Heroin addiction. Hepatitis C. HIV.
They're all killers, all major public health concerns. The three diseases are linked together by the way they're often spread — through intravenous drug use.
In Madison County, as elsewhere in the state, the effort to stanch the spread of hepatitis C and HIV, the virus that causes AIDS, is directly related to the heroin epidemic choking the community.
In mid-2015, then-Gov. Mike Pence signed into law a measure enabling counties at high risk of hepatitis C and HIV outbreaks to adopt, with state approval, syringe exchange programs.
This initiative allows counties to provide clean hypodermic needles to heroin users in exchange for used needles. The idea was to keep heroin users from sharing needles, which can spread the diseases.
Citing a rise of new cases of hepatitis C in the county — from 70 in 2013 to 130 in 2014 — the Madison County Health Department in June 2015 was granted its request to begin a needle exchange program.
Reasoning that any item used to inject intravenous drugs could contact contaminated blood and spread hepatitis C or HIV, the health department developed a kit to provide to drug users, who were promised that their identities would be confidential and that they wouldn't be subject to arrest.
While the health department contends that its needle exchange program has been successful in slowing the spread of the two diseases, the policy has come under fire from Madison County Prosecutor Rodney Cummings and others.
They, essentially, have two points of contention — the number of needles given out, and the range of items included in the kits. Both, they say, enable drug use and also create danger from used needles, tourniquets and other items discarded in streets, parking lots, parks, sidewalks, alleys and elsewhere. They believe the needle exchange, while reducing the spread of HIV and hepatitis C, has encouraged the proliferation of heroin use.
Bowing to pressure exerted by Cummings and other opponents, the health department recently agreed to remove the small metal "cooker" from the kit. But opponents are not resting; they'd like to see needles distributed in smaller numbers, as well as a better system of accounting for returned needles.
The Madison County Council is considering a measure that would strip the health department of funding for the needle exchange program, essentially shutting it down. The proposed ordinance is on the agenda for council's Aug. 8 meeting.
Both sides in this argument raise salient points. The looming question is whether the needle exchange program provides a greater service by reducing new cases of hepatitis C and HIV, or does a greater disservice by enabling heroin use and causing more dirty needles, syringes and other items from the kit to be discarded in the community.
While public health is the top concern in this argument, it's becoming increasingly clear that heroin use is as much a public health concern as hepatitis C and HIV.
As usual, the best solution can be found in compromise. Can't the health department, the council, the prosecutor and other health-care and law-enforcement stakeholders come together to establish a needle-exchange program that addresses the hepatitis and HIV problem without going too far in providing items that enable intravenous drug use?
We're not saying it would be easy. But, then again, the best solutions rarely are.