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Syringe exchanges key to fighting Hep A

EDITORIAL

The Advocate-Messenger

While Kentuckians remain divided on syringe exchange programs, they are likely the key to continuing a reduction in cases of viral hepatitis and the spread of other diseases in the state.

According to the Foundation for a Healthy Kentucky’s Health Issues Poll released Thursday, “About half of Kentucky adults favor programs that allow people who use intravenous drugs to exchange used needles for sterile ones, while about 40 percent oppose such programs.”

However, some health professionals are encouraging expanding access to needle exchange programs to more Kentucky communities in hopes of curbing the spread of the worst hepatitis A outbreak in the country.

Kentucky has seen 44 deaths due to hep A since the outbreak began here more than year ago.

There have been cases of the inflammatory liver disease in 104 of Kentucky’s 120 counties, and more than 20 new cases were reported in the first week of March.

“So far, the nation’s largest hepatitis A outbreak, declared in November 2017, has sickened 4,288, sending 2,065 to the hospital,” the Courier Journal reported Thursday.

In Kentucky, the hep A outbreak has primarily affected those who use intravenous drugs, making it difficult to tackle the spread of the disease, which causes fatigue, nausea, vomiting, abdominal pain, fever, joint pain and more, including the potential for death.

Dr. Charles Noplis, a psychiatrist focusing on addiction medicine, told the Courier Journal, “many of the Kentuckians who die from hepatitis A are more vulnerable because they have other health issues, such as hepatitis C. Among the general public, death from hepatitis A is rare.”

Syringe exchange programs would help connect people with more than clean needles. These programs remove dangerous used needles from the community, and they offer access to vaccinations, substance use disorder treatment, overdose prevention information and disease screening.

Kentucky lawmakers recently advanced a resolution ordering the Cabinet for Health and Family Services to review its response to the deadly outbreak. One key addition to the response might be expanding these needle exchange programs, which have already proved effective in many Kentucky communities, including Boyle County.

Kentucky Cabinet for Health and Family Services reports there are about 50 needle exchange programs operating in Kentucky.

Syringe exchange programs are designed to mitigate a number of public health issues, but there are many misconceptions among the public about the programs.

According to the cabinet, syringe exchange programs:

• do not encourage the initiation of drug use nor do they increase the frequency of drug use among current users.

• reduce the spread of infections like HIV and viral hepatitis.

• do not increase community crime; studies have shown that syringe exchange programs actually decrease crime in the area they are located.

• increase community safety by promoting public health and safety by taking dirty syringes off the streets and protecting law enforcement personnel from needle stick injuries, which can result in the transmission of diseases such as HIV/AIDS and hepatitis B and C.

• connect people to treatment; one study found that SEP participants are five times more likely to enter a drug treatment program than nonparticipants.

Many SEPs are operated through local health departments, including Boyle County’s. These health departments are leaders in community response to the hep A outbreak and drug addiction issues.

In order to promote access to SEPs, the state should look at establishing more mobile SEP units, which can travel to more rural communities and reach more of the intravenous drug user population.

Additionally, legislators should look at policies that might promote establishing SEPs in all of Kentucky’s counties. Since the most recent legislation passed in 2015, communities have the option to establish SEPs, but are not required to do so.

One of the most important aspects of increasing access to these programs will be education.

According to the Foundation for a Healthy Kentucky, “Generally, the more familiar Kentucky adults are with needle exchange programs, the more likely they are to support exchanges as a strategy to reduce” the spread of disease and increase access to health care for IV drug users.

One aspect of promoting the programs will be to continue breaking down the stigma of drug use and addiction. These programs are not about promoting drug use, but enhancing community safety.

As Kentucky continues battling the most deadly outbreak of hep A in the country, expansion of these programs will be key to reaching the populations most affected.