Needle Exchange

Programs Are they right for your community?

Deena Dodd

Indiana Rural Health Association

2017 Indiana General Assembly

House Bill #1438

Syringe exchange programs:

Allows a county or municipality to approve the operation of a syringe

exchange program (program).

Allows a program to be renewed for not longer than two years.

Requires a program to keep a sufficient quantity of an overdose

intervention drug in stock to administer when needed.

Requires the state health commissioner to receive written notice when a

program is renewed, expired, or terminated or if the qualified entity

operating the program changes.

Extends the law concerning programs until July 1, 2021. (Current law expires

July 1, 2019.)

Public Law 198 4/26/17 Governor Eric Holcomb

How’d we get here? If only it was a simple path………….

Over prescribing of opioids

Mental and behavioral health challenges – self medication

Stigma – “those people”

But wait……

Young mothers back pain

Children to run after, keep in activities

Young men trying to keep up with their peers

Quick game of pick-up basketball

Teenagers playing sports

Looking to get that college scholarship

Mature breadwinners with responsibilities

Just because I hurt doesn’t make my mortgage go away

Retiree’s with back, hip and shoulder pain

I want to keep moving, stay young, be active

Veterans

Vietnam, Afghanistan, Gulf War, Iraq, Operation Enduring Freedom, Somalia, Yemen, ISIS/ISIL, Israel-Gaza, countless other conflicts, unrests, insurgency

Changing trends in demographics of

people who inject drugs (PWID)

Opioid overdoses in U.S. by age range

23%

19%

23%

26%

% BY AGE RANGE

35-44 55+ 45-54 25-34

Hoosiers impacted.…

What are Needle Exchange Programs?

Needle exchange programs (NEP), also known as Needle and

Syringe Programs (NSP), or a Syringe-Exchange Program (SEP), are

Community based public health programs.

These services allow people who inject drugs (PWID) access to

obtain clean, new hypodermic needles as well as other necessary

paraphernalia needed for injecting drugs.

These supplies come at little to no cost to the PWID contingent upon

the return of used syringes. Typically, PWIDs are given an equal

number of syringes to those that they return or “exchange”.

What’s the motive?

The primary motive behind these programs is harm reduction.

The basic premise is that people are going to use drugs regardless of whether or not they have clean and sanitary materials. With the

prevalence of bloodborne pathogens among IV users, the goal is to

prevent further infections due to limited access to clean

paraphernalia

Bloodbourne pathogens

Hepatitis C – usually spread when blood from a person infected with HCV

enters the body of someone who is not infected. Most people become

infected by sharing needles or other “dirty” equipment to inject drugs.

The virus CAN NOT be transmitted through casual contact, i.e. eating utensils, hugging, holding hands, sneezes or coughing.

HIV/ AIDS - usually spread when blood from a person infected with HIV

enters the body of someone who is not infected. Most people become

infected by sharing needles or other “dirty” equipment to inject drugs.

The virus CAN NOT be transmitted through casual contact, i.e. eating utensils, hugging,

holding hands, sneezes or coughing.

Scott Co. Indiana has over 210 cases of HIV in a population of 23,000.

Prevent the Spread of Diseases

• It is estimated that in 2013, 6% diagnoses of HIV infection in the United States were

attributed to Intravenous drug use. With these trends continuing, it is expected that 1

out of 23 women who inject drugs and 1 out of 36 men will contract HIV.

• Among persons who inject drugs (PWID), HCV is approximately 10-fold more

transmissible than HIV. It is estimated that one IV user who is Hepatitis C positive is likely

to infect up to 20 other people.

• 50-90% of HIV-infected PWID are co-infected with HCV.

• An estimated 33 percent of PWID aged 18-30 years are HCV-infected

Magnitude of the crisis

More overdoses caused by PRESCRIPTION DRUGS than illegal drugs

6/10 overdose deaths involve an opioid

Opioid abuse costs U.S. employers $18 billion in sick days and medical

expenses

Opioid abuse among employees is estimated to account for more than

64% of medically related absenteeism from work and 90% of disability

expenses resulting in more than $25 billion a year in lost work productivity.

For every one person who dies from opioids there are 851 people in various

stages of use, misuse and abuse.

The controversy or the conversation…………

The controversy……………..

Community Perception -- Many people believe there are far better ways to spend

tax dollars than to provide drug paraphernalia-- not “feeding into” their addictions.

The lack of understanding leads to a lack of compassion which in turn makes it

harder for these programs to operational.

Harm Reduction Not Actually Fixing the Problem -- Rather than providing

rehabilitation services or overtly enticing recovery, many people believe that these

programs merely perpetuate the problem by giving addicts access to the

paraphernalia. While it is assisting in preventing the spread of various diseases and

promoting “safe” using, these addicts are still using.

