A few months ago I wrote about the discouraging possibility that the number of HIV infections, which have been falling for years, might begin to rise as the number of people who shift from swallowing painkillers to injecting heroin increases. I also noted that it wasn’t clear that this would actually happen, but that we should take evidence-based steps to prepare for it, such as ensuring that syringe exchange programs (SEPs) are implemented and fully funded. Sadly, I wasn’t too off-base with my precautionary post.
Scott County, Indiana appears to be in the midst of an HIV epidemic triggered by the sharing of syringes not for injection heroin, but rather for injecting prescription opioids, particularly the medication oxymorphone. As of April 17, there were 128 confirmed new cases of HIV in the county, with more expected – in a county that typically sees fewer than five new cases a year.
The official response has been mixed. Indiana governor Mike Pence responded on March 26 by declaring a public health emergency in the county that, among other things, essentially legalized syringe exchange for county residents. The county began running a syringe exchange program on April 4. The public health emergency, which is limited by law to 30 days, was extended for an additional 30 days on April 20.
The right steps are being taken in Indiana, but there are a number of issues that could work against the preventive measures. First, the order applies only to one county, even though data suggest that many others are at risk of similar outbreaks. Second, there are reports that local law enforcement may either not be aware of the order or are purposefully ignoring it. At least one local woman appears to have been arrested for possession of a syringe, something that is explicitly permitted under the emergency declaration, and other people who use drugs report that others are afraid to use the exchange for fear of being arrested.
Third, gubernatorial support for following the evidence and expanding access to clean syringes statewide appears to be lacking. A law that would permit the operation of SEPs in counties with high hepatitis C rates if certain conditions are met is currently working its way through the legislature, but will likely be vetoed by Indiana’s governor.
This seems to run counter to action on another law: The Indiana legislature recently passed, and the Governor signed, a law that will increase access to the opioid overdose antidote naloxone. It is not clear why there appears to be support for one evidence-based intervention to reduce the harms associated with problematic drug use while continuing to deny the effectiveness of another. In public health, we like to think that if we get the message out about what works, effective interventions will be rapidly adopted. Unfortunately, that’s often not the case. If anyone out there has good ideas for what we’re doing wrong and what we should be doing instead, my e-mail address is at the bottom of this post.
This post was developed by Corey Davis, Deputy Director, the Network for Public Health Law – Southeastern Region at National Health Law Program.
The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this post does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.
Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not necessarily represent the views of, and should not be attributed to, RWJF.