Evaluating Needle and Syringe Exchange Programs in Kentucky
The spread of communicable diseases through the sharing of needles in intravenous drug users is a prevalent public health issue in the United States and can be considered so because of the vast number of people impacted by both infectious diseases and opioid addiction. Human immunodeficiency virus (HIV) and hepatitis can both be spread through sharing a needle with a person who has one of the aforementioned diseases. According to the CDC, about 1 in 10 new HIV diagnoses have been among people who inject drugs (Injection Drug Use, 2020). To prevent the spread of diseases like HIV and hepatitis through the sharing of needles, syringe exchange programs have been established. These programs facilitate the “safe disposal of used needles and syringes. Providing testing, counseling, and sterile injection supplies also helps prevent outbreaks of other diseases” (Syringe Services Programs (SSPs), 2019). A specific example of these programs and the impacts of their implementation can be seen in Kentucky. The State of Kentucky’s legislature allows local health departments to establish syringe and needle exchange programs that serve a variety of functions. Under this law, needles and syringes that would normally be considered “drug paraphernalia” are not looked at as such, allowing people who use these items a safe place to go without the fear of arrest or prosecution. This paper will examine Kentucky’s needle and syringe exchange programs, the impact they have had on population health, and the greater community’s responses to their implementation.
While needle and syringe exchange programs have been proven to be effective, public opinion on these programs is mixed as some believe they encourage drug use and would prefer programs that would discourage intravenous drug use instead. The Kentucky Health Issues Poll (KHIP) is an annual poll done by phone in which Kentucky residents are asked about health issues. According to the 2018 KHIP report, about 50% of adults in Kentucky favor needle exchange programs, while 40% of adults are against these programs (Kentucky Health Issues Poll, 2019). The same report breaks these results down into familiarity with the programs and show that among adults who are “very or somewhat familiar with needle exchange programs,” 55% favor them, but among adults who are “not very or not at all familiar with needle exchange programs,” only 43% favor them (Kentucky Health Issues Poll, 2019). Based on the data, one’s level of education surrounding the needle exchange programs clearly had an impact on whether or not they supported the program. Support of needle exchange programs is further influenced by the general public’s preconceived notions regarding intravenous drug users and their behavior. In Bourbon County, Kentucky, community members debated about the implementation of a needle exchange program for three years. While public health officials pushed for the program, other members of the community were largely against it. Their arguments against the program included that drug users were “just looking for a handout” and that the program would be “enabling ‘druggies’ to break the law” in the words of one community member (Franklin, 2018). In the same group of community members, another opinion was present as well. Greg Lee who is the state of Kentucky’s HIV and AIDS educator argued that because the price of treating HIV and hepatitis C is so high, that “the price of prevention is far lower” (Franklin, 2018). Lee’s point of view is largely influenced by the public health implications and economic impacts of the program, while the rest of the community is more focused on how they personally feel about having a program in their county and is potentially influenced by the stigmas associated with being an intravenous drug user.
Yet another perspective on this issue comes from the community pharmacists who would likely play a role in some of the programs by aiding in needle exchange and the disposal of used needles. A survey study done in 2018 attempted to gage community pharmacists in Kentucky’s willingness to participate in the needle exchange programs and in what ways they would be willing to contribute. The survey results found that 39.1% were not willing to provide program participants with clean needles and syringes and only 30% of the pharmacists surveyed were willing to do so (Goodin et al., 2018). These differences became even clearer when study participants were asked if they were willing to dispose of used needles and syringes. Only 18.7% of the pharmacists were willing to help with disposal and 62.6% were not willing to play this type of role (Goodin et al., 2018). Another interesting aspect of this study revealed that upwards of two thirds of the pharmacists strongly agreed with the statement that “access to clean syringes and needles is important to prevent blood-borne infections such as HIV and hepatitis” (Goodin et al., 2018). The participating pharmacists generally have an understanding that needle exchange programs can have an impact in preventing blood-borne infections, yet at the same time, the majority of them are unwilling to participate in the programs themselves. Although the study cannot prove why these pharmacists were largely unwilling to provide exchange and disposal services, it could be due to the persistent stigma that surrounds intravenous drug use and could be eliminated with further education regarding the exchange program specifically as well as drug addiction in general.
While others may be divided on the use of needle and syringe exchange programs, the public health community is in agreement about their effectiveness and their role in preventing the spread of infectious diseases. As part of a webinar series done by the U.S. Department of Health and Human Services, Dr. Connie Gayle White provided a perspective from the state of Kentucky on the issue of the exchange programs. In her presentation, she outlines the services that some Kentucky needle and syringe exchange programs offer which include, “testing for HIV/HCV and other comorbidities, vaccination (Hepatitis A), naloxone supply, peer support specialist availability, referral to infectious disease treatment, and transfer to substance use disorder treatment” (White et al., 2019). All of the services outlined by White are essential in the process of treating and helping an intravenous drug user, and the more people these programs can help, the more the public health of the community improves.
