The Boone County Health Department continued its series of presentations on needle exchange with a stop at Tuesday's Boone County Council meeting.
County councilors heard information on the merits of having a needle exchange program from Public Health Nurse Brandy Franklin and Health Department Administrator Cindy Murphy.
Murphy explained that the health department’s current mission is to inform the public about public health concerns surrounding intravenous drug use. She said that mission was planned in response to the ever-rising Hepatitis-C rate in Boone County, in an effort to prevent the disease from reaching epidemic levels.
Boone County has seen an 86 percent increase in the disease from 2014 to 2016, with a jump from 36 to 67 cases in that time span.
“We are seeing an increase in our Hepatitis-C cases, and I don’t think that (figure) even speaks to the number of cases really out there,” Murphy said. “Do I believe that we are in a crisis? Yes I do. Do I believe we can become Scott County? Unfortunately, yes I do.” Murphy did not officially proposed a needle exchange, however, Franklin presented her research so the council could be knowledgeable in the event that an official request is made in the future.
Franklin said the goals of the program would be to give users a place to safely dispose of the needles so they do not end up on the ground or exposed in a trash can. She said the program would also make sure that users can have a supply of clean needles so they don’t use the same needle over and over, or share the needle.
Franklin said users report they often use a needle until it breaks, for months or weeks at a time, which is a very dangerous practice. Franklin added users share needles with other users, sometimes in very large groups, which is likely to spread blood-borne diseases like Hep-C.
The presentation also included information about the costs of drug abuse. Though Franklin did not have the cost of implementing a needle exchange program on hand, she said one syringe costs eight cents, in contrast to $78,000 that is needed to treat a Hep-C patient.
According to Franklin’s research, needle exchanges are often paid for with some combination of private donations, grants and public funds.
If Boone County were to implement a program, Murphy said she would want the program to be administered through the health department using trained public health staff. In that instance, at least some public monies would likely fund the program.
While the Boone County Council was hearing information on needle exchanges, their Madison County peers voted against continued funding of its needle exchange program. According to reports from the Anderson Herald Bulletin, the Madison County Council voted against the program because it was more akin to a needle giveaway. "We didn't have a needle exchange program, we had a needle giveaway program," said Madison County Councilor Anthony Emery.
Franklin told the Boone County Council that the health department would avoid mistakes of other departments like Madison County, by keeping users accountable for returning needles.
According to Franklin’s research, needle exchanges are already present in nine Indiana counties, as well as many other places around the country and the world. Franklin said the programs vary in success and model by county. Some have low return rates in the 40th percentile, while some like Scott and Fayette counties have rates in the 90th percentile.
She said the ideal model for Boone County, if implemented, would be a one-for-one exchange, with health department staff monitoring who is, and is not, returning the needles they take. She said the program would not give out new needles to those who do not return their used ones. In addition, Franklin said, the health department would give out a cleaning kit with swabs and sterilized water to make needle users as safe as possible.
Information on local resources for treatment and mental health services would also be offered at each visit. She said this would be done as a way to connect with drug users and show them that help is out there if they can find the strength to quit.
County council members asked a lot of questions during the presentation, and gave their points of views on the issue. Each member said they are still undecided at this point, however, some said they are leaning toward a "yes" if the issue came up.
Councilor Kevin Van Horn said he was leaning toward a "yes," but still wants to hear from constituents and do more research on the topic. He said people he has spoken with on the topic have passionate views on both sides.
Meanwhile, Council President Steve Jacob said he will ultimately do what public health professionals say is best. At this point, he is also leaning toward "yes," because many professionals like newly appointed Indiana drug czar Jim McClelland, Franklin and Murphy are pointing toward clues that a needle exchange is needed. However, Jacob said the council must weigh the monetary and the social costs along with those opinions.
Councilor Tom Santelli said something definitely needs to be done to address the drug problem, but he would want to see a proposal that was cost effective before deciding.
“The horse is already out of the barn,” Santelli said. “At this point we need to find a way to address the problem.”
Council members Brian Buchanan, Marcia Wilhoite and Elise Nieshalla all said they are undecided and noted that making the decision will be hard, especially because they do not want to be seen as encouraging drug use.
“I have a lot of concern for the culture,” Nieshalla said, noting her concerns that some construe a needle exchange as catering to those who do drugs. “How can you put a price on our culture? This is a real cost.”
Franklin said her research did not find evidence that a needle exchange leads to an increase in the drug user population, but said it did conclude that the spread of disease is slowed and there is a reduced risk for stick injuries.
Commissioner Jeff Wolfe spoke up at the meeting, saying that the commissioners are also undecided. Wolfe, a member of the Boone County Substance Abuse Task Force, urged the public and the council to have an open mind about the issue, and asked them to make an educated decision on the issue if a proposal comes before them.
“We’ve been meeting now for a year-and-a-half as a substance abuse task force. We have come to say that we need to consider this,” he said. “The point I want to make to the public is — keep an open mind. There are more people involved in this than drug users; they have kids, spouses, caregivers at the hospital, caregivers at the health department. We would be doing it for many more people than drug users.”
Murphy said the needle exchange is just one part of curbing drug addiction in the community. She said the exchange, if executed, needs to come alongside other addiction services in the county. One particular item she said the county is missing is a safe place to detox under medical supervision.