NEWS: The Courier-Journal, June 01, 2015

Needle exchange plans include street outreach

Phillip M. Bailey and Chris Kenning, The Courier-Journal 10:47 p.m. EDT June 1, 2015

Louisville's highly anticipated needle-exchange program will operate six days a week at the health department's downtown headquarters and reach out to participants on the street level, according to a report to be presented to a Metro Council committee on Wednesday.

Funded largely by metro government, the $224,900-a-year program is aimed at reducing the spread of HIV and hepatitis C amid the region's rising heroin epidemic. Under the program, four syringes are expected to be provided per day to about 500 people, who will be granted confidentiality, according to the program's budget.

Louisville health officials declined to comment ahead of Wednesday's presentation to the council's Public Safety Committee, saying the plan still could change.

But the 22-page report offers a range of details about how the program would work, including work policies and procedures at the Metro Department of Public Health and Wellness' Gray Street facility. Officials at the facility will provide syringes, HIV testing and prevention supplies, referrals to drug treatment and social services, and education on proper needle disposal, according to the report.

The program also could provide syringe access and needle-exchange services at other fixed sites, venues and community events, the report says. But it notes that the method of service may evolve.

The report says community partners initially will provide street-level services.

Jennifer Hancock, president of Volunteers of America, said Friday that officials were working to determine if her group — which gets federal funding that cannot be used for needle exchanges — could give out syringes as part of outreach efforts.

The city is allowed to set up the needle exchange under state legislation passed this year to combat Kentucky's deadly heroin epidemic, which has claimed hundreds of lives in the state in recent years.

According to the Kentucky Cabinet for Health and Family Services, around half of the state's 9,300 HIV cases as of June 2014 were Louisville residents and up to 15 percent of the state total were attributed to intravenous drug use. Kentucky also has the highest hepatitis C infection rate in the nation, the report says.

While some critics have argued needle exchanges encourage drug abuse, supporters say they connect addicts to treatment and prevent disease. The issue gained urgency after an outbreak of HIV in Scott County, Ind. — just 30 miles north of Louisville — that has led to 160 cases related to intravenous drug use. Indiana also has adopted needle exchanges.

In Louisville, former drug users said such a program would be a big benefit.

"Some people will use anything they can get their hands on or reuse the same needle until it breaks," said Kimberly Holmes, a former heroin user. "I never understood why there wasn't something like that a long time ago."

Louisville became the first municipal government in the state to establish an exchange for syringes after the issue breezed through the council last month.

Lexington health commissioner Rice Leach said he hopes to get city council buy-in for an exchange and begin operating before Sept. 1. In Northern Kentucky, which has been hit hard by heroin addiction, health officials are still working to get approvals from the board of health and local cities.

In Louisville, a bipartisan coalition of council members praised the idea of a needle exchange when the proposal came before them last month but raised concerns about a lack of specifics. They added a provision requiring the health department to report back to the council before the program is implemented.

The budget also includes $30,000 for the maintenance of an RV as part of the program and $60,500 for a dedicated substance abuse counselor.

The city has been working with a dozen different agencies such as the Kentuckiana AIDS Alliance, University of Louisville School of Public Health and Walgreens to form a plan for the program.

The report says street-level services are an important strategy to "develop rapport and credibility" with clients and will be provided by community partners such as the local Volunteers of America.

It also states that participants will receive clean syringes regardless of whether they brought in used needles to exchange, but the health department says it will strongly encourage the return of older syringes.

Narelle Ellendon, a nurse with the New York-based Harm Reduction Coalition, which provided four-day training to staff and partners last week, said not requiring a needle-for-needle exchange is considered a best practice because it reduces barriers to using the program.

If a participant tests positive for HIV, staff will assign that person a case manager at a University of Louisville outpatient clinic for treatment, according to the plan.

Staff also will be trained in the appropriate use of naloxone, an overdose reversal drug, which will be kept on site, the report says. Overdose education will be provided to clients and their families, and those participants asking for naloxone will be referred to a harm-reduction task force.

The report says community partners, including Louisville Metro Police, need to ensure participants will be given confidentiality and notes that participants can legally carry needles so long as they declare them prior to a police search.

"While much research demonstrates that needle access is a best practice, much stigma is attached to the practice by those fearing promotion of risk behavior," the health department's report says.

Despite the cost to the city, the report notes disease from drug addiction carries a hefty price. In 2014, the cost of providing hepatitis C treatment hit $84,000 a person.

It also says that more than 22 years of research has shown "that a syringe exchange program is one of the most effective methods ... to prevent HIV and other blood-borne diseases in persons who inject drugs."

Reporter Phillip M. Bailey can be reached at (502) 582-4475. Follow him on Twitter at @phillipmbailey. Reporter Chris Kenning can be reached at (502) 582-4697. Follow him on Twitter at @ckenning_cj.