01/29/17 Doug McVay

The state of Indiana is considering expansion of its harm reduction efforts. This week, we look at House Bill 1438, to promote public health and give communities more effective tools to address injection drug use.

Century of Lies
Sunday, January 29, 2017
Doug McVay
Drug War Facts
Download: Audio icon col012917.mp3



JANUARY 29, 2017


DEAN BECKER: The failure of drug war is glaringly obvious to judges, cops, wardens, prosecutors, and millions more now calling for for decriminalization, legalization, the end of prohibition. Let us investigate the Century Of Lies.

DOUG MCVAY: Hello, and welcome to Century Of Lies. Century Of Lies is a production of the Drug Truth Network for the Pacifica Foundation Radio Network, on the web at DrugTruth.net. I'm your host Doug McVay, editor of DrugWarFacts.org.

Well folks, this week we're going to look at harm reduction and public health in the state of Indiana. Many of you are no doubt aware that in March of 2015, Indiana Governor Mike Pence – our new vice president, hashtag #ImpeachPenceFirst – signed an executive order declaring a state of emergency in the state of Indiana relating to an outbreak of HIV related to injection drug use. That state of emergency cleared the way for some municipalities in the state to allow the operation of limited syringe exchanges.

Well, Indiana has a new governor now, Republican Eric Holcomb. He has already stated that these syringe exchanges should continue, and he's come out in support of legislation to make it easier for public health officials to provide these services. House Bill 1438 was recently introduced in the Indiana House of Representatives. The first hearing on that bill was January Twenty-Fifth, before the Indiana House Committee on Public Health. The chair of that committee, Representative Cindy Kirchhofer, is the bill's author, and two other committee members, Representative Steven Davisson and Representative Charlie Brown, are co-sponsors.

Let's hear some audio from that hearing. First, the bill is introduced by Chair Kirchhofer. She's followed by Indiana's new attorney general, Curtis Hill.

STATE REPRESENTATIVE CINDY KIRCHHOFER: Thank you, Mister Chairman, members of the committee. I would like to thank my co-authors, I'm not certain if they're on your copy yet or not, but Representative Charlie Brown and Representative Steve Davisson.

So, House Bill 1438 is an enhanced syringe exchange program. It gives locals more power to institute their local syringe exchange program, and makes it easier for them to work with the state Department of Health to implement that. So, I'll go over a couple of key points, and then, if it meets with your approval, Mister Chairman, I think that there are several people who signed up to talk about it, and those folks are the experts, and so, we can defer to them.

But, I would like to tell you that it allows communities and municipalities to establish a program through local decision-making, without having to request a public health emergency designated by the Health Commissioner, while keeping the current program in place.

It requires needle exchange programs, or syringe exchange programs, to keep naloxone, the opioid overdose prevention drug, in adequate stock. It allows for additional collection of data by the State Department of Health, including non-identifiable data on referrals and sources, meaning, non-identifiable data, it means that they can collect data that is confidential without the divulgence of names, particulars, but pure data.

It's important to note that House Bill 1438 would keep in place important provisions, including the data coordination with the State Department of Health by the locals, the power of the State Health Commissioner to end the needle exchange program if necessary, and the non-allowance of state funds for the purchase of needles. As you may recall, our state does not fund that process, but locals do, and hopefully with the help of not-for-profits and other advocates in the community, to help their programs thrive.

So, why do this? Between 2014 and -- December 2014 and July 2015, there were 176 confirmed cases of HIV in Scott County. In the year and a half following, there have only been 36 additional cases. So, often folks will say that this is an avenue to promote the intravenous drug usage among offenders, but I think it's an opportunity to decrease the transmission of communicable diseases.

So, with that, Mister Chairman, I'm not the expert, I'm happy to take questions, but otherwise I defer to the experts here in the audience.

INDIANA ATTORNEY GENERAL CURTIS HILL: By way of background, I am a former prosecuting attorney, and have been involved in the public safety arena for a number of years, and I would say this. I'm concerned about the expansion of the program from a public safety standpoint. There is absolutely no question that our heroin situation in Indiana is a public health matter. It's also a public safety matter. And we really need to have a comprehensive approach going forward.

When the original impetus of the program, the needle exchange program, came about, there was a great deal of discussion and concern about the concept of having needle exchanges, and the state essentially giving approval for that point, in terms of expanding this process. I know there was a great deal of agony over this. The bright spot in that regard was that it was done in connection with a very narrowly defined emergency, a crisis, that it would have to be declared in order to proceed in this fashion, and a limited approach.

Having said that, the reality is that these exchange programs have actually morphed into a distribution program, where the exchange is not necessary in order to get the needles. What ends up happening is, you get a net increase in the number of needles, and that net increase in the number of needles can provide a greater risk of exposure and expansion of the infectous diseases that we're trying to prevent.

Now having said that, I think that's an unintended consequence, it's, this is an opportunity, everyone here is working with the same goal, which is, what can we do to help and save these folks who have a very serious addiction to heroin. So, first and foremost I want you to know that I really want to work with this committee and with the General Assembly to find some comprehensive approaches that include enforcement and treatment, as a matter of how we proceed going forward.

I am concerned that if you expand this program into the local communities, without the provision of a declaration of an emergency, and, thereby relaxing the methodology in which needles can be passed out, it can have the detrimental effect on not only increasing the number of needles that are out there and exposed, but also limiting law enforcement's ability to address it from an enforcement standpoint.

