County council members and health department administrator Cindy Murphy, RN, discussed the ethics of a needle exchange program at the council’s April meeting.
“I absolutely would recommend it,” Murphy replied when Council President Steve Jacob asked whether she would or would not recommend an exchange.
House Bill 1438, which would allow a county or municipality to operate a needle exchange program, is awaiting action by Gov. Eric Holcomb.
Currently there is no state funding for a syringe exchange program, Murphy said. HB 1438 requires providers to maintain a stockpile of an overdose intervention drug, such as naloxone or Evzio. An average insurance payment for a dose of naloxone in 2015 was $42 for the aerosol and $501 for the injection, the Indiana Legislative Services Agency said.
Nine counties now operate needle exchange programs; another 15 counties are working to implement such programs, according to the agency.
Murphy sent nurses to Scott and Fayette counties to study their exchange programs, which are funded primarily through donations.
Success varies by county, Murphy said. In Scott County, where sharing of contaminated needles by drug users led to an HIV epidemic, more than 95 percent of syringes distributed through the exchange program are returned.
While that return “is great,” Murphy said, “it’s slow going getting it started because you need to develop a trust relationship.”
Once that trust is developed, health officials can discuss with users the risks and the treatment options, she said.
One of the biggest issues facing public health officials in addressing the opioid abuse epidemic is the disconnection from society felt by many addicts, Murphy said. “If you can break through that, it can be a world of difference.”
Councilwoman Elise Nieshalla was concerned that a needle exchange program would send an “unintended message.”
How, she asked, could the county emphasize that drugs “enslave your life”?
“I see the need,” Nieshalla said. “I also see the need to make sure that the message we communicate is to stay away at all costs?”
Exchange programs help fight the epidemic, Councilman Tom Santelli said. “We know that needle exchange programs do work,” he said. “It’s the opportunity to get treatment.”
He compared the absence of needle exchange programs to the withholding of medical treatment from an overweight person who suffers a heart attack.
“We are not condoning this,” he said.
Murphy said she appreciated Nieshalla’s concerns. “It’s public health,” Murphy said. “It has to do with harm reduction.”
That is why the county’s sexually transmitted disease clinic hands out condoms to its clients, Murphy said. “They exchange sex for pills and drugs,” she said. “We know they are going to have sex. We prefer they have safer sex.”
“And we don’t want them to reuse needles.”