Needle exchanges: Where politics and public health collide in Northern Kentucky

Posted at 6:36 AM, Mar 23, 2017

CINCINNATI - First, it was prescription opioids that masked Katlynn Hornsby’s pain of losing her first child.

Next it was snorting heroin. Eventually, it was shooting up heroin using a friend's needle.

“When you’re in that awful place, if you don’t have a clean needle, you find a way to get it in you,” said Hornsby, who’s been in recovery and heroin-free for more than a year.

But the private pain and addiction that local residents like Hornsby have battled has ballooned into a public health nightmare. Hornsby is among thousands of local residents who are living with hepatitis C -- a potentially fatal virus contracted through IV drug use.

As the heroin scourge has unfolded, rates of hepatitis C have exploded locally. In Cincinnati, the rate has nearly doubled with more than 800 new cases reported in 2016. In Northern Kentucky, almost 1,300 new cases of the virus were logged last year – up from 314 just six years ago.

Map courtesy of the Northern Kentucky Health Department

Compounding the problem: Syringe exchange programs – where IV drug users can trade in used, dirty needles for new, clean ones – are absent in communities where the epidemic has hit the hardest. 

In Northern Kentucky, two exchange programs are sitting in limbo – lacking the final political sign-offs needed to get them up and running.

“These programs have been shown to be very effective, but getting some of our counties and cities to approve them has been challenging in some areas,” said Lynne Saddler, director of the Northern Kentucky Health Department.

Among the most vocal opponents of the programs is Campbell County Fiscal Court Commissioner Charlie Coleman. He says the exchanges enable drug use by giving addicts tools to inject heroin – something the government shouldn’t have a role in.

“Doctors say addiction is a disease," Coleman said. "No, it's not a disease -- it's a choice, and it's a bad choice. And this is not a needle exchange. It's a needle distribution, and it's so enabling."

COMPLETE COVERAGE: Heroin in the Tri-State
As the debate lingers on, health care leaders say the problem isn’t going away. They fear an explosion of HIV and hepatitis C that could far exceed the outbreak experienced in nearby Scott County, Indiana. There, scores of intravenous drug users in the county's tiny city of Austin got HIV from sharing and re-using dirty needles. Nearly 95 percent of the infected also have hepatitis C.

“We know the first stage is Hep C. If you’re not able to control that, then you’re looking at the risk for an HIV outbreak,” said Garren Colvin, CEO of St. Elizabeth Hospital. “If we’re not able to implement these programs, the health of our community is at risk.”

Needle Exchanges: Where politics and public health collide

Already, the Northern Kentucky Health Department has been operating a needle exchange program for more than a year at its Grant County health center.

The department released data this week showing the impact of a syringe exchange it has operated for a year in Grant County.

"We have an example in our own district to show that, yes, these programs do work, they are effective and that we are very capable to operate the program," Saddler said.

Infographic courtesy of the Northern Kentucky Health Department

The health department has presented plans to open exchanges at its three other community health centers in Boone, Campbell and Kenton counties.

“The health centers are the ideal location to operate these programs, because it’s an opportunity to get people who are injecting drugs into the health care system where we can provide them vaccines, testing and education – besides just the exchange of needles,” Saddler said.

But so far, those plans have hit a number of hurdles as the health department has worked to navigate a complicated layer of political sign-offs required by the state.

Under state law, a local Board of Health must approve any needle exchange program, along with the city and county where the program operates.

A year ago Kenton County Fiscal Court and the city of Covington approved a measure that would allow a mobile exchange program. But the ordinance requires at least three Northern Kentucky communities to offer an exchange.

In May, Campbell County Fiscal Court gave its nod for an exchange, but a city within the county has yet to sign off. The health department presented a plan to the Newport City Commission more than a year ago for a program at its Campbell County health center on Monmouth Street.

But since then, the commission hasn't discussed the matter, and officials told WCPO they’re not sure when the issue might be taken up.

“The way the plan has been presented, a needle exchange will either happen or won’t based on what Newport does,” said Newport Mayor Jerry Peluso. “I can only tell you I support it, but when or whether it will happen – I can’t answer that question.”

The health center where the program would operate in Newport also shares office space with a host of other Northern Kentucky government offices, including Campbell County Fiscal Court.

“It’s probably the worst location (for a needle exchange),” said Newport Commissioner Ken Rechtin, who says he would rather see a proposal for mobile exchange unit that can serve all parts of the county.

“We’ve set up a system for failure,” Rechtin said. “We’ve juxtaposed two entities in opposition here – the city and the county. We can’t resolve anything this way.”

‘Start treating these people as humans’

As decisions are delayed, local health officials fear the problem with Hepatitis C will only get worse and more costly.

Treatments for Hepatitis C can cost up to $90,000 per patient, said St. Elizabeth’s Colvin. And increasingly, the health care system is taking in patients who have contracted deadly bacterial infections from dirty needles. Treating those infections require up to 45-day stays in the hospital for continuous doses of  IV antibiotics at a cost of up to $130,000.

“What the taxpayer isn’t picking up through Medicaid, we have to eat – which is very disruptive and costly,” Colvin said. “We need to do something about the Hep C outbreak today, so we’re not battling an HIV outbreak down the road.”

Winning over people who are opposed to syringe exchanges, Colvin said, will take continued education. 

The Cincinnati Needle Exchange van parked in Northside on Tuesday, March 14, 2017.

“The opposition in the community is really tied to a lack of understanding, not only of the benefits of having an exchange program but the harm of not having one,” Colvin said.

Saddler agreed.

“We’ve all been socialized to believe certain things about people who use drugs, even though science and research has uncovered a lot about the disease of addiction,” Saddler said. “If we start treating these people as human beings who are deserving of services and support, it will go a long way to earning trust so we can help them.”