Bevin administration says syringe exchanges funded by state grants must be one-for-one after initial supply to a user

By Melissa Patrick
Kentucky Health News


The administration of Republican Gov. Matt Bevin is requiring syringe exchanges funded by state grants to be limited to one-for-one trading of clean needles for dirty ones, raising the chance that all such programs might have to do likewise.

Republicans said in the last legislative session that the 2015 law allowing syringe exchanges was intended to only allow a one-to-one trades. Their effort to impose such a limit died in the House, notes The Floyd County Times in Prestonsburg. The county recently approved an exchange.

If the Democratic-majority House goes Republican in November, both the legislature and the administration would be Republican, and in a position to impose a one-syringe limit. That would reduce the protection provided by syringe exchanges, say health officials running them.

The exchanges are meant to slow the spread of HIV and hepatitis C, which are commonly spread by the sharing of needles among intravenous drug users. They are not required to have a one-for-one exchange because of an opinion by then-Attorney General Jack Conway.

Clark County Health Director Scott Lockard said in a telephone interview that most Kentucky syringe-exchange programs use a “patient negotiation model,” which provides the user with as many needles as they need for one week to assure they use a clean needle each time, often up to a capped amount.

“The goal is that they use a clean needle for each time they inject,” he said. “We want to stop the spread of HIV. We want to stop the spread of hepatitis C and any of these other blood-borne pathogens that can be spread through the sharing of contaminated needles.”

Lockard noted that while a one-for-one exchange is the goal, sometimes it is impossible to adhere to such strict requirements. For example, he said users don’t always keep up with their syringes or sometimes will tell you they are sharing them.

So, with a strict one-for-one exchange you aren’t able to provide them with enough needles to prevent sharing, “which means you are not doing anything to prevent the spread of disease. And the purpose of these exchanges is to prevent disease,” he said.

Dr. Sarah Moyer, then interim director of the Louisville Metro Department of Public Health and Wellness, told Kentucky Health News in March that it is widely accepted that not requiring one-for-one is considered a best practice.

The state grant program requires applicants who plan to use the money for a syringe exchange program to promise that it would be a strict one-for-one exchange after an initial transaction with a client.

Asked why the requirement was added, Van Ingram, executive director of the state Office of Drug Control Policy, said only, “That was an administration decision.” The governor’s office and the Cabinet for Health and Family Services did not respond to requests for an explanation. Neither did Thayer.

The grant program is funded by the Agency for Substance Abuse Policy. The deadline for application was Sept. 23 and grant amounts will be considered up to $20,000. The grants can also be used for Narcan (naloxone) programs, community education and other harm-reduction efforts. The agency received 38 applications and expects to announce the recipients near the end of October, Ingram’s office said.

Boyle and Floyd counties are the most recent counties to approve syringe exchange programs, bringing the total in the state to 20.

Both counties will offer a one-for-one exchanges and have applied for an ASAP grant to help fund their programs. Both say their decision to implement a one-for-one exchange was largely driven by the requirements of the grant.

Boyle County Health Director Brent Blevins said, “The grant we are applying for is very important to help us get this off the ground.”

Floyd County Health Director Thursa Sloan said, “It was just a better fit for our area, for the board and for the people. We don’t know that that couldn’t change down the road, but the funding we are seeking to help support it is contingent on an equal exchange program.”

Both Blevins and Sloan noted that the original version of the 2015 legislation called for one-to-one exchanges. Boyle and Floyd, respectively, are considered the 35th and 10th most vulnerable counties in the nation for HIV and hepatitis C outbreaks among those who inject drugs, according to estimates by the federal Centers for Disease Control and Prevention.

Lockard said syringe exchanges are a “very political issue,” and while one-for-one exchanges are not the ideal solution, they may be what is “politically palatable.”

Ingram stressed the importance of such programs: “We have the fastest growing rate of hepatitis C in the country in large part due to the sharing of needles.” He added, “More than 100 people have been guided into treatment as a result of their participation in a needle exchange program.

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