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Monday, April 20, 2015

Ind. Gov't. - Needle exchange program bill in conference committee

The needle exchange language is now in SB 461 (the language was added in the House), the meeting is at 10:30 in Rm. 431. Watch it here. The needle exchange language is in SECTION 5, beginning on page 5 of the March 31st printing.

Maureen Hayden of CNHI reported Friday in a story that includes:

Public health experts are pushing Indiana lawmakers to pass legislation to allow for needle-exchange programs in communities at high risk for the deadly virus that causes AIDS, despite continuing opposition from Gov. Mike Pence.

They’re trying to make the case that giving clean needles to intravenous drug users doesn’t increase illegal drug use, as Pence contends, and instead could ward off the spread of the HIV epidemic that has hit rural Scott County in southeast Indiana.

“No one is going to run out and start using heroin just because you give them a syringe,” said Bill Piper, director of national affairs for the Drug Policy Alliance and an Indiana native who’s asked Pence to reconsider his stance.

On Monday, a joint Senate and House legislative committee will consider a measure that gives authority to local public health departments and law enforcement in high-risk counties to work together to start their own needle-exchange program.

Current law bars such programs without an emergency declaration like the one Pence issued in March for Scott County, where the number of HIV cases hit 130 on Friday.

Pence opposes the measure authored by House Public Health Chairman Ed Clere, R-New Albany. The governor has threatened to veto it, despite support for it from public health experts, including those inside his administration.

Pence has declined to publicly explain his opposition. But earlier this week, Senate President David Long, R-Fort Wayne, said the governor believes needle exchange programs lead to greater drug use.

Clark County Medical Director Dr. Kevin Burke, who diagnosed the first HIV case in the current epidemic, said Pence is wrong.

“The studies show that with needle-exchange programs, you increase the probability that someone will go into a drug rehabilitation program,” Burke said. “You don’t increase IV drug abuse, and you save the state millions and millions of dollars by preventing the spread of HIV infection.” * * *

Dr. Shane Avery, a Scott County physician who’s been treating HIV patients, plans to testify at Monday’s hearing. He said health officials in other high-risk counties can’t wait until they have a crisis on their hands to act.

“You can’t just stick your head in the sand,” Avery said. “These decisions need to be based on science, not political ideology.”

Among those who support Clere’s legislation is House Ways and Means Chairman Tim Brown, R-Crawfordsville, the legislature’s only physician.

The language in Clere’s measure, tagged onto Senate Bill 461, is limited in scope. It would only apply to counties with a high level of Hepatitis C, a potentially lethal bloodborne disease spread by intravenous drug use. Its presence is considered an indicator of risk for HIV.

The bill would clear the way for local health departments, working with police, to declare their own health emergencies so they could a put needle-exchange programs into place.

Clere has been frustrated by Pence’s opposition.

“I don't understand how anyone could walk away from an opportunity to prevent what's happening in Scott County from happening in other counties,” he said. “Unfortunately, Scott County is not an outlier, and other counties are at similarly high risk.”

Giles Bruce of the AP had a long story Sunday, datelined Austin, in the NWI Times headed "Largest HIV outbreak in Indiana history: A toxic mix of drug addiction, poverty, hopelessness." Some quotes:
As of Friday, there have been 130 cases of HIV diagnosed in southeast Indiana since December, according to the Indiana State Department of Health. That number is expected to increase as more people get tested. The cases are centered around Scott County and, in particular, Austin, a town of 4,225 about 35 miles north of Louisville, Ky.

"I think what happened in southeast Indiana can happen in any county or any city in the state of Indiana or United States," said Tammy Morris, executive director of the Aliveness Project of Northwest Indiana, an agency that delivers HIV and AIDS services out of Merrillville. "People have become very complacent. The way medications are going right now, people look very healthy. There's no way, physically, to tell if someone has the HIV virus."

Most of the infections in southeast Indiana resulted from IV use of the prescription painkiller Opana. State investigators have yet to locate where the drug is coming from, though they say it's not being prescribed in Scott County. One possible reason for the outbreak is that a single pill of Opana, once crushed and liquefied, contains eight injections, making it natural for sharing. A bag of heroin, by comparison, is generally used in just one injection. Opana also sells on the streets for as much as $160 a pill.

Narcotics experts said Opana abuse isn't as widespread in Northwest Indiana — heroin is the opiate of choice in the region — but warn that sharing needles containing any drug puts users at risk for HIV infection.

"What I can say is that statewide, nationally, locally, opiate addiction is an epidemic," said Aaron Kochar, director of education and prevention at Porter-Starke Services, a mental-health and drug-treatment agency based in Valparaiso. "We are continuing to recognize that opiate abuse is a tremendous problem. We see it in our communities all the time."

Kochar said the danger of Opana is that it is an extended-release pill, meaning that when it is crushed up and injected it is extremely potent.

The NY Times also ran an AP story Sunday, dateline Indianapolis. Some quotes:
But the future of the Scott County program, as well as the fate of legislation that would allow needle exchange programs in other counties, is not clear.

Mr. Pence, a Republican, opposes needle exchanges as an antidrug policy. David Long, the State Senate’s president pro tem, said Thursday that the emergency exchange for Scott County was “the right reaction” but added that he was not sure if it was the correct long-term approach. Nor was he sure, he said, whether the Senate would support legislation sponsored by the chairman of the House Public Health Committee, Representative Ed Clere, that would allow the 23 Indiana counties with the highest rates of hepatitis C to establish their own needle exchange programs.

Health officials say that high rates of hepatitis C are an indicator of needle-sharing.

The House approved the bill on April 7 in a 54-to-39 vote. The measure is scheduled for a hearing on Monday in a House-Senate conference committee, which will try to work out a final version for lawmakers to consider before the legislature’s April 29 adjournment deadline.

Mr. Long said the governor was not alone in his concerns that needle exchanges could promote instead of prevent drug use. “At the same time, you adapt and you evolve based on the world we live in, so we’re going to have to see if that requires a pivot for us,” he added.

Mr. Clere said he appreciated the governor’s approval of the needle exchange, but he added: “It doesn’t help in other areas of the state that are at risk for a similar outbreak. It’s just not enough.”

He said the association between needle exchanges and illegal drug activity made many people, including lawmakers, uncomfortable. But he said the exchange program should be viewed as “a proven and effective harm-reduction policy,” not as an antidrug policy.

“We simply can’t afford to view this as a short-term problem,” Mr. Clere said.

Money could also be an issue as lawmakers weigh their options. Since 1989, the federal government has banned public financing of needle exchange programs. Mr. Pence’s executive order did not include money for the Scott County program.

“They asked the state agencies to find their own money. How sustainable is that?” asked Beth Meyerson, a director of the Rural Center for AIDS/S.T.D. Prevention at Indiana University.

Posted by Marcia Oddi on April 20, 2015 08:57 AM
Posted to Indiana Government