Pubdate: Sun, 04 Dec 2016
Source: Blade, The (Toledo, OH)
Copyright: 2017 The Blade
Author: Lauren Lindstrom


Health officials in Lucas County are working to get the area's first
needle exchange program up and running by the spring.

Health officials in Lucas County are working to get the area's first
needle exchange program up and running by the spring, adding another
weapon to their arsenal in the fight against the heroin and opioid

Toledo will be the last large metro area in Ohio to adopt such an
exchange. Cleveland, Columbus, and Cincinnati all have them, as do the
smaller cities of Dayton and Portsmouth. Such programs aim to decrease the
likelihood of spreading HIV or hepatitis C among users who share needles.

The Lucas Syringe Access Program will operate at two locations: St. Paul's
United Methodist Church in UpTown and the Talbot Center in East Toledo.
It's a one-for-one exchange program that also will offer medical
screenings, the overdose-reversal medication naloxone, and other

The goal of such programs is to meet drug users where they are, and
provide resources to mitigate the damage of their drug use and steer them
toward treatment if they are ready.

"The main thing for us is to meet face-to-face with drug users, test them
for HIV and hepatitis C, give them naloxone," said Jerry Kerr, HIV
prevention coordinator at the Toledo-Lucas County Health Department.
"We're really excited to be doing what we can to help people move into
treatment. As difficult as it can be, that will be one of our main goals."

In July, the health board voted unanimously in support of starting such a

Mr. Kerr said the delay in starting one was not because of lack of
interest from county health officials, but rather lack of funding.

The Centers for Disease Control and Prevention reports that in 2015, 6
percent of HIV diagnoses in the United States were attributed to injection
drug use. Nationwide, the number of HIV diagnoses linked to injection drug
use is falling. More than half of injection drug users in the United
States used a syringe services program in 2015, according to the CDC.

Mr. Kerr said the local health department works with the Lucas County
Coroner's Office to test the blood of people who have died of opioid

In an 11-month period in 2015 and 2016, 42 percent of those blood samples
were positive for hepatitis C, Mr. Kerr said. None tested positive for
HIV, indicating that at this time, HIV is not being transmitted among
injection drug users in Lucas County.

That doesn't mean it can't happen here.

Mr. Kerr points to outbreaks in Scott County, Indiana, and Shelby County,
Ohio, where health officials in each community recently responded to an
HIV outbreak crisis. In 2015, health officials diagnosed the first of
nearly 200 HIV cases spread by sharing needles in the rural Indiana
county. In Shelby, a much smaller, though similarly concerning outbreak
resulted in a handful of HIV and hepatitis C diagnoses among injection
drug users who admitted to sharing needles.

He's hoping the local program is another safeguard against a similar
public health emergency here. In Lucas County, nearly all new HIV cases
are transmitted through sexual contact and the number of new cases has
fluctuated over the last decade. More recently, the number of new
diagnoses was 56 in 2011; 64 in 2012; 39 in 2013; 54 in 2014; 32 in 2015,
and 45 through Oct. 31 of this year.

In the exchange's first year, health officials could swap between 50,000
and 80,000 syringes and see 720 individuals, Mr. Kerr said. Those figures
are based on estimates for the number of intravenous drug users in Lucas
County, which some health officials have pegged at 2,400.

"People I talk to in substance abuse treatment centers say that is much
too low," Mr. Kerr said, meaning the program might surpass its projected

Participants will agree to some rules upon joining the program.

"People who show up at one of the program sites will sign an agreement not
to sell drugs on the property and discuss their rights to be treated with
respect," Mr. Kerr said.

Health care officials can do basic exams to check patients' injection
sites for abscesses or other signs of infection.

Participants will get an identification card with a unique number - though
no names or photographs - which identifies them as a member of the Lucas
Syringe Access Program. This, Mr. Kerr said, identifies them to law
enforcement and, thanks to provisions in state law, exempts them from
Ohio's drug paraphernalia laws within 1,000 feet of a program location.

Toledo police spokesman Lt. Joe Heffernan said the department will abide
by the laws related to the program and will participate in discussions
with organizers as program details are finalized.

St. Paul's church member Kathie King, who sits on a committee to develop
the program, said it was an easy decision to make the church one of the
sites, given the congregation's long history of working with people in
need. She said participants in the exchange program can also use the time
to visit the Marketplace for All People, a food and clothing shelter the
church opened in August.

"Where we've seen successful needle exchange programs is in places where
there are other services," she said. It also destigmatizes the visit, "so
they don't have a sign on their forehead that says 'I'm getting needles.'

With the resources available, Lucas County's will be "a well-funded"
syringe exchange program, Mr. Kerr said. The program, operated through the
Toledo-Lucas County Health Department, is receiving funding from the
University of Toledo Medical Center and Lucas County Mental Health and
Recovery Services Board.

UTMC, the former Medical College of Ohio Hospital, has committed up to
$160,000 per year; the mental health board will contribute $20,000 for
supplies, Mr. Kerr said.

Scott Sylak, executive director of the Mental Health and Recovery Services
Board, said he sees the syringe exchange as one facet of a larger strategy
in the effort to provide education, prevention, and treatment in the
heroin epidemic.

"Folks that are considering coming in to treatment, they are in varying
stages of contemplation," he said. "We want to be able to provide this
first point of contact and give them some information to create an easy
pathway for them to do that and enter treatment."

Toledo's program comes after changes to Ohio law in 2015 to allow
"bloodborne infectious disease prevention programs" without declaring a
state of emergency.

The Free Medical Clinic of Greater Cleveland has been operating Ohio's
oldest needle-exchange program since 1995, created through a health
emergency declared by then-Cleveland Mayor Michael R. White. That
designation, in response to the area's growing HIV rate, gave the city the
ability to run the program despite state laws.

Other cities followed suit. Columbus started an exchange program in early
2016, the first created under the new state law.
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