Ken de la Bastide and Devan Filchak, Herald Bulletin
ANDERSON — As Madison County considers changes in its needle exchange program, the state's health commissioner defends such measures, noting they are important tools to get people into treatment programs.
The Madison County Council tabled a request last month from the county's health department to use $15,000 from a grant for the local needle exchange program implemented in 2015.
Madison County Prosecutor Rodney Cummings and several council members raised concerns about the local program and items that are included in a kit distributed with needles.
The county council is expected to consider the funding request and a resolution that would prohibit the health department from using local tax dollars or grant funds to purchase needles when it meets at 7 p.m. Tuesday. The department would still be able to use needles that are donated.
Indiana Health Commissioner Dr. Jerome Adams and Deputy Health Commissioner Pam Pontones said in a telephone interview with The Herald Bulletin on Friday that needle exchange programs are effective in lowering the spread of hepatitis C and HIV. They say such programs also have resulted in a decline in overdose deaths in the state.
“The programs are not pretty,” said Adams, who has been nominated by President Donald Trump to be U.S. surgeon general. “But we’re in the middle of an epidemic. The programs are a critical tool to get people to other services. In an ideal world, we wouldn’t need these programs.”
Adams said in Scott County, the first in Indiana to have an exchange program, 100 people have gotten into recovery programs. While syringe exchange programs first address public health, the face-to-face conversations during exchange appointments about recovery lead to staff connecting addicts with treatment, he said.
“It’s not about enabling drug use,” he said. “It’s enabling people to recovery.”
Adams said it's also a misconception that exchange programs increase drug use.
"Unequivocally, syringe exchange programs do not increase drug use," Adams said. "I say that based on evidence nationwide."
He said the misportrayal started when a governor's task force report showed a rise in the amount of syringes used in Scott County, which implied an increase in drug use in the county.
Opana was a drug being used frequently in Scott County at the time, which stays in the body system for a very short amount of time compared to other opiates. In April 2016, Scott County Public Health Nurse Brittany Combs said people who use Opana inject the drug up to 20 times a day, just to keep from being sick.
Because those addicted to Opana were using so many more syringes than the average intravenous drug user, the statistic shared in the report was inflated. Participants in the program using Opana were instructed to use a clean needle each time, which resulted in them using more syringes but the same amount of the drug.
"That has been misportrayed over and over again," Adams said. "I think it’s very important for folks to know the CDC (Centers for Disease Control and Prevention) said there is no evidence of increased drug use in the United States, in Indiana or in Scott County."
Adams said the Indiana program is being used as a national model.
“They are looking at the success rate in Scott County,” he said. “It’s nothing short of a miracle.”
Of the kits being distributed with the needles in all Indiana counties with exchange programs, Adams said no one is comfortable with the contents, but each piece is necessary in stopping the spread of infection.
The Madison County Board of Health recently voted to remove the so-called "cookers" from the kits, the only Indiana county to do so. A cooker is a container used for mixing and heating the drug. For users on the street, it can be something as simple as a spoon or a bottle cap. In the Madison County kit, it's a small bowl about the size of a quarter.
“The cookers are a necessary part of reducing the spread of disease,” Adams said. “People are taking a clean syringe and dipping it into a dirty cooker. There have been people in Scott County that contracted HIV by using a clean syringe and sharing a cooker.”
Pontones said all the components of the kits have to be available to prevent the spread of hepatitis C and HIV.
“People are using clean needles and the disease is still being transmitted,” she said. “It (cooker) is a primary part of reducing the transmission of disease.”
Adams said in Scott County, there are 219 people infected with HIV, but there are 500 intravenous drug users.
“The CDC estimated there would be more than 400 people with HIV without the syringe exchange program,” he said.
Adams said the number of fatal overdoses have gone down in the counties with the exchange programs.
Pontones said the number of overdose deaths in the counties with programs declined from 424 in 2015 to 241 in 2016.
“There are almost 2,800 people enrolled in the program and approximately 800 have been referred to treatment programs,” she said. “Every person is able to access the resources. That is potentially lifesaving.”
Both Adams and Pontones said the one-to-one exchange of syringes, advocated by Cummings are not effective.
Adams said 79 percent of the needles being exchanged in Indiana are returned. He said that figure is an improvement compared to the past.
“They’re going to inject anyway,” he said. “Instead of disposing of the needles on the streets or in the trash, they are being returned. That’s significant for the local communities.”
Pontones said there is not one model that fits all the communities.
“Each community has to decide what is best,” she said.
Pontones said county health departments and county governments are also providing local oversight and can withdraw from the program at any time.
Adams said the next step has to be discussions at the local level with input from both sides of the needle exchange issue.
“For the advocates, the increased freedoms of the program come with increased responsibilities,” he said.
When informed that Delaware County decided not to implement an exchange program but set aside $100,000 for treatment, Adams said it’s not an either or decision.
“The exchange programs are a touch point to connect people to treatment services,” he said. “There is no wrong or right (move or program).
“The public health and public safety agencies in all communities have to work together.”