Clark County needle exchange inches closer

Clark County Health Officer Dr. Kevin Burke declared an HIV epidemic attributed to intravenous drug use in July and county commissioners voted to adopt that declaration in August.

The vote allows Burke to request that Indiana Health Commissioner Dr. Jerome Adams declare a public health emergency in Clark County, which in turn would allow the county to set up a needle exchange program for one year.

Neighboring Scott County has had an operating needle exchange since April. Exchanges aim to curb the spread of infectious diseases like HIV and Hepatitis C by providing clean needles in exchange for dirty ones. Exchanges typically also provide support services and treatment referrals.

Burke said he hopes to submit a nearly 50-page request to Adams in the next couple of weeks. Adams has 10 days to approve or deny the request.

"What I've decided to do is to talk to vested parties now and get their feedback, comments, concerns, questions, so that I can try to address those issues in the plan," Burke said. "I was trying to balance the sense of urgency with the idea that I'd like to get some feedback."

The plan outlines details of why the needle exchange is needed in Clark County, how the needle exchange would operate and how the program would be funded. Burke’s recent meeting with the AIDS Healthcare Foundation answered several of those questions.

Burke said he has decided to partner with the foundation to operate and fund a Clark County needle exchange. It’s the same foundation, he said, that has consistently had a presence in Scott County while other agencies came and went. Through a partnership, the cost of the needle exchange would be low, Burke said, though he is still waiting on numbers for estimated operating costs.

The partnership would also provide a needle exchange van already owned by the foundation. Burke said there isn’t solid data on where the exchange would be most needed, so a van would allow the county to learn by trial and error. In the meantime, the Clark County Health Department’s main location on Duncan Avenue or the clinic location on Akers Avenue could serve as fixed locations.

A partnership with Marian University would provide medical students as volunteers, Burke said. The AIDS Healthcare Foundation would cover salaries for any other staff and the operation of the van.

CATCH-22?

Burke said he has also spoken with several local law enforcement agencies and planned on speaking with prosecutors and judges. Some of the concerns raised included how the program would regulate who gets needles, how many and how often.

The preliminary plan includes issuing a card for needle exchange participants, but because the program is anonymous, the cards would not include photos or names. Instead, cards would be coded with information that correlates to birth years and initials, for example. The cards would help the exchange track participation and make it more difficult for people to share cards.

Still, Clarksville Police Department Chief Mark Palmer said he worries about a "catch-22" where dirty needles would be eliminated but so would barriers to drug use. With a needle exchange, anyone with a valid card would not be arrested if found in possession of a syringe. Typically, possession of a syringe is considered a level 6 felony that can result in six to 30 months in the Clark County jail.

"The biggest concern is in reference to this turning into a get out of jail free card," Palmer said. "We just don't want this to turn into a situation where people feel like they can ride around with needles openly."

Burke has previously said that Clark County has an estimated 5,000 IV drug users, according to News and Tribune reports. With 11 people per 100,000 with HIV in 2014, Clark County's rate of new HIV cases was about 37 percent higher than the state average. The county's rate of hepatitis C — 97 per 100,000 people in 2014 — was about 40 percent higher than the state average.

Palmer said safety precautions and strict guidelines need to be put in place for a needle exchange. But some of those guidelines, like the anonymous cards, could mean more red tape for officers to get through to do their jobs, Palmer said. He added that every situation involving syringes is different and calls for different responses, including making an arrest.

"I think if you're going to try and curb drug usage then you have to have every tool possible at your disposal," Palmer said. "And if you use it or not is the ability of the officer to read the situation they are involved in."

COMMUNITY CARES

Concerns over needle exchanges making drug use easier aren't new. But people like Burke and Nancy Woodworth-Hill, a co-pastor at St. Paul's Episcopal Church in Jeffersonville, contend that studies show needle exchanges are effective in reducing the spread of disease. Woodworth-Hill facilitates a community group that meets once a month to talk about community-based solutions to the drug and HIV and Hepatitis C epidemic in the region.

The group has met regularly since April and was recently named Clark County CARES for community, addiction, resources, education and support. The group's primary goal is to educate the community. Burke and other local officials have attended group meetings, but the group is mostly composed of concerned members of the community, many of whom have in one way or another been affected by drug use.

"The group is completely behind the concept of a needle exchange," Woodworth-Hill said. "The challenge of course is that we're dealing with a population that is unknown. What I mean by that is we don't know exactly where and who all of the users are. And so that comes with some challenges but we feel that it will take quite a bit of work by quite a number of folks to be able to establish that this is a safe practice."

Woodworth-Hill considers the drug epidemic a "community health concern" and that a needle exchange would address that issue. She said no one person can "fix" another, but that the exchange would offer a window into treatment once the drug user is ready.

"I think that it's [about] establishing trust with those who would benefit most form the exchange," she said. "It's a matter of keeping people alive long enough so they can help themselves with others' assistance."

TREATMENT OPTIONS

Should needle exchange participants request or accept treatment, LifeSpring Health Systems is ready to support them. LifeSpring serves six counties, including Floyd, Clark and Scott counties, and offers mental health and substance abuse treatment. Beth Keeney, LifeSpring's senior vice president for community health services, said the facility has served people in Scott County who said they never would have sought treatment had it not been for the needle exchange.

"I think it's important that when we think about a needle exchange that we're not just thinking about it as an opportunity to stop disease, but also as an intervention point," Keeney said.

LifeSpring expects more referrals if Clark County establishes a needle exchange program, but Keeney can't estimate how many to expect. She said the needle exchange program in Scott County has taught LifeSpring more about the people they seek to serve. Many people, Keeney said, incorrectly assume treatment means 30 days in a facility away from home. In reality there are outpatient programs and varying therapy options. LifeSpring providers have since changed their language to reflect the different options, Keeney said.

Burke expects the needle exchange would be slow to start and that it will take time for drug users to trust they won't be harassed. Time will also bring changes as trial and error shows what does and doesn’t work. But Burke hopes that the time he's taken in preparing a plan will address the biggest issues from the start.

While Palmer said he still doesn't have as many answers as he'd like, he agrees something needs to be done to address the spread of disease from intravenous drug use.

"Will this work? I hope it does, I really do. I don't want us to have an epidemic continue," Palmer said. "I don't have an answer, so when somebody does and they feel confident then I'm willing to try it. We're willing to try to help every way possible, but we always have to work on protecting the community as a whole."