By Ciara Smith, Gary Crusader
After becoming the flashpoint for the opioid epidemic in 2015, Indiana may finally be getting the Syringe Exchange Programs it needs.
Indiana State Health Commissioner Jerome M. Adams, M.D., M.P.H., testified on March 22 in favor of House Bill 1438, that would give local officials the ability to establish syringe exchange programs (SEPs) without first seeking state approval.
Two years ago, Austin, IN, a city of about 5,000 people, became home to one of the biggest HIV outbreaks in decades. Nearly 200 people were diagnosed as a result of sharing dirty needles. In them, was the powerful painkiller opana. It’s used for moderate to severe pain and anesthesia work, but when crushed and liquefied, can contain up to eight injections. Its abuse led to Adams declaring public health emergencies in southern Indiana’s Scott and Madison counties, and Governor Mike Pence lifting the long-held ban on needle exchange programs.
These events spawned Executive Order 15-05, which included a “targeted short-term needle exchange program for the sole purpose of containing the epidemic.” Needle exchange programs were formerly illegal in Indiana.
“When Indiana first approved syringe exchange programs, we drew heavily on best practices from other states while we gained experience,” Dr. Adams said of the bill. “We now have two years of date under our belts and know that local control is the best option. This bill recognizes the hard work and dedication of our health partners across the state and empowers local communities to be more nimble in responding to public health threats created in part by the opioid crisis.”
The initial syringe exchange programs, only in place 60 days, provided free sterile syringes and collected used syringes from injection-drug users to reduce the transmission of blood borne pathogens, including HIV, hepatitis B virus, and hepatitis C virus. Also provided, was immunity from criminal liability for those participating in the programs.
According to the Centers for Disease Control and Prevention (CDC), SEPs falls under a category of public health prevention known as “harm reduction,” which aims to minimize disease spread and injury associated with high risk behaviors.
The CDC recommends SEPs be used as part of a comprehensive approach to address the prevalence of HIV in adults. Since the authorization in 2015, Scott County experience a 73 percent viral suppression rate, 150 people received treatment for substance use disorder and hundreds were connected to health insurance, medical care, and other vital services.
Thirty-one states, including all of Indiana’s bordering states, the District of Columbia, and Puerto Rico have SEPS.
Though Gary has a local HIV/STD clinic, the closest syringe exchange program is in Laporte County.
New Indiana law could allow more communities to establish SEPs, and inform many counties threatened with similar HIV outbreak risk factors on how to move forward.
The onus, however, was not left on drug users. Dr. Adams also spoke up about the role prescribers play in the drug epidemic in his support of Senate Bill 226.
Also authored by State Representative Cindy Kirchofer, Senate Bill 226 limits the amount initial dosage of opioids that can be prescribed between patient and doctor in a first-time encounter.
According to Adams, the number of prescriptions for opioid pain relievers has quadrupled since 1999 and Indiana is one of the highest-prescribing states in the United States. But Senate Bill 226 offers a work-around to discourage sharing of any excess medications.
“Senate Bill 226 takes an important step by offering a common-sense solution to overprescribing that empowers both prescribers and patients,” said Adams. “It gives prescribers a legal leg to stand on when they tell a patient they don’t need more than a week’s worth of painkillers. It also allows patients to take some control of how much they’re receiving. For example, this bill would allow a patient to fill only a portion of their prescription if they don’t think they need the full amount. That provision creates a safety net for patients who realize the full prescription they’ve received is excessive or simply unnecessary.”