Louisville Medicine Volume 69, Issue 2 - Page 35

AUTHOR Mary Barry , MD


SPEAK YOUR MIND If you would like to respond to an article in this issue , please submit an article or letter to the editor . Contributions may be sent to editor @ glms . org . The GLMS Editorial Board reserves the right to choose what will be published . Please note that the views expressed in Doctors ’ Lounge or any other article in this publication are not those of the Greater Louisville Medical Society or Louisville Medicine .


AUTHOR Mary Barry , MD
The other night we took our dogs to dinner at a riverside patio restaurant over in Indiana , the longtime home of the unmasked , per gubernatorial direction . We were eating outside so also unmasked , watching the swift brown current and eying up the other diners . I was intrigued by the amount of pathology evident in just one place .
A lady expounding on the dangers of mRNA vaccines had an unusual facial tic , with repeated grimacing followed by eyes squeezed shut , with a separate involuntary snout movement . She appeared unfazed by it and I thought , “ Tourette ’ s ” but then I heard , “ When I was in the hospital with it ,” and began to wonder if she had a longterm neurological consequence of COVID-19 .
Another lady had the classic pallor of uremia , and her younger companion looked hyperthyroid - she even talked fast . The uremic lady had port issues , and so did another , thin elderly woman who needed a strong arm to hold , walking in . She had a Picc line in one arm and lymphedema in the other , and I thought , “ Chemo for breast cancer ” and hoped her taste buds could manage the menu .
It ’ s not just the Indiana governor I disagree with . It ’ s also the Scott County Commission , who in early June voted to end the needle exchange program which has saved lives since its 2015 founding by Dr . William Cooke , the only doc in Austin in 2015 . A family medicine doc who has since gotten boarded in addiction medicine , he spearheaded the syringe exchange and the many services that grew out of it . In 2015 , 237 people from a population of only 24,000 acquired HIV , with 92.5 % co-infected with Hepatitis C . 1 But in 2020 , only one person got HIV from drug injection - not 150 , as in the worst year .
The facts are all on the side of the syringe exchange champions .
The CDC found that from 2015-2018 , local needle-sharing dropped from 74 % to 22 %. Cases of Hepatitis C were already endemic in Scott County , since at least 2010 , with genetic studies finding new strains in four separate clusters of cases . Case rates have now dropped by two-thirds since 2015 . 2
Many PWID ( people who inject drugs ) have entered treatment since Dr . Cooke partnered with other community service organizations . Their port of entry is most often the syringe exchange program , which provides referrals , education and nonjudgmental kindness with each visit . Dr . Cooke said of his community in a 2018 Rural Monitor / Rural Health Information Hub interview :
A syringe service program offers an olive branch or a bridge into care for people who are disconnected , marginalized , and criminalized . One of Maslow ’ s basic needs is safety . So , when people go to Hope to Others , Food 4R Souls , recovery community organizations , the syringe service program , to one of my mobile outreach community workers , or when they just come meet with me in the office , they need to know that the relationship is safe and they are not going to be turned away as less than human . They need to know that they are going to be seen as a person first , and then they are going to be provided access to the care that they need . 3
Contrast this with Scott County commissioner Randy Julian , who has stated that syringe exchanges “ fuel ” drug use and overdoses , quoted in the June 15 Courier . 2 “ With proper care , people can live with HIV and hepatitis . They can ’ t come back from death . If they ’ d have overdosed anyway , then I didn ’ t help them to do it .”
This self-righteous homage to blame and shame is not helpful to the addicted person , and its premise ignores the fact that people make it into recovery via the exchange and associated outreach services . ( continued on page 34 ) JULY 2021 33