Let's support and pay for needle exchanges

Posted at 5:00 AM, Mar 18, 2016

The Tri-State is on the brink of an HIV epidemic.

The widespread abuse of shooting heroin has created a disaster-in-waiting, an outbreak of the AIDS virus from sharing dirty needles.

IN DEPTH: Tri-State vulnerable to HIV outbreak

There’s a way to prevent this – needle exchanges. And our communities should be asking for them and paying for them.

Needle exchanges are controversial. On the surface, the idea doesn’t seem to make sense. Giving addicts free, clean needles so they can shoot up? Isn’t that enabling their addiction?

But distributing free, clean needles to addicts is an effective weapon to prevent the spread of HIV and hepatitis among needle users. Research has proven that.

They can also be a place where addicts can turn to for help. That’s also been proven.

They don't enable drug use, because heroin is so addictive that users will do it any way they can, even with a used needle.

Some communities are beginning to get it. Grant County, in rural Kentucky, started a needle exchange Wednesday. The city council of Independence, in Kenton County, passed a resolution supporting the idea. Colerain Township is considering one. Those should move forward with community support and funding, as should others in the works.

More Than Clean Needles

In Cincinnati, the neighborhoods of Mount Auburn and Walnut Hills host needle exchanges. The Cincinnati project has served about 700 clients so far. Along with clean needles, users can get a bit of counseling, and referrals to treatment if they’re ready for that.

No drugs are taken there, and project organizers say police will be contacted if drugs are taken on or near the site.

About 70 needle exchange clients are currently in recovery from their addiction, says co-founder Dr. Judith Feinberg. Volunteers also train people how to use the overdose antidote Narcan, and have documented saving 110 people from overdose deaths.

The Cincinnati Exchange Project’s mobile van.

Needle exchanges can get used needles off the streets, parking lots and sidewalks, a growing problem as the heroin epidemic spreads.

But starting the exchange and getting neighborhoods to allow the mobile van to set up was a slow process. “The fact that it took nine years for us to get this started is a tragic, tragic public health story,” Feinberg says.

Another tragic public health story is in the making, and this time a more urgent response is needed.

The widespread abuse of heroin and other drugs injected with needles can spawn other diseases, specifically AIDS and hepatitis. An outbreak of the AIDS virus could be catastrophic. But that’s exactly what the Centers for Disease Control and Prevention foresees in this region.

This map was put together by the CDC, the federal government’s chief disease trackers. It should be a wake-up call. The CDC has mapped 220 counties in the U.S. most likely to experience an HIV outbreak from needle abuse.

HIV-vulnerable counties are concentrated in the Tri-State, the CDC found.

What it shows is the Tri-State is on the brink of an outbreak of HIV due to needle sharing.

The widespread use of heroin and other opiates, poverty and a lack of public health resources are the factors behind the CDC's forecast. Heroin addicts aren’t picky about sharing needles. If they need to use dirty needles to get the drug, they will.

“Heroin users will use whatever needle is available, often sharing or re-using needles,” says the most recent report from the Ohio Substance Abuse Monitoring Network.

MORE: Heroin is a disease, not a choice

Sharing needles is an efficient way to spread disease, especially bloodborne diseases such as HIV. Distributing clean needles to users can slow or stop the spread.

The CDC’s national analysis was done after an outbreak of HIV in Scott County, Indiana, a rural county of only 24,000 people in the south-central part of the state. The county normally reported five new HIV cases a year. So far, 190 people have contracted the virus in this outbreak -- nearly all of them from sharing needles to inject drugs.

A Path to Treatment

Needle exchanges don’t enable drug use. Heroin addicts will seek out the drug every day, whether they have clean needles or not. And a well-run needle exchange can actually help lead addicts to treatment.

“Our goal is to get people off drugs, not to encourage drug use,” Feinberg says.

An exchange can put addicts in contact with sober professionals, who can make a referral to treatment or build a relationship with the addict in order to steer them to treatment when the user is ready.

And they’re effective in preventing the spread of HIV and hepatitis among needle users.

The Cincinnati Needle Exchange is supported by “a hodge-podge of funding,” mostly private grants and donations, says Feinberg. So far, its expenses amount to about $150,000 a year, far less than it costs to treat one HIV case. To donate, go to Your donation will be matched by Cincinnati-based Interact for Health.

Washington D.C. once had a banned funding for needle exchanges. The ban was lifted in 2007, and researchers at George Washington University studied the difference in HIV cases. They concluded that the exchange programs averted 120 new cases of HIV. After the change, the number of new HIV cases per year dropped by 73 percent.

And many communities are still resistant.

Needle exchanges aren’t the answer to the heroin epidemic. There is no single answer. But they are an important piece of a community response. And more communities should set them up and pay for them.

WCPO's Heroin Project: How Do We Respond?