Needle Exchange Programs

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Dustin Jenkins
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1 Needle Exchange Programs Are they right for your community? Deena Dodd Indiana Rural Health Association

2 2017 Indiana General Assembly House Bill #1438 Syringe exchange programs: Allows a county or municipality to approve the operation of a syringe exchange program (program). Allows a program to be renewed for not longer than two years. Requires a program to keep a sufficient quantity of an overdose intervention drug in stock to administer when needed. Requires the state health commissioner to receive written notice when a program is renewed, expired, or terminated or if the qualified entity operating the program changes. Extends the law concerning programs until July 1, (Current law expires July 1, 2019.) Public Law 198 4/26/17 Governor Eric Holcomb

3 How d we get here? If only it was a simple path. Over prescribing of opioids Mental and behavioral health challenges self medication Stigma those people But wait Young mothers back pain Children to run after, keep in activities Young men trying to keep up with their peers Quick game of pick-up basketball Teenagers playing sports Looking to get that college scholarship Mature breadwinners with responsibilities Just because I hurt doesn t make my mortgage go away Retiree s with back, hip and shoulder pain I want to keep moving, stay young, be active Veterans Vietnam, Afghanistan, Gulf War, Iraq, Operation Enduring Freedom, Somalia, Yemen, ISIS/ISIL, Israel- Gaza, countless other conflicts, unrests, insurgency

4 Changing trends in demographics of people who inject drugs (PWID)

5 Opioid overdoses in U.S. by age range % BY AGE RANGE % 23% 19% 23%

6 Hoosiers impacted.

7 What are Needle Exchange Programs? Needle exchange programs (NEP), also known as Needle and Syringe Programs (NSP), or a Syringe-Exchange Program (SEP), are Community based public health programs. These services allow people who inject drugs (PWID) access to obtain clean, new hypodermic needles as well as other necessary paraphernalia needed for injecting drugs. These supplies come at little to no cost to the PWID contingent upon the return of used syringes. Typically, PWIDs are given an equal number of syringes to those that they return or exchange.

8 What s the motive? The primary motive behind these programs is harm reduction. The basic premise is that people are going to use drugs regardless of whether or not they have clean and sanitary materials. With the prevalence of bloodborne pathogens among IV users, the goal is to prevent further infections due to limited access to clean paraphernalia

9 Bloodbourne pathogens Hepatitis C usually spread when blood from a person infected with HCV enters the body of someone who is not infected. Most people become infected by sharing needles or other dirty equipment to inject drugs. The virus CAN NOT be transmitted through casual contact, i.e. eating utensils, hugging, holding hands, sneezes or coughing. HIV/ AIDS - usually spread when blood from a person infected with HIV enters the body of someone who is not infected. Most people become infected by sharing needles or other dirty equipment to inject drugs. The virus CAN NOT be transmitted through casual contact, i.e. eating utensils, hugging, holding hands, sneezes or coughing. Scott Co. Indiana has over 210 cases of HIV in a population of 23,000.

Prevent the Spread of Diseases It is estimated that in 2013, 6% diagnoses of HIV infection in the United States were attributed to Intravenous drug use.

10 Prevent the Spread of Diseases It is estimated that in 2013, 6% diagnoses of HIV infection in the United States were attributed to Intravenous drug use. With these trends continuing, it is expected that 1 out of 23 women who inject drugs and 1 out of 36 men will contract HIV. Among persons who inject drugs (PWID), HCV is approximately 10-fold more transmissible than HIV. It is estimated that one IV user who is Hepatitis C positive is likely to infect up to 20 other people % of HIV-infected PWID are co-infected with HCV. An estimated 33 percent of PWID aged years are HCV-infected

11 Magnitude of the crisis More overdoses caused by PRESCRIPTION DRUGS than illegal drugs 6/10 overdose deaths involve an opioid Opioid abuse costs U.S. employers $18 billion in sick days and medical expenses Opioid abuse among employees is estimated to account for more than 64% of medically related absenteeism from work and 90% of disability expenses resulting in more than $25 billion a year in lost work productivity. For every one person who dies from opioids there are 851 people in various stages of use, misuse and abuse.

12 The controversy or the conversation The controversy.. Community Perception -- Many people believe there are far better ways to spend tax dollars than to provide drug paraphernalia-- not feeding into their addictions. The lack of understanding leads to a lack of compassion which in turn makes it harder for these programs to operational. Harm Reduction Not Actually Fixing the Problem -- Rather than providing rehabilitation services or overtly enticing recovery, many people believe that these programs merely perpetuate the problem by giving addicts access to the paraphernalia. While it is assisting in preventing the spread of various diseases and promoting safe using, these addicts are still using. NEPs Require Government Funding - As with any government sanctioned program, NEPs require government funding in order to keep providing their services. Government funding comes directly from the tax payers pockets, so many people resent having to essentially finance addicts drug problems, furthering community opposition.

