What is the Syringe Exchange Access Program?
(Needle Exchange)
and Why We Need it in Northern Kentucky


The Syringe Exchange Access Program (Needle Exchange) is a public health program that reduces the spread of communicable diseases like hepatitis C and B and HIV in people who inject drugs, exchanges sterile syringes and needles for contaminated equipment, and properly disposes of contaminated equipment, while providing access to other health services, such as drug treatment, along with education, counseling and enrollment in health care coverage.

Northern Kentucky is gaining
national attention for its rates of
blood-borne diseases.

  • In 2014, NKY’s hepatitis B rate was
    0x
    the national average.

  • In 2014, NKY’s hepatitis C rate was
    0x
    the national average.

NKY’s HIV rate has not increased yet.
Now is the time to prevent new HIV infections.

  • Rates of hepatitis B and hepatitis C in Northern Kentucky have increased dramatically in the last five years.

  • Hep B
    0%

  • Hep C
    0%

The Health Department is required by statute to prevent the spread of infectious diseases and is uniquely positioned to provide a syringe access exchange program due to its facilities, qualified staff and on-going partnerships with the community.
The Northern Kentucky Board of Health has approved the Syringe Access Exchange Program but other approvals are required, including local city approvals. We need to ask the leaders of Newport and Covington to open a public discussion concerning the Syringe Access Exchange Program! See the links below to contact the leaders of Newport and Covington, and ask that they allow an open forum to discuss the Syringe Access Exchange Program at their monthly council meetings as soon as possible.
  • Treatment of blood-borne diseases is expensive. Syringe access programs are cost effective.

  • For Every
    $0
    Spent on Such a Program

  • Up To
    $0
    Is Saved in HIV Treatment Costs Alone.

Individuals in syringe access exchange programs are 25% more likely to eventually enroll in a drug treatment program.

Syringe Access Exchange Program Frequently Asked Questions 
(click on your question for the answer)


A: Yes, over 225 programs have been running in other parts of the country for more than 30 years. Research has shown that individuals participating in syringe access exchange programs are 25 percent more likely to enter a drug treatment program, and rates of HIV decline. For example, a study in Washington state showed that cases of HIV declined in the first two years.
A: The reality today is that we have people who are injecting drugs, are addicted to drugs, and have a substance abuse disorder. Until individuals who inject are ready for treatment, they will continue to use regardless of whether we give them clean needles. They will continue to engaging in behavior that puts them at risk for infectious diseases. Our ultimate goal is to prevent drug use and help those who are using get into treatment, but we aren’t there yet. Syringe access is a measure we can employ keep individuals from contracting infectious diseases like Hepatitis C and HIV, until the heroin epidemic can be reversed.
A: Many of the additional services that we are proposing to provide to syringe access exchange clients are already offered at the Health Department, including vaccinations, HIV testing and case management, STD testing and treatment, and health insurance enrollment. New services would be the provision of naloxone kits and substance abuse counseling. Our nurses would be trained to do basic substance abuse education and referrals. We hope to partner with a treatment provider to offer more extensive counseling.
A: No one will be forced to participate in other services such as testing for diseases, immunizations and education, but they will be available. We hope that as staff build relationships with exchange program participants, they will begin to take advantage of all the services offered.
A: We are giving clients sterile equipment that can protect about hepatitis C, HIV, etc. We are trying to stop the transmission of disease. About 91% of local users say they have shared needles at least once. Many users also buy needles from dealers, which may not be clean.
A: The attitudes of local law enforcement officers are changing. They are recognizing that those with addiction need treatment and not incarceration. Law enforcement also has a vested interest in helping to prevent needle sticks themselves. We are speaking with law enforcement officers about syringe access exchange programs as a way to prevent the spread of disease and protect first responders while helping people access treatment, which is the best solution.
A: The Health Department has secured grant funding from a private foundation for the initial start-up of the program. These programs are inexpensive when compared to the costs of the diseases they prevent. We estimate that one year of participation for one user would cost $825. With an estimate of about 750 program participants, it breaks down to a cost of about $1.39 per Northern Kentucky resident per year.
A: Information will be shared with partners who interact with individuals who inject. This includes law enforcement, St. Elizabeth emergency departments, and community groups working to reduce the impact of heroin and word of mouth.
A: Nurses working in the program would get baseline training, but we would ultimately like to work with a partner organization to have their substance abuse counselors support the program. We are exploring a partnership in which beds at a treatment provider might be reserved for syringe access program participants. Of course, we are also a part of the larger Heroin Impact Response Task Force’s efforts to expand treatment capacity.
A: The Health Department Board of Health wants some sort of exchange element in our program, so clients will need to bring something contaminated in to get clean needles. There are reasons for which participants may not come in with dirty needles in the beginning of their visits. For example, the individual may be sharing and not have their own, or have discarded their needles to keep individuals in their home from knowing about their use. We will provide needles in situations such as these and instruct the participants they are to bring the contaminated equipment back so that we can properly dispose of it. Returning contaminated equipment will be included as a responsibility of the participant.
A: We are waiting for a legal opinion on this issue.
A: In general, the cost to run the program are low, especially when you consider the costs of the diseases that it’s designed to prevent. HIV can cost $600,000 over a lifetime. One course of medicine to treat hepatitis C is $80,000. Our high-end estimate is that running a program would cost about $825 per participant per year. We have already received a $225,000 grant from the RC Durr Foundation for the program. Many of the services beyond needle exchange, such as HIV testing, STD testing and pregnancy testing, are funded through program allocations from the state. We have also received St. Elizabeth’s commitment to dispose of the contaminated needles and the national Harm Reduction Coalition provided staff training. These commitments reduce our operating costs as well.
A: We are ready to implement pending approvals. Approval from the Board of Health, city and county in which the program will operate is needed. Williamstown City Council and the Northern Kentucky District Board of Health have approved the operation of the program.
A: Building relationships between the participants and nurses is key. We also need to emphasize the program’s rights and responsibilities, and make sure that clients realize that the need to return products as part of their participation–if they don’t, the program could be in jeopardy.
A: Our region looks a lot like Scott County demographically. We are not different from them–our hepatitis rates have already gone up; HIV could follow. If you look at the HIV rates in Scott County and applied them to Northern Kentucky, we’d see an additional 3,000 cases. Costs to treat that could be upwards of $1.8 billion.
A: Not in our area of Northern Kentucky. There are programs operating in Louisville, Lexington and Pendleton County. Cincinnati also has a program in operation.
A: The community is working to pull together resources against all aspects of the heroin problem. Prevention is a part of the local Heroin Impact Response Plan, and local counties have prevention coalitions working on the issue.

