14
doc • Summer 2015
Kentucky
The Heroin Bill and
Public Health
By Rice C. Leach, M.D.,
President, Lexington
Medical Society
This brief note is to share
general information about
needle exchanges and the
people it will serve. It is not intended to be a
detailed analysis of SB 192 but it is an overview of what is happening at the LexingtonFayette County Health Department
(LFCHD) and it offers some insight into
those who use drugs.
Senate Bill 192, the “heroin bill”, passed
by the Kentucky General Assembly is in
response to the rapidly increasing number
of deaths from overdose in Kentucky and
related issues. It authorizes health departments to operate needle exchange programs
and to refer patients for help so the LFCHD
and the Board of Health decided early on to
act. The department has produced a preliminary design to operate an exchange at the
health department and is reviewing it with
the appropriate community partners. From
the outset the department decided to focus
on (1) a needle exchange as part of the com-
municable disease program, (2) a way to
accept referrals from outside for the needle
exchange and related services and (3) a way
to develop a referral network for patients
needing infectious disease or substance
abuse services. The initial planning included
consultation with the Kentucky Department
for Public Health, national substance abuse
experts and persons experienced in operating needle exchange programs in Cincinnati
and other cities. We learned quickly that
the take home message is: get started, get as
many clean needles on the street as you can,
keep it simple, don’t be overly prescriptive,
be flexible and build trust with the people
you serve.
Communicable disease control: The health
department has expertise in communicable disease control and the problem is
real. Kentucky has the worst statistics in
the country for hepatitis (over 7 times the
national average for the rate of hepatitis
C and 4 times the rate of hepatitis B) and
needle exchanges have been shown to be
an effective way to interrupt their spread
among drug users and into the general
population as sexually transmitted diseases
and they increase health care costs.
Referral for other services: Health departments are expected to accept referrals from
emergency medical services and emergency
departments and to expedite access to treatment for infections and for drug abuse. Part
of the challenge in meeting these expectations is that health departments are expected
to do these this without using any state or
federal public health funds. That means that
communities develop effective partnerships
to manage the potential increase in cases.
In Lexington the preliminary design is being
reviewed by law enforcement, hospitals,
mental health organizations and others
including heroin addicts to determine what
needs to change before we start. The comments from partners have not been completed but we do have some input from drug
users. We interviewed drug users incarcerated in Lexington on drug related charges
and got very good advice. These men and
women emphasized the need to make sure