13 NEPs provide Testing, Education, Conversation, Opportunity The conversation.what really transpires with a NEP Testing: By allowing PWIDs to learn their status when it comes to these diseases, it will allow them to either seek treatment or use responsibly to prevent further infections from spreading Education: By giving PWIDs access to vital information surrounding addiction, it can be beneficial in preventing overdose and even encourage recovery for many struggling addicts. Conversation: NEPs have the ability to reach populations of people who otherwise would not have access to the educational content or health services that are provided. Opportunity: Through this TEC approach healthcare services may be rendered to people who need it most!

14 Why should I consider it? Harm reduction. Advice on safer injecting practices Advice on minimizing the harm done by drugs Advice on how to avoid and manage an overdose Information on the safe handling and disposal of injecting equipment Referrals to HIV testing and treatment services Help to stop injecting drugs, including access to drug treatment and encouragement to switch to safer drug taking practices Other health and welfare services (including condom provision)

15 Costs associated with Hepatitis C and HIV/AIDS Hepatitis C - the cost of one full treatment course which includes drugs in combination can reach about $100,000 per patient. And some patients will need two courses of treatment. HIV/AIDS - The average annual cost of HIV care was estimated to be $30,000. The most recent published estimate of lifetime HIV treatment costs was $367,134 (in 2009 dollars; $379,668 in 2010 dollars) for an individual that contracts the disease at 35 years of age. A nominal jump of $12, 534 year. It s now 2017 so add $87,738.so 2017 $467,406 and addicts range in age from

16 Medicare member opioid dependency Medicare Part D paid almost $4.1 billion in opioid prescriptions in prescribers had questionable opioid prescribing patterns for patients 90,000 Medicare patients are at serious risk 1 in 3 Medicare patients received opioid in ,000 received high amounts of opioids

17 The # s Hep. C HIV

18 By law.. By law, Medicaid and Medicare are required to cover medically necessary treatments; they can t exclude an entire class of medications that are proven effective for cost considerations alone. Commercial insurers also typically agree to provide all medically necessary care.

19 Needle Exchange Kits Kits can be tailor made for a community. The basics of the kit include: STERILE alcohol swab, tourniquet, syringe, cup / bowl. Additions such as dirty needle container, condoms, band-aid, cotton swab, etc.

20 Why does Sterile equipment matter? Syringes Cup w/ filter

21 Delivery Models Depending on the program, and which county it is located in, needle exchange programs are delivered in a variety of ways. The more common delivery methods for needles include: Fixed sites Mobile programs Outreach programs Syringe vending machines Pharmacies Clients are able to enter the exchange site, where they hand in used injection equipment and receive new needles or syringes. The main benefit, besides consistency for those in need of clean needles, is that these programs are better able to provide additional services to clients, such as HIV testing, healthcare and drug counseling. Communities can set up NEPs as they desire. You can execute them to fit the needs of your community!

Costs can vary depending on the NEP packets, educational outreach, wrap-around services provided etc.

22 Let s look at the fiscal model numbers It costs between $20 and $60 per user per year for a NEP to be executed in a community. Costs can vary depending on the NEP packets, educational outreach, wrap-around services provided etc. One syringe-infected AIDS patient will require upwards of $120,000 per year in public health expenditures One infected Hepatitis C patient can cost upwards of $100,000 per case depending on the path of treatment.

Whom do needle exchange programs protect? What s the financial impact?

Paramedics Linemen City Street Dept. Parks Dept.

needle and requires treatment the insurance costs go where?

23 Whom do needle exchange programs protect? What s the financial impact? First Responders Firefighters Police Dept. Sherriff Dept. Paramedics Linemen City Street Dept. Parks Dept. Community Volunteers If any city/county employee gets stuck with a dirty needle and requires treatment the insurance costs go where? Who s left paying that bill? What would that do to your fiscal bottom line? Taxpayers need to know, this isn t just the users problem.

24 Questions, Comments, Concerns? What is the current status of your community? How informed is your local legislator? What conversation needs to happen around your community? What support does your school have? How can I support your community?

25 The Indiana Rural Health Association supports all Hoosiers. We are a great resource for a vast array of issues. Join us at Individual $100 Organizations $600

26 Deena Dodd Network Development Officer Indiana Rural Health Association or x 228

SYRINGE SERVICES PROGRAMS IN INDIANA

SYRINGE SERVICES PROGRAMS IN INDIANA Erika L. Chapman, MPH, CPH, CHES, RYT- 200 Harm Reduction Program Manager Division of HIV, STD, Viral Hepatitis Indiana State Department of Health What is Harm Reduction?