Wise addresses needle exchange programs and opioid epidemic

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Overdose deaths have increased by more than 400 since 2010, statistics show

By Zac Oakes

The opioid epidemic and discussion of a potential syringe exchange program in Taylor County were at the forefront of conversation during State Sen. Max Wise’s presentation at the meeting of the local American Association of Professional Coders (AAPC) chapter.

The state legislature approved a syringe exchange program during the 2015 session as part of a bill that took wide-ranging steps to address the growing heroin epidemic. The language in the bill that regarded the syringe exchange program allowed it to be a county-by-county option, meaning that for it to begin, it had to be approved by the local governing bodies, namely the city council and fiscal court, as well as the local board of health.

But before that, the program had to be approved by the district health board, which includes representatives from each of the 10 counties that make up the Lake Cumberland District.

The counties that make up the Lake Cumberland District are Adair, Casey, Clinton, Cumberland, Green, McCreary, Pulaski, Russell, Taylor, and Wayne.

The district board voted to approve the measure to give each county the option to start a program last September.

As it stands, four of the counties have currently approved programs and two are operational. Russell County approved a program that began operating June 1. Adair County approved a program that began operating at the beginning of September.

According to The McCreary County Voice, the McCreary County Fiscal Court approved a syringe exchange program, but it hasn’t begun operation yet. Pulaski County is also in the process of starting a program. It has been approved by the Pulaski County Fiscal Court, according to The Commonwealth Journal, and the Somerset City Council was expected to discuss the topic during a meeting this week.

The North American Syringe Exchange Network shows 23 counties in Kentucky with syringe exchange programs.

The Taylor County Fiscal Court discussed the topic in a meeting on Nov. 9, 2015, according to an article in the Nov. 12, 2015, Central Kentucky News-Journal. Magistrates were interested in hearing more information at the time.

Proponents of syringe exchange programs point to the town of Austin, Indiana, a town of about 4,300 that suffered a severe Hepatitis C outbreak due to the shared use of contaminated needles, as well as pointing out that those who come can be tested for Hepatitis C and HIV, as well as be referred to a treatment center. The U.S. Center for Disease Control and Prevention says that syringe exchange programs lessen the risk of accidental needle sticks. Proponents also state that there are fewer needles found in playgrounds, parks, schools, businesses, etc. when people have a place to return contaminated needles.

Those who oppose the programs say they enable drug users by giving them free needles.

According to LCDHD officials, there are no statistics that show an increase in drug use due to syringe exchange programs.

Wise, who voted in support of the bill in the State Senate, said he believes this is one tool that can be used in fighting back against illicit drug use, and said he believes syringe-exchange programs are something that counties should take a look at.

“I talked with Judge [Eddie] Rogers and told him I would be voting in favor of it,” Wise said. “And I told him that it kind of pushed the ball into his court, making a decision… But when I think you start to see some other counties in this area start to pass it and have this program, I think the court needs to take a hard look at that, but again, it is a local control decision.”

However, Wise said he respects individual counties’ decision to either approve or not approve the program, which is why they wrote the bill to give each city/county the option.

“Some communities have gotten on board with this and some have been resistant,” Wise said. “I do understand those who don’t want to have the program… That is why we passed the bill, to provide the local option.”

In addressing the opioid epidemic that has taken hold across the country, but especially in Kentucky, Ohio, and West Virginia, among others, Wise said there is not an easy legislative fix for a crisis that has caused the number of overdose deaths to jump from 996 in 2010 to 1,404 in 2016.

Wise said the heroin and opioid epidemic affects many areas, ranging from foster care to unemployment to education to healthcare.

“It’s complex and multifactorial,” Wise said. “There is not one simple answer.”

Wise said it has to be viewed as a public health issue and said we can’t incarcerate our way out of this crisis.

“Our prisons are becoming overcrowded,” Wise said. “And that’s not saying I am soft on crime by any means… but we cannot continue to incarcerate and incarcerate.”

Wise said we need to look at treatment options inside prisons to prepare people for life after they are released.

While some may think the heroin and opioid epidemic only affects people of certain races, genders, or economic status, Wise said that is not the case at all.

“When it comes to heroin, any family can be affected,” he said. “It can affect each and every one of us.”

Along those same lines, Wise said a lot of people stigmatize it as an Eastern Kentucky problem. However, a report from the Cabinet for Health and Family Services shows Taylor County ranking in the fourth quartile in the state’s Composite Risk Index for Opioid Overdoses, which factors in fatal opioid overdose rates, opioid overdose ER visits, overdose hospitalization rates, and neonatal abstinence syndrome rate, among others.

Instead, Wise said it will take everyone to fight against the epidemic.

A grant awarded to the state will help aid in that fight, Wise said, through the 21st Century CURES Act. Kentucky is referring to this initiative as the Kentucky Opioid Response Effort, or KORE. Kentucky’s Year 1 award is for a little more than $10.5 million.

The program will focus on prevention, treatment, and harm reduction.

A few other notes from Wise’s visit with the AAPC Chapter:

·      A bill passed in the legislature is being challenged in the courts. The bill, which authorized Medical Review Panels to hear lawsuits against medical providers, is being challenged, and Wise said it could be brought onto a ballot for Kentucky voters to decide whether Medical Review Panels would be authorized in Kentucky.

“That’s going to be challenged, the legality of that,” Wise said. “… I wouldn’t be surprised if we make it a vote by the people as a constitutional amendment, where the voters will get to decide on that. We don’t do those very often, but that’s possible.”

·      There is a pre-filed bill for the next legislative session dealing with drug testing for government welfare recipients. Wise said he recognizes there are issues with people who abuse the system, but added that this issue must be addressed at the federal level, since that is where most of the funding comes from.

“It’s very difficult to do that,” he said.

Wise also said he would be supportive of the bill, but doesn’t know if it will pass due to more pressing concerns such as the pension issue and passing a budget in the next session.