It
was something of a shock when Indiana Governor Mike Pence declared a
public health emergency last March—Scott County, in the southern part of
the state near the Kentucky border, isn't the kind of place that comes
to mind when you think of drug abuse and HIV outbreaks. But by that
March, 79 people in the county had tested positive for HIV, a consequence of rampant intravenous drug use in southern Indiana. But it didn't have to be that way, according to a new perspective published today in the New England Journal of Medicine.
The real culprits, the authors argue, are counterproductive drug
policies such as Indiana's ban on needle-exchange programs, and the
overuse of prescription painkillers.
"Many observers were surprised" by Pence's declaration, according to authors Steffanie Strathdee and Chris Beyrer. "Other
observers, however, had seen it coming." A growing number of people in
Scott County, as well as neighboring counties and states, had been using
drugs such as the painkiller oxymorphone. But as new policies made
those drugs harder to acquire, addicts increasingly turned to
alternative injectable drugs, including heroin. And
because Indiana makes it hard to get clean needles—using a needle for
non-medical purposes is a felony punishable by up to three years in
prison—more and more people had to either share or go without a fix.
This
was a recipe for disaster when it came to HIV and other blood-borne
viruses, like hepatitis C. By June 10th of this year, 169 people had
tested positive for HIV in southeast Indiana, where Scott County is
located, compared with the typical five per year. Eighty percent of
those with HIV also tested positive for the hepatitis C virus.
All
of this points to the need for an overhaul of some of Indiana's—and the
nation's—drug policies, Strathdee and Beyrer argue. First,
needle-exchange programs should be the norm. While Pence's order lifted
the effective ban on such programs, the reprieve is temporary and only
applies to counties undergoing declared public health emergencies, "a
requirement that ensures they can only respond to, rather than prevent,
new outbreaks." the authors write. That goes for other
states—needle-exchange programs are effectively illegal in 24 other
states—as well as the federal government. Congress should permanently
lift the federal ban prohibiting funding to needle-exchange programs,
Strathdee and Beyrer argue.
Bring Back Needle-Exchange Funding - Pacific Standard
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