Lawrence County's year without a needle exchange since 2017

The program, run by Bloomington’s Indiana Recovery Alliance, provided clean needles for a couple hours once a week at the Lawrence County Health Department. The program was funded through grants.

The Lawrence County Health Board urged approval of the contract because of a surge of hepatitis C cases, which led the county to declare a state of emergency in January 2016. Needle exchanges, where people anonymously turn in used needles for clean ones, were designed to curb the increase of potentially fatal and infectious diseases.

The Times-Mail previously reported that people mostly in their early 20s, and most often women, were exchanging dirty needles for clean ones. Clients could also receive hep C and HIV testing.

A new set of commissioners voted against renewing the program, bringing national media attention to the area. The debate over providing drug users with tools versus reducing the spread of infectious disease and keeping dirty needles out of public spaces continues a year later.

In the year since the county commissioners terminated the program, analyzing how its absence has affected Lawrence County has been difficult.

Tracking hep C

According to data from the Indiana State Department of Health, hep C cases rose sharply in the county, from 57 cases reported in 2015 to 83 in 2016, and 84 last year. Data for 2018 has only been collected and published through the first quarter, when 13 cases were reported.

The state of emergency was declared when it was reported that Lawrence County’s hepatitis C infection rate was the 15th highest in the state. The county’s hep C rate increased 112 percent from 2010-14, according to previously published health department data. In 2010, the county rate was 62.8 per 100,000 population. In 2014, the county’s rate jumped to 133.5 per 100,000 population.

Rates for hep C can be difficult to measure because the virus can exist in the body for a long time before symptoms develop, Lawrence County health nurse Mary Kinser said.

“It’s really hard to say whether there has been a recent rise because hep C has a long incubation period, and some people don’t even have symptoms,” Kinser said. “And when they finally get tested, they might not have any idea where it came from.”

There have not been any new cases of HIV, which can also be spread by dirty needles, for a couple of years, according to data from the state health department.

When Kinser started as county health nurse, the hepatitis A outbreak was in full swing. The outbreak, which has been statewide since November, was found to be linked to an outbreak in Kentucky and other states. While the exact cause of the outbreak is not known, Kinser said many of her hep A patients over the summer had hep C. Having one hepatitis illness makes it easier to contract another type and can exacerbate symptoms. And often, Kinser said, people do not realize they can be treated.

Another difficulty in keeping track of hep C investigations is reaching patients. Many are transient, without addresses or phone numbers. But Kinser said once they do find patients, people open up easily.

“Usually they are very honest and will tell you if they have done IV drugs, or they will let you know they had a blood transfusion years ago,” she said.

She said the drug crisis and the high hep C rates are still a priority for her department — including the possibility of bringing back an exchange program.

“I think we all would probably like to revisit it at a later time,” Kinser said. “Right now, it doesn’t look like we’re going to be doing it in the near future, but we will be discussing it. Whether or not it is possible, I’m not sure. There could be new officials, and it may be a whole different thing.”

Commissioners’ response

The county commissioners heard arguments on either side of the issue in October 2017. Health department officials and advocates said the program saves lives and keeps disease rates from inching higher. Others, such as Lawrence County Prosecutor Michelle Woodward, said providing needles just helps criminals.

In a statement to the Times-Mail, Rodney Fish, who voted against renewing the program, said he does not see a difference in the county since the program ended, but that he extends his compassion for those struggling with addiction. “Our experiences here in Lawrence County are no more or any less than those other southern Indiana counties, many of which have continued their programs,” he wrote in his statement.

Fish quoted the Bible when giving his reason for not renewing the contract at the time of the vote, citing 2 Chronicles 7:14: “If my people who are called by my name will humble themselves and pray and seek my face and turn from their wicked ways, then I will hear from heaven, and I will forgive their sin and will heal their land.”

Chris Abert of the Indiana Recovery Alliance interrupted Fish, yelling, “You’re killing people,” and stormed out of the chambers.

What has changed?

Abert, project coordinator with IRA, said his organization has continued to help people in Lawrence County, specifically by giving naloxone and providing training on how to respond to overdoses.

“If the commissioners want to go ahead with an evidence-based, compassionate approach, I would be willing to help again,” Abert said. “ … They said they would have their own solution, and what have they done in the year since? They’ve done absolutely nothing. They’ve left people to suffer alone.”

Other counties

Lawrence County was the second Indiana county to terminate its needle exchange program in 2017, following Madison County that August.

Needle exchange programs are still active in Scott County, Wayne County, Lafayette, Indianapolis, Fort Wayne and Bloomington.