Kentucky’s state Senate voted for a bill on Tuesday that would require local health departments with a syringe exchange to only dispense one free needle for every one used needle returned, which would prohibit the needs-based model implemented in Louisville last summer.
The Louisville Metro Department of Public Health and Wellness has argued their needs-based model — which allows the number of new syringes dispensed to be greater than the number returned and commensurate with the patient’s weekly drug use — is widely held to be the best practice among public health experts to prevent the spread of blood-borne diseases like HIV and Hepatitis C among intravenous drug users from shared needles. While the rate of new syringes distributed to used ones returned was initially high last summer, it has consistently been below 2-to-1 during 2016.
The Kentucky General Assembly passed a bill last year to allow local health departments to create such an exchange, citing the rampant increase in heroin use and the potential for an outbreak in diseases among users, which happened in Austin, Ind. last Spring. But now some Republicans have complained that the bill did not require those exchange programs to have a one-for-one model, criticizing Louisville for distributing more than it receives.
House Bill 160 — requiring the Kentucky Department of Health to promote guidelines for safe needle disposal and allowing collection stations at pharmacies and physician offices — passed unanimously out of the House last month. However, the state Senate attached an amendment to the bill requiring that any local health department setting up such an exchange must be a one-to-one model. Of the four exchanges implemented in Kentucky so far, Louisville’s is the only one that is needs-based, while in Lexington a patient must bring in used needles to receive new ones, with a maximum of 21 new syringes given per week.
The Senate passed the bill Tuesday by a 28-10 vote, with several Republicans indicating that they thought last year’s bill only allowed health departments to institute a one-for-one exchange. Senate Majority Floor Leader Damon Thayer, R-Georgetown, said that if the Senate’s version of HB 160 did not pass, “I will file a bill next year to eliminate the needle exchange altogether. I’m willing to give this one more year.”
A slight majority of Senate Democrats voted against the bill, despite Minority Floor Leader Ray Jones, D-Pikeville, voting for it. The only two senators from the Louisville delegation to vote for HB 160 were Republicans Dan Seum and Julie Raque Adams.
According to figures provided by Louisville’s health department, since the beginning of its exchange program, 257,272 new syringes have been distributed and 151,059 used ones have been returned — a return rate of 59 percent. While the ratio of syringes distributed to used syringes returned was over 2-to-1 in the majority of weeks last year, that ratio has been below 2-to-1 in every week but one in 2016.
Their statistics also show that returning clients — who now make up 73 percent of all clients — have returned 66 percent of the syringes they were given since Louisville’s exchange began. Last week, returning clients turned in 80 percent of the number of new syringes they received, and in two weeks this year they actually returned more syringes than they received.
The health department figures also showed that 220 patients have been tested for hepatitis C, with 102 testing positive and 146 referred to treatment; 290 have been tested for HIV, with two testing positive and eight referred to treatment for that disease. And 150 patients have been referred to drug treatment programs to break their addiction — the large majority of which is to heroin.
Asked about the version of HB 160 passed by the Senate, Metro Department of Public Health and Wellness interim director Dr. Sarah Moyer said Louisville’s needs-based exchange is working to prevent the spread of disease, as their return rate continues to improve.
“A one-to-one syringe exchange implies that no needle sharing is occurring – we know that is not the case,” said Moyer. “The ‘need based negation model’ is a best practice across the country. Our goals are to prevent the spread of HIV and hepatitis C in our community and to stop intravenous drug users from sharing and reusing needles. The program is working.”
Metro Councilman Bill Hollander, D-9, told IL that “one-for-one exchanges have been specifically cited as a ‘practice to avoid’ (by public health experts). With the epidemic raging and deaths increasing, we should let public health experts and not politicians decide what works.”
Asked if Louisville Mayor Greg Fischer had any comment on the Senate’s passage of HB 160, his spokesman Chris Poynter said the mayor would defer to the health department.
Democratic House Speaker Greg Stumbo did not immediately respond to a request for comment on the Senate’s version of HB 160.