Harm reduction services are spreading in Kentucky, but not nearly fast enough for some of its most vulnerable residents. A Kentucky Health News analysis found that as of August 2020, the state has 74 syringe exchange centers in 63 out of 120 counties, just over half. That’s five more counties than last year.
But 20 of the counties that still lack syringe exchange are also considered among the highest-risk in the country for an HIV or hepatitis C outbreak, according to a 2015 study conducted by the Centers for Disease Control and Prevention (CDC).
The CDC identified 220 counties throughout the US most likely to have an outbreak of blood-borne disease from injection drug use—that is, sharing needles. The state of Kentucky has a total of 54 counties considered high-risk; Wolfe County is actually number one in the nation. The state’s neighbors of Ohio and West Virginia also have severely at-risk counties.
People who use drugs and their allies have advocated forcefully for syringe exchanges in these areas of the country, because they know what can happen without them. Scott County, Indiana—just 30 miles away from Louisville, Kentucky—suffered a disastrous outbreak of HIV among drug users in 2015. That health emergency resulted in syringe exchanges finally being authorized in Indiana. An analysis showed that had the government acted sooner, giving out sterile syringes among other actions, it would have dramatically reduced HIV spread.
Blood-borne disease via shared needles in Kentucky is not just a hypothetical risk: It’s already here. In 2017, the state ranked first in the nation for rates of hepatitis C infections, according to a health department report that looked at infections from 2008-2015. The report identified unsafe injecting of heroin and other opioids as the main cause.
Besides preventing blood-borne disease, expanding syringe access in the state will also help to reduce overdose deaths. The centers that give out syringes can also provide lifesaving tools like naloxone and fentanyl test strips, as well as overdose-prevention education. Kentucky suffered nearly a thousand opioid-involved overdose deaths in 2018, at a rate above the national average.
The fight against hepatitis C in Kentucky is also a fight against liver cancer, because untreated hep C can cause liver scarring that leads to cancer. Kentucky has the highest overall rate of cancer diagnoses and deaths in the US, especially in the Appalachian region.
Kentucky legalized syringe exchanges only in 2015, because of these growing crises. The first center to open was in Louisville. State law requires that the county health board, fiscal court and city government all approve any new center. Local battles over syringe exchange have often been politically charged, with some residents and politicians viewing them as enabling drug use and sryinge litter.
Those perceptions, of course, contradict decades of evidence showing that syringe exchanges help reduce syringe litter, and help people who use drugs to stay safer, and in many cases to seek addiction treament or discontinue their drug use.
“It is about getting dirty needles off the street and off of our playgrounds and off of the places we go, certainly that’s a huge part of it,” Bracken County Health Director Tony Cox told The Advocate-Messenger. “But it is also a program that is about helping the people in our community as well that need help because they are addicted to drugs. Be open-minded and get educated.”