Since June, a large mobile van parked outside the Metro Department of Public Health and Wellness on East Gray Street downtown has been the frontline of Louisville’s battle against its heroin epidemic. Inside is the first free syringe exchange program in the state, made possible by the state legislature this year and passed unanimously by Metro Council in April.
The primary goal of this program is to prevent an outbreak of HIV and Hepatitis C cases in Louisville, which is precisely what happened 35 miles north in Scott County, Ind., earlier this year. Due to the rampant use of shared needles among heroin users in the tiny rural town of Austin – with a population of 4,200 – 181 people contracted HIV and 167 contracted Hepatitis C. According to the figures of the health department, if such a proportional outbreak was to happen in Louisville, those numbers would be 30,000 and 25,000, respectively, with treatment costs estimated to be a staggering $40 billion.
But preventing the spread of blood-borne disease among intravenous drug users is far from the only goal or intended benefit of the program, as Insider Louisville observed for eight hours over two afternoons last week while sitting in with health department counselor Matt La Rocco as he spoke with participants in the program.
Observing over 70 participants in this period, La Rocco discussed the extent of their drug use, then gave them the corresponding amount of new syringes for the next week, along with other supplies like empty tea candle tins, containers of sterile water, small cotton balls, tourniquets and a storage bin that can hold up to 50 used syringes. Those who were new to the clinic received free HIV and Hepatitis C testing, as well as a variety of pamphlets on disease prevention and drug treatment.
But most of these patients received much more than clean supplies, pamphlets and a blood test. La Rocco dispelled misinformation about how such diseases are contracted; taught users about how to prevent track marks, wounds and infections from improperly inserting needles; gave warnings to those most at risk for an overdose or physical injury; and spent hours going over treatment options that will help them overcome their addictions – if they so choose.
For those patients who were the most distraught at where they found themselves in life – hopelessly addicted, severely depressed and not knowing what to do next – he served as a person to talk to about their troubles without casting judgement, at times providing a shoulder to cry on.
La Rocco told Insider Louisville they expected to serve around 500 people at this early point in the program, but as of early December, 1,450 people had participated, with 44 percent of those returning at least once. Last week, 76 percent were returning participants.
“It’s not that there are more addicts in Louisville than we thought,” said La Rocco. “We just didn’t know that this program would be so popular. Most programs take years to get off the ground and have this type of participation.”
La Rocco partly credits the large number of participants to the credibility of the health department, but also to the respectful and nonjudgemental manner in which he, fellow Volunteers of America counselor Donald Davis and the nurses treat clients, which has helped build trust.
“We show that we care for these people,” said La Rocco. “We get them jackets in the winter if they’re living on the street. They’re treated with respect, like people. It’s important to be kind, loving and compassionate. They also know they will get good, unbiased treatment. All of that together has drawn people in.”
The numbers, the people, and building trust
Early numbers from the program show that Louisville has acted proactively enough to jump ahead of any potential outbreak of communicable diseases among intravenous drug users. So far, 166 people have been tested for HIV, with none testing positive. While many already know they have Hepatitis C, 95 have been tested for that disease, with over 60 percent being found positive. In addition, 91 people have been referred into a drug treatment program.
Participants are not required to turn in the same number of used needles as they receive in new ones, though La Rocco continued to stress to those who failed to return syringes as to how important that is to both public safety and the program itself. While the ratio of new syringes distributed to used ones received was nearly 9-to-1 when the program started, it has fallen to a steady 2-to-1 rate in recent months, with the department having a long-term goal of a 90 percent return rate.
As for the participants IL observed, the diversity of their demographics and backgrounds might surprise many. Their ages ranged from early 20s to late 50s, with just over 60 percent being male. Over 90 percent were white, even though whites comprise roughly 74 percent of Louisville’s total population. While most live in Louisville, some made the trip from Southern Indiana and other Kentucky counties. Almost half indicated they were unemployed and at least six were homeless, though most indicated they had health insurance, most commonly a Medicaid plan.
Still, many participants had steady jobs and did not outwardly resemble what many would expect a heroin addict to look like. Some were fashionable 20-somethings, while others were conservatively dressed in their 40s – including an African-American Muslim man who engaged in a prolonged philosophical and academic discussion with La Rocco about the nature vs. nurture aspect of addiction. A number of couples came in together to get syringes, and while some indicated they had several children at home, some of the younger people said they still live with a parent.
There also was a wide variety of experiences when it came to participants’ drug use, though almost all shared a specific addiction to heroin. While most indicated they inject four or more times per day, a few said they only inject once or several times a week. Eight people said they inject 10 times per day, while others took no needles at all and said they had either entered or planned to soon enter a drug treatment program.
Most people said they already have been in treatment at one point in their life, though some flatly refused La Rocco’s offers of information about available programs. La Rocco often engaged in conversations about unrelated topics – from cartoons to his own family — in order to help break the ice so they might open up and share more of their own experience, but others were tight-lipped and uncomfortable, sticking to one-word answers.
For those who were closed off, La Rocco did not push drug treatment, saying of one, “He didn’t want to talk to me, but he’ll come back and he might be ready next time.” Indicating how trust with such participants must be built up over time, the next day a man came in and had a lengthy casual discussion about his drug use. “That guy used to be standoffish and barely said a word to me,” said La Rocco. “Now he’s having conversations with me… that’s progress.”
Though many of the participants have been hardened addicts for many years, it was common that such people had no idea how to properly inject in order to avoid serious physical damage to their arms and veins, while others were misinformed about how diseases are contracted. One 30-year-old longtime drug user revealed several bad track marks and infections on her arms, with La Rocco giving his common refrain about not hitting the same spot more than once in a 24-hour period.
“I’ve been shooting up for eight years, and I’ve never had a conversation like this with anyone,” she told La Rocco, who informed her that this is intended to be a safe place for her to talk about such things. “I have a whole crew back at the house who don’t think this place is real.”
First-time participants often had the same moment of shock when they realized they could obtain clean syringes and supplies, saying they had heard about this program but had trouble believing it was legitimate and not an elaborate police sting operation. A woman in her 40s who has returned multiple times to the van told IL about her early suspicions that have melted into trust, expressing great gratitude for the supplies and medical advice to treat and avoid the infections from which she previously was suffering.
“The first time I came here was really scary,” she said. “Like, is there a cop outside who’s going to follow me home and bust me? But they made me feel really comfortable, they talked to me and broke the ice. I really need this, and I don’t take it for granted… If this van wasn’t here, a lot more people would be sharing, I know that for sure.”