Should health agencies in the Mahoning Valley give needles to addicts?

By Tim Rudell

89.7-WKSU

YOUNGSTOWN

The Mahoning Valley, one of Ohio’s hardest hit areas in the ongoing opioid crisis, is looking for solutions to all the problems that come with the addictive painkillers.

Deaths in Trumbull and Mahoning counties doubled in two years, from 2014 to 2016, and Trumbull by itself has a death rate that is seventh highest in Ohio, which is one of the worst states in the nation.

For every death, there may be hundreds of people using needles to inject the mind-numbing substances daily, as much to avoid the gut-wrenching effects of withdrawal as for the momentary high.

Dirty needles are creating another crisis: More hepatitis C cases, a disease of the liver that requires hundreds of thousands of dollars in treatment. In Trumbull County, the number of known cases jumped 52 percent in 2016 alone, pushing the rate higher than the state average, according to Ohio Department of Health statistics.

If needles are shared, the risk of spreading other diseases, such as HIV, also increases.

That has raised a policy debate of whether to provide users with free needles to reduce the spread of ailments that add to the public-health costs.

Do exchanges enable abuse? Does the government become liable in criminal activity?

As part of the Your Voice Mahoning Valley media collaboration, WKSU explored whether needle exchanges are a solution and the debate that surrounds them. The collaborative includes The Vindicator, 21 WFMJ-TV, The Tribune Chronicle of Warren and a broader Your Voice Ohio media group.

Mahoning Valley a holdout

Local health department needle exchanges — at least six are now up and running in Ohio — allow addicts to get clean syringes free of charge and free from arrest.

Cleveland has Ohio’s longest-running program, dating to 1995, and Cincinnati’s Hamilton County exchange has expanded to neighboring counties.

Summit County has had a program since late last year.

Summit Health Commissioner Donna Skoda says the exchanges offer an opportunity to make contact with users and encourage treatment.

“A substance abuse disorder is a chronic disease. Individuals who are users or in recovery recover their whole lives. It’s like diabetes; it doesn’t just go away,” she said. “And the last thing we want is for individuals wanting recovery and wanting to get well have another chronic disease to deal with. Like Hep-C or HIV/Aids or both.”

Canton started its own needle exchange several months ago. Diane Thompson with the city health department says reducing the use of dirty syringes can head off a potential “secondary epidemic” of communicable diseases that would dramatically worsen the problem of dealing with addiction.

“In Stark County our HIV rates historically have not been tied to injection drug use.” Thompson said. “But just this past 2016 we started seeing that. Not as much as the outbreaks in Scott County, Ind. But that is what we’re trying to prevent. They had, I believe, over 200 individuals test positive for HIV, and it was all linked back to injection drug use. So, we’re in a position to prevent that.”

In Indiana the infection outbreak was so dramatic that in 2016 then Gov. Mike Pence, a long-time opponent of the philosophy of needle exchange, issued an executive order to begin syringe distribution.

The Youngstown-Warren area is the largest urban center in Ohio without an exchange. Smaller ones, among them Gallia and Scioto counties, have them.

Mahoning County Health Commissioner Patricia Sweeney said health board officials have discussed the idea before, but that Mahoning County’s Hepatitis C and HIV rates, at least for now, do not warrant implementation of a needle exchange program. The department monitors those rates on a monthly basis, and Sweeney said the department has not seen an increase in total numbers of Hepatitis C or HIV cases. If this year stays on track, it will have lower rates than last year.

“A needle exchange program is not something that is on our radar screen in the immediate future, but it is not something that is not on our radar screen,” she said. “We are not seeing an increase in the Hepatitis C or HIV rates, and we have other initiatives underway that are working” such as making naloxone available to community members, schools and law enforcement; working with physicians on prescribing practices; and working to get people with addictions into treatment.

“While I think what they’re doing in Summit and Cuyahoga is great, and we might get to that point, we are not there right now,” Sweeney said. “We are watching it, and we are open to conversation. This is not the approach we are taking yet.”

“Even if the rates don’t go up, and we’re seeing a spike in a particular age group, I’m sure we would start to discuss it,” she said.

Prosecutor opposed

In Trumbull, the county prosecutor cautions that while a 2015 change in state law does relieve local jurisdictions of criminal liability for providing needles for illegal drug use, it does not protect them from civil actions.

Professor Jonathan Entin of Case-Western Reserve University School of Law says that is an accurate assessment – in context.

“If you are extremely risk averse. If you do not want to be sued at all, then maybe you shouldn’t have the health department participating in the needle exchange,” Entin said.

“But, just because you can’t guarantee that the county will be immune from lawsuits doesn’t necessarily mean that the county would lose. And it doesn’t necessarily mean that participating in the needle-exchange program is somehow bad public policy.”

Summit County Health Commissioner Skoda says she understands why, in general, there are concerns.

“I get the criticism,” she said. “I mean, if you just look at the surface it probably seems like you’re just helping people use drugs. But these folks are going to get needles anyway. They’re going to get out and they’re going to do it. You’re just preventing the spread of communicable disease.”

Skoda said the needle exchange provides a larger opportunity as well. It creates a safe point of contact for drug users to find help in overcoming their addictions.

“We get an opportunity to talk with them about treatment, how to stay clean, about other health services,” Skoda said. “We can offer testing for Hep-C as well as HIV. And, therefore, it’s easier to impact and start to chip away at the addiction, and have them want to get healthier and sober.”

Amanda Archer oversees Canton’s program. She says the safe contact aspect of it has been showing traction with the exchange participants.

“Almost a hundred percent! None of them are interested in living in this world of addiction,” Archer said. “They talk about treatment options every week that they come.”

WKSU reporter Tim Rudell can be emailed at rudell@wksu.org. For more on the opioid crisis and community solutions, visit yourvoiceohio.org. Vindicator reporter Jordyn Grzelewski contributed.