NEWS

As needle exchange is extended, lawmakers ponder legalizing programs

Shari Rudavsky
shari.rudavsky@indystar.com

As Gov. Mike Pence granted a 30-day extension to the nascent needle exchange program in Scott County, lawmakers listened to a string of testimony supporting a measure that could open the door for many other counties to adopt such programs.

An Indiana Senate committee heard testimony Monday about a proposal to allow the counties at the highest risk of HIV outbreaks linked to intravenous drug use to put in place needle exchange programs to prevent such an occurrence.

Interest in the measure was sparked earlier this year by the HIV epidemic in Scott County that has now climbed to more than 130 cases, all linked to injecting drugs. In response to the outbreak, Pence declared a public health emergency in March that allowed local authorities to establish a temporary needle exchange program.

That program, scheduled to expire Saturday, now has been extended for 30 days, after which Pence will re-evaluate. More than 85 people have entered the program, and more than 5,300 needles have been handed out.

Pence has said he is opposed to needle exchange programs as "anti-drug policy."

But during Monday's hearing at a House-Senate negotiating committee, Joey Fox, director of legislative affairs for the Indiana State Department of Health, said the state is learning more about such programs as it battles the Scott County HIV outbreak.

"This is a brand-new concept for the state of Indiana," Fox said. "I think the administration would be open to having a conversation."

The measure divides the state's 92 counties into quartiles of risk, based on their hepatitis C rates. Health officials often use hepatitis C as a surrogate indicator for HIV risk because the two often go hand in hand for IV drug users.

Under the measure, local governments in the top two quartiles would be allowed to institute needle exchange programs. The measure leaves it to those localities to fund the programs.

The lone person testifying against the measure expressed concern that the proposal did not include any provisions for improving drug treatment options for those in needle exchange programs.

"I think it's too early" to pass such a measure, said David Powell, executive director of the Indiana Prosecuting Attorneys Council. "If you don't have a treatment program, what does that fix? ... We don't want the government to endorse handing out needles."

Needle exchange programs, however, have been established not to reduce drug use but to lower rates of highly infectious and potentially fatal diseases such as hepatitis C and HIV, the virus that causes AIDS, said Beth Meyerson, co-director of the Rural Center for AIDS/STD Prevention at Indiana University.

Ideally, she said, needle exchange programs go along with testing for HIV and hepatitis C, treatment for those diseases and substance abuse counseling.

"This is not primarily a drug reduction strategy," she said. "The nice thing about the science is that (with needle exchange) we see a reduction in HIV, hepatitis C."

Southern Indiana, like much of the rural part of the state, has been sorely lacking in such services, those familiar with the area testified. Dr. Shane Avery, a physician in Scottsburg, came to talk about the need for a needle exchange program in his area.

First, however, he painted a dire picture of the problem. An estimated 10 percent of the population of Austin, or about 430 people, are thought to use intravenous drugs. The HIV outbreak in the region could climb to about 200, he said, or about half of all the IV drug users.

Failing to take steps to halt this outbreak and potentially prevent others like it, he said, would be "Indiana's most historic failure in public health."

Unlike the response to tornadoes, such as the one in 2012 that struck Henryville just a few miles south on I-65, a town cannot simply rebuild after an outbreak like this one, Avery said. Those who are HIV positive will require treatment for years to come.

"This is the new normal for Indiana," he said. "It won't go away."

And there's no reason to think that Scott County is unique. While it has an average three-year hepatitis C rate of about 260 cases per 100,000 population, Fayette County, the next highest on the list, comes in at 250 cases per 100,000 population.

Rep. Terry Goodin, D-Austin, said his area has been asking for help dealing with its IV drug problem and lack of social services for years. But, he said, many other communities with a similar lack of resources could find themselves facing a similar problem.

If help does not arrive for those places, he said, "we're going to see this bounce up. It's going to be like Whac-a-Mole all over the state of Indiana."

Call Star reporter Shari Rudavsky at (317) 444-6354. Follow her on Twitter: @srudavsky.