Kentucky Health News
Jessamine, Carter and Elliott counties are the latest Kentucky counties to approve needle exchange programs, joining Fayette (Lexington), Jefferson (Louisville) and Pendleton counties.
The approval of exchanges in Carter and Elliott counties, in northeastern Kentucky, creates a major rural beachhead in a state where officials have said rural officials will be slow to adopt the strategy of preventing HIV, hepatitis and other diseases transmitted by illict drug users.
The major obstacle is a widespread belief that needle exchanges enable drug users, despite studies that say otherwise. That has created another big hurdle, lack of federal funding. However, Congress removed that obstacle last month at the behest of two Kentuckians: Senate Majority Leader Mitch McConnell and U.S. Rep. Hal Rogers, chair of the House Appropriations Committee.
The two Republicans had opposed federal funding for needle exchanges, but recently led the charge to get Congress to lift a ban that was enacted in 1988, lifted in 2009 and reinstated in 2011 The latest change was included in the omnibus spending package passed in December. The measure still doesn’t allow federal funds to be spent on the syringes themselves, but it can be spent on relayed costs such as staff, transportation, counseling, treatment referral and outreach.
Not only does the lifting of this ban potentially bring much needed dollars into Kentucky to help pay for the exchanges, but the support of two top Republicans and the federal government could go a long way in convincing local governments to support needle exchanges in the state, Laura Ungar reports for The Courier-Journal..
Kentucky’s needle-exchange program is part of the landmark heroin bill the General Assembly passed in 2015. It is intended to prevent the spread of disease and steer drug users toward treatment. Kentucky leads the nation in hepatitis C and suffers more than 1,000 drug overdose deaths each year.
However, the law requires local-government approval for needle exchanges, which has proven to be a challenge in many counties, even Northern Kentucky an urbanized area that has been hit hardest by heroin.
Jessamine County Public Health Director Randy Gooch said about 20 county health boards have approved needle exchanges, but most have been thwarted by city or county governments, reports Rosalind Essig of The Jessamine Journal.
Gooch said he hoped Jessamine County’s action would encourage other communities to start talking about needle exchanges and hoped that to do likewise.
“The more that smaller communities — maybe like Jessamine and Pendleton County — are able to engage the community and create these programs, the stronger that we become, from a public health perspective,” Gooch told Essig.
Jessamine County is the most recent county to get approval for a needle exchange. Its Fiscal Court voted 4-2 in favor of it Jan. 19. The Nicholasville City Commission, with a 4-1 vote, and the Jessamine County Board of Health had already given approval, Essig reports.
The county and city officials struggled with such concerns cost, efficacy, mandated counseling and whether the program enables drug use.
“I am excited, and it’s been a long road,” Gooch said after the final vote. “It’s a difficult thing, I know, for elected officials and for the community, as well, because most people are very skeptical, because they think it’s enabling the users.” Gooch told Essig that addicts will inject drugs regardless of whether they have clean or dirty needles.
As for the cost, Gooch said in the meeting that the health department would involve community partners and existing staff to do the work so that it would not incur a high cost, stating that he did not foresee a tax increase to pay for it. He noted that one of their partners is St. Joseph Jessamine, which will dispose of the needles for free. He estimated the program could grow to about 200 participants, putting the cost of the one-time-use-only syringes at about $4,300 a year.
Jessamine’s program will operate one day a week at the local health department during normal business hours, and will provide a separate entrance for the participants. After initially providing addicts with clean syringes based on their level of drug use, the program will then require future needle exchanges to be one-for-one.
The Jessamine Journal recently published the first of a series of stories about heroin and its impact on the local community. The Woodford Sun has published a similar series, but its health board has not acted. Both communities are largely suburbs of Lexington.
Carter and Elliott counties
The Little Sandy District Health Department, which serves Carter and Elliott counties, has received a $3,900 grant from the Kentucky Agency for Substance Abuse Policy to help fund a needle exchange program through June. 30, at which point the district will cease to exist because Carter County is quitting it, Joe Lewis reports for the Journal-Times in Grayson. “The needle exchange program would presumably fall under the direction of the new Carter County Health Department,” Lewis writes.
Carter County will have to re-evaluate whether it can maintain the program, Trena Greene, nursing supervisor for the health department, told Kentucky Health News.
Greene said the final protocol for the program was submitted Jan. 13 at the board meeting and awaits approval. She said it will be a one-for-one needle exchange, held on set days and times. It will be conducted at two offsite locations, one in Grayson and the other in Olive Hill.
Hepatitis C cases are being reported to our health department at “two or three or four a week,” Greene said. It is “just phenomenal.”
“When they come for the needle exchange, we can offer rapid hepatitis C and HIV testing,” Greene said. “And of course, we will offer them resources and counseling at the time we make the connection,” with the goal of getting the users into a treatment program.
Greene said Carter and Elliott counties and the Carter County towns of Grayson and Olive Hill gave approval for the exchange some time ago, and the state grant allowed it to move forward.
Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.