The issue of the creation of needle and syringe exchange programs is regulated by both state and local governments. In her presentation, White also outlines the three levels of government approval at the local level needed in order to create the needle and syringe exchange programs in the state of Kentucky. First, the development of the program must be approved by local boards of health. White describes this process as “quite a lift considering the fiscal restraints that [their] local boards of health have been feeling” (White et al., 2019). Once the board of health approves the program, the city council members as well as the magistrates of the county specific government have to approve as well. While this may seem fairly straightforward, it is a lot more complicated than it seems. In White’s words, “you also had to get buy-in from city police and the County Sheriff’s Office [and] many of our local health department directors and their staff were busy holding open forum meetings in the community for community input” (White et al., 2019). In general, local public health departments are responsible for the daily public health related activities that occur in our lives and they are given the money to fund programs that impact public health by the state. Each state’s constitution requires them to protect the wellness and the health of the people that live there and they do this through the funding of programs and the creation of new legislation. For the needle exchange programs in Kentucky to even make it to the local level for approval, new laws first need to be passed at the state level. As previously mentioned, this legislation was passed in Kentucky in 2015 and allows local health departments to create and operate needle and syringe exchange programs.
In the state of Kentucky, these programs have been largely successful and have greatly improved population health. Program sites in Covington, Kentucky and Newport, Kentucky have collected over 44,000 used syringes, nurses at the sites have given out 171 HIV kits, and in total the programs have given out over 1300 naloxone kits to patients (DeMio, 2019). Naloxone is essential in treating overdoses and according to the article, “at least 92 lives have been saved with naloxone handed out at two Northern Kentucky syringe exchanges” (DeMio, 2019). Because of these programs, fewer people have died from a drug overdose, and many are receiving the preventative care they need in order to stop the spread of infectious diseases like HIV. Another aspect of these sites that is improving population health is their ability to refer patients to drug abuse treatment programs. By referring patients to treatment programs, the exchange programs further improve population health by treating the root of the issue: drug addiction.
Overall, the implementation of needle and syringe exchange programs in Kentucky have greatly improved population health in places where program sites exist. Even though the programs generally improve population health by decreasing infectious disease transmission and providing resources for drug addicts, public response to their implementation continues to be mixed. The public health community and those who benefit from these programs see their importance and are all for their implementation. Others believe they are encouraging drug users to continue using by providing them with clean needles without the fear of being arrested for possession of drugs or drug paraphernalia. The stigmas surrounding drug addiction continue to influence public perception of the exchange programs, but could be easily eliminated through educational programs. As more needle and syringe exchange programs pop up in Kentucky and across the country, their positive impacts on population and individual health will continue to highlight the need for public health informed legislation as well as the importance of supporting public health education and initiatives to better the community as a whole.
DeMio, T. (2019, July 18). Health officials say syringe exchanges have saved 92 lives in Northern Kentucky. Cincinnati Enquirer. https://proxy.lib.umich.edu/login?url=https://www.proquest.com/docview/2259229288?accountid=14667
Franklin, J. (2018, April 2). How A Rural Ky. County Overcame Fear To Adopt A Needle Exchange. 89.3 WFPL News Louisville. https://wfpl.org/how-a-rural-kentucky-county-overcame-fear-to-adopt-a-needle-exchange
Goodin, A., Fallin-Bennett, A., Green, T., & Freeman, P. R. (2018). Pharmacists’ role in harm reduction: A survey assessment of Kentucky community pharmacists’ willingness to participate in syringe/needle exchange. Harm Reduction Journal, 15(1). https://doi.org/10.1186/s12954-018-0211-4
Kentucky Health Issues Poll: KENTUCKY ADULTS STILL DIVIDED ON NEEDLE EXCHANGE PROGRAMS. (2019). Foundation for a Healthy Kentucky. https://www.healthy-ky.org/newsroom/news-releases/article/299/kentucky-health-issues-poll-kentucky-adults-still-divided-on-needle-exchange-programs
White, C. G., Giroir, B., Staley, D., Gans, A., Swatek, J., & Dan, C. (2019, September). Syringe Service Programs—State and Local Perspectives on the Role of Policy, Funding, and Partnerships. https://www.hhs.gov/sites/default/files/OASH-Syringe-Service-Programs-Webinar-09162019.pdf