Needle-exchange proponents say the programs reduce the spread of blood-borne diseases and help reduce some of the harm of IV drug abuse. A rise in Hepatitis C and HIV infections in rural areas shows it may be time to promote them far beyond the big-city limits.
“I’m bothering no one but myself,” said 52-year-old eastern Kentuckian Joseph Cook.
At least that’s how he felt in his younger days.
Twenty-five years later, sitting on the wrong side of the safety glass at the Letcher County jail, he sees things differently. It’s his third trip to jail on drug charges.
“I feel responsible because when my son was 15, he found my OxyContin, which started my son’s addiction to opiates,” Cook said.
His son now suffers from liver failure caused by the Hepatitis C virus, which he contracted using a contaminated needle to inject drugs.
A needle exchange program could have helped his son avoid the life-threatening disease, Cook said.
Needle exchanges allow people to trade used syringes for sterile ones. The programs can help reduce the risk of disease like hepatitis and HIV and create a safer path to recovery, according to the World Health Organization.
Dirty needles are the likely cause of an increase in new cases of Hepatitis C and HIV in rural places like southern Indiana’s Scott County earlier this year. The Centers for Disease Control and Prevention has linked drug injection and prescription opioid abuse to Hepatitis C outbreaks in four eastern states, including Kentucky.
While needle exchanges could help slow the spread of disease, the programs can be controversial. Part of that may be due to how people perceive IV drug users – as pariahs, the lowest of the low.
Cook doesn’t fit the stereotype. He worked as a coal miner for 29 years, earning up to $85,000 annually. But most of that went to purchase drugs.
“I was living a double life,” Cook said. “I was raising a family and working all at the same time functioning as an addict.”
When Cook was growing up, no one else in his middle-class family had a drug problem. His father would occasionally have a beer during the summer months. His mother was a homemaker. His sister and brother were successful in their schooling and careers.
“I smoked the gateway drug—marijuana,” Cook said.
For him, marijuana led to opioids like high doses of OxyContin.
Cook said he used another drug, Suboxone, to wean himself off opioids each month. He spent a $400-a-month copay to get a doctor to write a prescription for the drug. Then he spent another $900 for the drugs.
Suboxone is primarily used to help addicts recover from opioid addiction. The pill contains an antagonist opioid that prevents addicts from getting high but has an opiate-like feeling so addicts can function. Yet, if addicts want to get high, Suboxone, taken in huge quantities, fills the void.
Beverly May, a specialized nurse practitioner in drug addiction and rehabilitation, said Suboxone can sometimes keep users on the addiction merry-go-round and continue to expose them to risks from contaminated needles.
“They crush it, and snort it up,” she said. “They can use it sublingually – stick it under their tongues and absorb it that way. They can cook it, and shoot it up.”
When they re-use needles, addicts continue to subject themselves to the risk of disease even while they are trying to reduce their dependency on opioids. It’s a common practice, said a recovering addict who wished to remain anonymous.
“If there are 10 people who come to the [Narcotics Anonymous] meeting, seven of those participants before attending these meetings were injecting prescription drugs including Suboxone,” he said.
Carriers of Hepatitis C, or Hep C, can continue to infect other people for decades before they realize they are ill, May said.
“The latency period for Hep C can be 20 years easily,” she said. “Unfortunately, all during that time, while they are unaware they have that infection, they could be passing it on to other people.”
Kentucky was the first state to pass legislation in the southeast to allow needle exchanges. But individual county health departments may opt out.
“Everyone does not have to implement needle exchange programs,” said Kentucky Public Health Commissioner Stephanie Mayfield Gibson. “It is optional.” Gibson made her remarks at the May 2015 summit of the Kentucky planning and development initiative, Shaping Our Appalachian Region.
Recovering from drug addiction can be a long process, May said. Pleasure receptors in the brain that respond to opioids need to adjust.
“Look at it this way: It takes 10 years for a cigarette smoker to calm those receptors,” she said. “Imagine how long it would take a recovering drug addict.”