Murphy said. “They should be treated and have a care plan just as complete as that for a cardiac patient,” she said.

Murphy suggested the healthy coalition evaluate what has been and what can be done to provide that treatment program.

A drug abuser “has a chronic brain condition” just as a heart patient has a chronic cardiac condition, she said.