Indiana has been making progress in the battle against opioid addiction. But the struggle is far from over, and abuse of other drugs including meth appears to be on the rise. Yet last week, the Indiana Senate passed on an opportunity to preserve one of the most effective strategies in the battle against illicit drugs and their consequences. Unless the legislature has a change of heart, the syringe-exchange programs in several drug-ravaged counties, including ours, could end next year.
The state's first syringe-exchange program began in 2015 in southern Indiana's Scott County after it became apparent that opioid addicts sharing dirty needles were also sharing HIV infections. Then-Gov. Mike Pence issued a short-term OK for an exchange program to cope with that county's HIV epidemic. That spring, the legislature approved a procedure by which other opioid-challenged counties facing potential HIV or hepatitis-C epidemics could ask permission to set up similar exchange programs.
As with previous programs in other states, the Scott County effort showed results – new HIV cases began to drop significantly.
In the five years since, several other counties facing intravenous drug-related health crises have implemented syringe exchanges. Allen County's program, which began in the fall of 2016, has shown results, according to Mindy Waldron, administrator of the county Department of Health.
“We've been very pleased with some of the behavior changes and outcomes we've made with some of our clients,” she said in an interview Tuesday.
The weekly syringe exchange clinic creates an unthreatening setting where health officials can connect with substance abusers and offer them a way out of addiction. Besides exchanging clean syringes for used ones and providing cotton balls and other items to prevent the spread of disease, the department offers “wraparound services” that include onsite addiction counseling, HIV and hep-C testing, vaccines to prevent hepatitis-A, wound care and Naloxone kits to treat potentially deadly overdoses.
After three years, Waldron said, the department's clinic has logged 1,350 unique visitors, with about 600 returning clients. All reported a history of drug abuse, and almost half said they had already tested positive for HIV or hep-C. More than 200 of the returning clients initially reported reusing needles – some, more than 200 times. But returning clients have reported using needles an average one to two times, “decreasing significantly the likelihood of spreading disease to others,” Waldron said. “We are reaching the target clientele; they've begun to trust us, and they're beginning to alter their behaviors.”
A measure streamlining the procedure for counties to be approved for syringe exchanges was signed into law by Gov. Eric Holcomb in 2017. Marion County, where acute hepatitis-C cases have increased 1,000% over the past five years, instituted its needle-exchange program just last year. But the law contains a sunset clause that takes effect in 2021 unless the legislature acts.
Sen. Jim Merritt's bill to remove the sunset clause should have been a no-brainer. But the need for syringe exchanges is counterintuitive; it's easier to take a stand against giving addicts needles than to acknowledge the exchanges help prevent disease and encourage addicts to seek treatment.
During the debate on Merritt's proposal, Senate Bill 207, a major concern seemed to be that the exchanges were giving out more needles than they were taking in. Waldron said Allen County's results refute that: As many as 30 needles may be given to addicts on their first visit, she said, but after their first visit, clients must bring in a dirty needle for every clean one they receive. Since the program began, about 99% of the needles given to repeat clients were returned.
Merritt, the Indianapolis Republican who has led the legislature's efforts to address the opioid crisis, said in an interview Monday he will try yet this session to persuade his colleagues to extend the sunset deadline to 2022. That would at least give Merritt and health professionals more time to make their case.