Indiana county starts needle exchange under new state law

Indiana's rural Scott County, currently at the epicenter of an HIV outbreak, received approval Thursday to operate the first needle-exchange program allowed under a new state law.

A needle exchange had already been instated under a temporary public health-emergency executive order issued by Republican Gov. Mike Pence. However, State Epidemiologist Pam Pontones with the Department of Health said at a news conference Thursday that the order is set to expire Sunday and Pence has indicated he will not renew it.

Pence had previously overridden state law and his own anti-drug policies in an effort to help contain HIV infections in the rural, economically depressed community.

Under the new law, county public health departments can operate needle exchanges for one year when there is a declared public health emergency involving drug-related HIV or hepatitis C outbreaks.

“We're going to be here for the long haul,” said Scott County Public Health Nurse Brittany Combs. Since opening March 30, a community outreach center in Austin, Ind., has collected 14,981 used needles and distributed 16,952 new ones, Combs said.

Pontones added that the executive order's expiration does not mean a “hard stop” for the needle exchange.

“We will continue to be here,” she said.

There are now 159 confirmed cases and one preliminary diagnosis of HIV in Scott County, with 95% of those cases related to sharing needles while injecting the painkiller oxymorphone (brand name, Opana). Nearly 90% of those individuals are also infected with hepatitis C.

Dr. Jerome Adams, Indiana State Health Commissioner, testified Thursday morning at a House Energy and Commerce Committee's subcommittee on oversight and investigation hearing on state efforts to combat opioid abuse.

Adams told the subcommittee that Scott County had only three confirmed HIV cases in the past four years. He said what was needed was different thinking on how to treat pain and an end to the stigma associated with addiction which makes people hesitate to seek help.

Adams took a step toward removing that stigma by introducing himself as “the brother of an addict.”

Instead of thinking of addiction as a “moral failure,” Adams said it needed to be re-framed as a medical disorder that requires lifetime attention.

Scott County has an 8.9% unemployment rate, 21.3% of its adults didn't complete high school, and 19% of the population lives in poverty. Adams said a “painful lesson” from Scott County was that “if people have no hope, they will increasingly turn to and stay on drugs.”

He added that the treatment of pain needs to focus on “functionality and outcomes” instead of medication.

Adams' comments were echoed at the hearing by Dr. Monica Bharel, public health commissioner for the Massachusetts Department of Health. She noted that states are no longer “arresting their way” out of opioid epidemics.

Under Indiana's new law, police are not allowed to use a person's visit to a needle-exchange facility as probable cause to search them.

The Indiana law also allows individuals to obtain and dispense the overdose-intervention drug Narcan (or naloxone). Bharel told of the widespread and successful use of Narcan in Massachusetts to prevent overdose deaths. But subcommittee member Rep. Joseph Kennedy III (D-Mass.) lamented how the price of the drug has increased from around $19 a dose to $66. The Massachusetts Attorney General has previously said that increase occurred over the span of less than a year.