NEPs Require Government Funding - As with any government sanctioned

program, NEPs require government funding in order to keep providing their services.

Government funding comes directly from the tax payers pockets, so many people

resent having to essentially “finance” addicts’ drug problems, furthering community

opposition.

NEPs provide Testing, Education, Conversation,

OpportunityThe conversation…….what really transpires with a NEP

Testing: By allowing PWIDs to learn their status when it comes to these

diseases, it will allow them to either seek treatment or use responsibly to

prevent further infections from spreading

Education: By giving PWIDs access to vital information surrounding

addiction, it can be beneficial in preventing overdose and even

encourage recovery for many struggling addicts.

Conversation: NEPs have the ability to reach populations of people who

otherwise would not have access to the educational content or health

services that are provided.

Opportunity: Through this TEC approach healthcare services may be

rendered to people who need it most!

Why should I consider it?

Harm reduction…….

Advice on safer injecting practices

Advice on minimizing the harm done by drugs

Advice on how to avoid and manage an overdose

Information on the safe handling and disposal of injecting equipment

Referrals to HIV testing and treatment services

Help to stop injecting drugs, including access to drug treatment and

encouragement to switch to safer drug taking practices

Other health and welfare services (including condom provision)

Costs associated with Hepatitis C and

HIV/AIDS

Hepatitis C - the cost of one full treatment course — which includes drugs in

combination — can reach about $100,000 per patient. And some patients

will need two courses of treatment.

HIV/AIDS - The average annual cost of HIV care was estimated to be

$30,000.

The most recent published estimate of lifetime HIV treatment costs was $367,134

(in 2009 dollars; $379,668 in 2010 dollars) for an individual that contracts the disease at 35 years of age. A nominal jump of $12, 534 year. It’s now 2017 so

add $87,738 ….so 2017 $467,406 and addicts range in age from 15 – 65.

Medicare member opioid dependency

Medicare Part D paid almost $4.1 billion in opioid

prescriptions in 2016

400 prescribers had questionable opioid prescribing

patterns for patients

90,000 Medicare patients are at serious risk

1 in 3 Medicare patients received opioid in 2016

500,000 received high amounts of opioids

The #’s Hep. C HIV

By law………..

By law, Medicaid and Medicare are

required to cover medically necessary

treatments; they can’t exclude an entire

class of medications that are proven

effective for cost considerations

alone. Commercial insurers also typically

agree to provide all medically necessary

care.

Needle Exchange KitsKits can be tailor made for a community. The basics of the kit include: STERILE alcohol swab, tourniquet, syringe, cup / bowl. Additions such as dirty needle container, condoms, band-aid, cotton swab, etc.

Why does Sterile equipment matter?

Syringes Cup w/ filter

Delivery Models

Depending on the program, and which county it is located in, needle

exchange programs are delivered in a variety of ways. The more common

delivery methods for needles include:

Fixed sites

Mobile programs

Outreach programs

Syringe vending machines

Pharmacies

Clients are able to enter the exchange site, where they hand in used injection

equipment and receive new needles or syringes. The main benefit, besides

consistency for those in need of clean needles, is that these programs are

better able to provide additional services to clients, such as HIV testing,

healthcare and drug counseling.

Communities can set up NEPs as they desire. You can execute them to fit

the needs of your community!

Let’s look at the fiscal model numbers

➢ It costs between $20 and $60 per

user per year for a NEP to be

executed in a community.

➢ Costs can vary depending on

the NEP packets, educational

outreach, wrap-around services

provided etc.

➢ One syringe-infected AIDS patient

will require upwards of $120,000

per year in public health

expenditures

➢ One infected Hepatitis C patient

can cost upwards of $100,000 per

case depending on the path of

treatment.

Whom do needle exchange programs

protect? What’s the financial impact?

First Responders

Firefighters

Police Dept.

Sherriff Dept.

Paramedics

Linemen

City Street Dept.

Parks Dept.

Community Volunteers

If any city/county employee gets stuck with a dirty needle and requires treatment the insurance costs go where? Who’s left paying that bill? What would that do to your fiscal bottom line? Taxpayers need to know, this isn’t just “the users” problem.

Questions, Comments,

Concerns?

What is the current status of your community?

How informed is your local legislator?

What conversation needs to happen around your community?

What support does your school have?

How can I support your community?

The Indiana Rural Health Association

supports all Hoosiers. We are a great

resource for a vast array of issues.

Join us at https://www.indianaruralhealth.org/membership

Individual $100 Organizations $600

Deena Dodd

Network Development Officer

Indiana Rural Health Association

ddodd@indianarha.org

317-414-2039 or 812-478-3919 x 228