Proposed Syringe Access Exchange Program
For Northern Kentucky

Program goals

  • Reduce transmission of diseases and infections spread by injection drug use.
  • Reduce the amount of contaminated needles and syringes improperly discarded in the community.
  • Act as an access point for individuals to obtain connections to treatment for substance use disorders, health care, counseling and other social services.

How will the program operate?

Northern Kentucky’s program has been modeled after similar successful programs throughout the country. It uses a cost-effective approach with best practices for disease prevention by utilizing existing staff and health centers already set up for providing services to this population.

  • The program would be open to anyone who uses injection drugs. Exchange of needles would be provided anonymously; however, other health services, such as laboratory testing for hepatitis C, HIV, syphilis and pregnancy, and immunizations will be provided confidentially.
  • Most participants will come weekly for clean syringes and other services. It’s estimated that the program will serve about 800 individuals annually across the four-county Northern Kentucky district. With four locations and weekly visits, it’s estimated that sites will see up to 10 participants per hour when the program is operating. The Health Department already handles much larger programs in its health centers—the WIC nutritional supplement program serves more than 8,000 participants annually.
  • Most services provided through the syringe access exchange program will be free of charge. Clinical services beyond the exchange of equipment and rapid testing for hepatitis and HIV may be billed per the regular sliding scale fee or to a third party payor if participant is enrolled. No participant will be turned away for inability to pay.
  • Current plans call for the program to operate during regular business hours, with designated times set for each county health center, based on expected use.
  • Clinic flow has been analyzed at each health center, and syringe access exchange services are designed to have minimal interruption to other health center services. Participants for syringe access will follow a separate streamlined process for services.
  • All participants will be required to agree to a list of Participant Rights and Responsibilities. Items covered by this policy include safely disposing of contaminated equipment and refraining from drug use on Health Department property. Violations can result in dismissal from the program.
  • Specially trained Health Department nurses will staff the program, with one nurse at each site serving as the primary provider. If client volume for syringe access is higher, additional staff can be assigned to assist with the program. If client volume for syringe access is low, the nurse can provide other public health services to other clients of the health center.
  • Participants in the syringe access exchange program will be offered a variety of referrals for other health and social services, including
    • Treatment for a substance use disorder
    • Other Health Department programs such as HIV case management, sexually transmitted disease treatment, family planning, etc.
    • Primary medical care
    • Mental health care
    • Health insurance enrollment for those who are eligible for coverage

Evaluation

As with any new program, the Health Department will closely evaluate the syringe access exchange program to ensure the program is working and to drive any changes that need to be made. Data will be shared with the District Board of Health as well as others in the community. Items to be tracked include:

  • Number of unduplicated participants with demographics such as age, ZIP code of residence and gender
  • Frequency of intravenous injection
  • Estimated number of needles brought to the exchange for proper disposal
  • Number of needles issued
  • Number of vaccines provided
  • Number of tests for syphilis, HIV, hepatitis C and pregnancy, and rates of positivity for each
  • Number of participants entering treatment for substance use disorders
  • Number of participants enrolled in health insurance coverage through kynect
  • Number of police and/or EMS runs to the health center for addressing issues related to individuals’ injection drug use.

How Can You Help Your Community?

We as a caring community need to inform our civic leaders of the importance of instituting Syringe Access Exchange Programs in Northern Kentucky.

You can become involved in the process by reaching out to your community leaders, including the city leaders in Newport and Covington. If you agree that Northern Kentucky is in dire need of Syringe Access Exchange Programs, visit a city council meeting in person and ask that they place it on the docket to open a public discussion. Or email them and let them know we need Syringe Access Exchange Programs NOW!