City’s nee­dle swap aims to pre­vent an epi­demic

Los Angeles Times - - THE NATION - By Katie Shep­herd katie.shep­herd@latimes.com Twit­ter: katemshep­herd

A trio of deadly af­flic­tions is rip­ping through a ru­ral county in south­ern In­di­ana.

More than 130 pa­tients in Scott County, Ind., tested pos­i­tive for HIV in less than a year, mak­ing the com­mu­nity of about 24,000 peo­ple the site of one of the worst out­breaks in decades.

Among the in­fected are 114 who also tested pos­i­tive for another blood-borne dis­ease — hep­ati­tis C, which at­tacks the liver.

Most of the HIV and hep­ati­tis C pa­tients share another sick­ness — the root of the HIV epi­demic and a driv­ing fac­tor in the pro­lif­er­a­tion of hep­ati­tis all along the Ap­palachian Moun­tains. They are also ad­dicted to opi­ates.

Nee­dle-shar­ing among ad­dicts is the No. 1 risk fac­tor in con­tract­ing hep­ati­tis C and HIV. Laws that track the pur­chase of sy­ringes keep drug users from buy­ing fresh nee­dles for each new high.

“A lot of peo­ple use the same nee­dle over and over,” said Amanda New­ton, a clin­i­cian and di­rec­tor of mar­ket­ing at the Jef­fer­son Al­co­hol and Drug Abuse Cen­ter in Louisville, Ky. “They get sores and the nee­dles break off in their arms.”

Health of­fi­cials in Louisville, just 35 miles south of Scott County, are brac­ing for the worst.

Last week the city’s health depart­ment opened the state’s first nee­dle ex­change, where drug ad­dicts can trade their used sy­ringes for ster­ile ones. Of­fi­cials hope the pro­gram will keep con­tam­i­nated nee­dles off the streets and pre­vent the spread of dis­ease.

Ken­tucky saw sharp in­creases in heroin over­dose deaths and hep­ati­tis C cases over the last decade, signs that could fore­shadow an HIV cri­sis. Louisville health depart­ment of­fi­cials hope the nee­dle ex­change will pre­vent an HIV out­break.

As Ken­tucky and other states tight­ened reg­u­la­tions con­trol­ling pre­scrip­tions for painkillers, heroin re­placed pills such as Oxy­codone. Heroin found in Louisville to­day is purer than what was sold in the city dur­ing the 1970s and 1980s, New­ton said.

The spike in hep­ati­tis C cases is likely the “tip of the ice­berg,” said Stephanie May­field, com­mis­sioner of Ken­tucky’s Depart­ment of Public Health. The dis­ease typ­i­cally doesn’t cause symp­toms for decades, so many of those in­fected don’t get tested un­til the dis­ease has al­ready dam­aged their liv­ers.

The CDC is­sued an ad­vi­sory on the In­di­ana HIV out­break in April re­mind­ing health de­part­ments and physi­cians to coun­sel both HIV- and hep­ati­tis-C-pos­i­tive pa­tients to avoid shar­ing nee­dles, and to pro­vide those who are ac­tively us­ing drugs with ster­ile nee­dles.

Ken­tucky’s Leg­is­la­ture passed an emer­gency bill per­mit­ting lo­cal gov­ern­ments to es­tab­lish needle­ex­change pro­grams in March, al­low­ing those gov­ern­ments to pro­vide re­li­able sources of clean sy­ringes for the first time.

Nearby states ex­pe­ri­enc­ing an in­crease in hep­ati­tis C in­fec­tions are still de­bat­ing the value of nee­dle ex­changes. Some op­po­nents of the pro­grams say they en­cour­age drug users to con­tinue seek­ing out highs with fewer wor­ries.

But Dr. Rice Leach, who is ad­vo­cat­ing for a nee­dle ex­change in Lex­ing­ton, Ky., doesn’t be­lieve clean nee­dles would in­crease the num­ber of drug users.

“Peo­ple who are go­ing to abuse drugs are go­ing to abuse drugs,” he said.

The nee­dle ex­change is “just go­ing to make the area safer for both drug users and nonusers,” he added.

“A huge mo­ti­va­tor in this is the HIV epi­demic just 35 miles away from the city — caused mostly by folks who are ad­dicted to heroin and shar­ing dirty nee­dles,” said Dave Lang­don, a spokesman for the Louisville Depart­ment of Public Health and Well­ness.

Hep­ati­tis C pat­terns in the state sug­gest an HIV in­fec­tion would spread quickly among drug-us­ing com­mu­ni­ties. If a sim­i­lar out­break of HIV were to make its way to Louisville — with a pop­u­la­tion of nearly 600,000 — Lang­don said the city could see as many as 5,000 cases in the time that it took for Scott County to re­port 135 new in­fec­tions. The virus would spread faster in the city be­cause there are more than 10 times as many peo­ple liv­ing in much closer quar­ters.

In the last decade, hep­ati­tis C cases have sky­rock­eted in Ap­palachia. Ken­tucky, West Vir­ginia, Ten­nessee and Vir­ginia col­lec­tively saw an in­crease of 364% in the num­ber of acute hep­ati­tis C cases, ac­cord­ing to the U.S. Cen­ters for Dis­ease Con­trol and Preven­tion.

The pro­lif­er­a­tion of the liver-killing dis­ease and other blood-borne pathogens co­in­cides with the spread of heroin use be­yond the con­fines of poor ur­ban neigh­bor­hoods to mostly white sub­ur­ban and ru­ral com­mu­ni­ties.

Most of the heroin users that come to the Jef­fer­son Al­co­hol and Drug Abuse Cen­ter are un­der 25 years old, and mid­dle- or up­per­class, New­ton said.

“It’s re­ally hard when you see 18- or 19-year-olds on their deathbeds,” New­ton said. “They don’t even know they have their whole lives ahead of them.”

Five years ago, the treat­ment cen­ter served mostly pre­scrip­tion-pill ad­dicts. Heroin users were rare, New­ton said. But now, 80% of the cen­ter’s pa­tients seek­ing ad­dic­tion ther­apy are us­ing the drug.

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