o combat the diseases associated with intravenous drug use, the Howard County Health Department is preparing for the potential adoption of a controversial program only recently accepted by state lawmakers.
Already enacted by numerous counties struggling with Indiana’s heroin epidemic, Howard County officials have begun work toward a syringe exchange program, a >tactic used to minimize the transfer of diseases like Hepatitis C or HIV.
While such a program isn’t imminent, county officials have for the last year been preparing for the possible need of an SEP, largely to ensure the county is “prepared and ready if we choose to move forward with it,” noted HCHD Health Officer Don Zent.
To assist the HCHD’s efforts, the Howard County council last week appropriated up to $25,000 through the remainder of 2016, grant funding that was approved by the Indiana State Department of Health specifically “for the purpose for staff to develop SEP programming and training should that be necessary,” according to HCHD administrator Kent Weaver.
“I don’t expect to spend nearly that much, but wanted to be sure we had funding in place in the event we needed to pick up speed quickly,” said Weaver in an email exchange.
Overall, the estimated cost of an SEP is roughly $25,000 to $35,000, according to HCHD Public Health Projects Coordinator Jennie Cauthern. Included in that would be syringes, harm reduction kits for clean injection and other health-based items.
To put the cost in context, prevention of one HIV case is nearly equivalent to paying for an SEP, due to the elimination of public health care costs, remarked Zent.
However, any decrease in disease figures would likely take five years, mostly because the department would see an uptick in the testing of at-risk patients, according to HCHD estimates.
For years, however, such an option wasn’t even available to Indiana counties. That changed last year in response to the HIV outbreak in southeastern Indiana.
In May 2015, Gov. Mike Pence — who originally opposed the idea of syringe exchange — signed legislation allowing counties to establish SEPs as a response to outbreaks of Hepatitis C and HIV.
The law requires a local health director declare an epidemic that can’t be handled effectively in other ways, after which the county commissioners hold a public hearing and approve the program. The program would then need state approval.
As noted by Zent, the process begins not when counties reach specific figures, but instead when the detection of alarming health and drug use trends are made by local officials.
Once that is done, however, the overall process for starting an SEP can become cumbersome, as recently shown in Clark County, which has waited nearly a year for state approval.
Part of the time requirements comes from the comprehensive nature of needle exchange programs.
Any SEP in Howard County would include health care, social welfare services, mental health services and more, according to Zent, who said his team is focused on changing the prevailing mindset that SEPs promote drug use.
According to The Foundation for AIDS Research, a recent study found that new SEP participants are five times more likely to enter a drug treatment program than non-participants. The foundation also found that SEPs protect law enforcement personnel from needle stick injuries.
“What we’ve been doing for the last year … is trying to develop a coalition looking [at] the necessity for our county, look at our numbers,” said Zent. “We’ve talked to the state many times, various people there, as well as our local partners.
“Right now, we want to develop a plan, have it ready if and when we choose to move forward and declare a [public health emergency] or epidemic in Howard County.”
As Zent noted, the timing also corresponds with the HIV outbreak in Scott County, which at last count has seen 191 people test positive for HIV and recently extended saw its public health emergency declaration extended to May 2017, according to the ISDH.
The extension allows to county to continue to operate its SEP.
For years, efforts to measure intravenous drug use include the study of disease rates, specifically Hepatitis C and HIV.
Currently, Howard County’s rate of new HIV cases is below 5 per 100,000 residents per year, according to Zent.
Additionally, Howard County’s Hepatitis C preliminary rate was 49.4 per 100,000 in 2015, a decline from 63 in 2013 and 69 in 2014. The state’s rates during those same times were 69 in 2013, and 64 in 2014, according to numbers provided by Zent.
With Howard County’s population below 100,000, the actual number each year is slightly smaller than those figures.
Despite the decrease, Zent and other HCHD officials cautioned against focusing too much on certain figures, as factors like counting techniques for acute and chronic cases can cause numbers to fluctuate from year to year.
Therefore, the likelihood of Howard County implementing an SEP depends on various factors, specifically trends recognized by local officials and future actions by the Indiana legislature.
“Obviously, an election is coming up,” said Zent. “The political climate may change; they may change the laws, who knows? There are several things we are looking at, but right now we think it’s not an urgent thing, although we don’t want to miss the boat either.
“We don’t want to be behind, we want to be proactive. But we haven’t made that decision to move forward from where we are right now, which is preparing and being ready to move forward if things warrant that.”
If trends do at some point warrant an SEP, Howard County could implement a variety of systems, including a central location, a mobile unit or a satellite location depending on the county’s specific needs, according to Cauthern.