Keep in mind as a prosecuting attorney it was never my intention to lock up addicts. I don't think it's anyone's here's intention to lock up addicts. But we do need to determine a measure of accountability, we need to make sure that we are finding solutions to bringing these folks who are addicted to this heroin into a system where we can get them cured.

Sometimes, and, sometimes one of those approaches is through arrest. Not to languish and die in prison, but in order to promote a methodology in which to get treatment, secure treatment, and then be returned back into society, and I think there are some legislative ways that we can do that to assure that those who are caught up in the addictions avenue and caught up in the judicial system can get the help and treatment that they need.

So I want to caution the committee as we're going forward, I know this is early in the process, I would have liked to and preferred to discuss this in a, more a preliminary fashion. We found out about the hearing this morning, but I did want to come down and introduced to you my concerns, and I want to express that I want to work with the committee and the General Assembly to fashion out more comprehensive solutions.

You'll recall, as the process evolved before, part of the needle exchange emergency program was to develop a comprehensive approach going forward, and I don't believe that we're there yet. So I would caution us by, in terms of just going out and spreading this all over the state of Indiana, I don't want to see anybody die from an overdose in the state of Indiana, but I surely don't want to see our sons and daughters dying from an overdose in Indiana with a needle that was provided by the state of Indiana.

So please, my door is open, and I would be happy to offer the assistance of my office to help fashion a comprehensive approach that would take a measure of accountability and is aimed at not just limiting the spread of infectious disease, but actually attacking the problem of addiction as it stands and to eliminate this problem. Thank you very much.

STATE REPRESENTATIVE ROBIN SHACKLEFORD: I understand your concern, but do you have any data to support, since the needle exchange programs have been in existence, that there has been an increase in, say, an excess of needles out in the community, and an increase of crime, since we have incorporated these needle exchange programs?

CURTIS HILL: Well, my understanding is that the rationale behind the needle exchange program in the first place was to address the infectious disease opportunity, as opposed to the spread of the addiction aspect, or even addressing crime issues. Those would be ancillary issues. As far as, what I'm aware of, as a prosecutor, and through my communications throughout the state, particularly in southern Indiana, is that the, the requirement that the needles be exchanged, which would typically mean I give you my dirty needle, you give me a clean needle, so there were, there's no net increase, with that not being the case, where there are those who are able to get the needles without the exchange, that's increasing the number of needles that are out there.

I think what needs to happen at some point is a study to make a determination of how pervasive that situation is with regard to the lack of exchange and just the net, or increase of distribution of needles in and of themselves. I think that's a question that we need to determine.

DOUG MCVAY: That was Representative Cindy Kirchhofer, chair of the Indiana House's Committee on Public Health, talking about House Bill 1438, which is legislation she has sponsored to help communities and public health officials deal with injection drug use. We also heard from Indiana's attorney general, Curtis Hill, who opposes harm reduction.

In his testimony, Hill lied. It could be argued that he simply took some things out of context, made presumptions, mis-statements, and echoed hearsay. But you know, I think we really need to get past the whole deference to authority and benefit of the doubt thing, at least in this context. That wasn't just some guy down the end of the bar shooting off his mouth, that was Indiana's attorney general, the highest-ranking law enforcement official in the state of Indiana, a career prosecutor, providing official testimony to a standing committee of the Indiana House of Representatives about a piece of legislation that will impact the entire state.

And it's not just Indiana we're talking about here right now. At a national level, we don't know what's going to happen with drug policy. During the Obama administration, we had an executive branch that supported harm reduction, that supported syringe exchange, that supported naloxone access. I disagreed with them about a lot of things, yet I do have to give them that much credit. We're entering a new administration now and there is a lot we don't yet know, but there's a lot to be concerned about.

Vice President Pence did sign that executive order when he was governor in 2015, but that was hardly a 'Road to Damascus' moment. On the other hand, there's no question that these programs work and that Indiana has benefited from allowing syringe exchange.

If I were a cynic, I'd say that back in Indiana, State Attorney General Hill has his eyes on higher office and he's trying to outflank Governor Holcomb on the rightwing side. He said in his testimony that he didn't get into law enforcement to put drug addicts in jail, I don't believe him. Why should I?

Curtis Hill has been a prosecutor for his entire career. He got his law degree at the height of the Reagan drug war and went into prosecution. In his testimony to the Committee, Curtis Hill made it clear that he wants to continue being able to arrest people for drugs. He wants to make it harder for people who addicted to be able to get help. He opposes harm reduction. He also tried to mislead the committee. He made claims about syringe exchange programs in Indiana that were just not true. He's a smart man, he had to know that what he was saying was not true. Now, where I come from, that's called lying.

Calling out people and organizations for their lies, that's kind of my job here, that's the mission for this show, that's why you tune in, dear listener. You are listening to Century of Lies. We're a production of the Drug Truth Network for the Pacifica Foundation Radio Network, on the web at DrugTruth.net. I'm your host Doug McVay, editor of DrugWarFacts.org.

This week we're talking about harm reduction in Indiana. There's legislation in that state to advance public health and to more effectively deal with injection drug use. There was a hearing on that bill, House Bill 1438, on January Twenty-Fifth before the Indiana House Committee on Public Health. We're going to hear from Indiana State Health Commissioner Jerome Adams. We'll also hear from Executive Director for Drug Prevention, Treatment and Enforcement Jim McClelland, the new Indiana Drug Czar.

JIM MCCLELLAND: My name is Jim McClelland, and I'm the recently appointed Executive Director for Drug Prevention, Treatment and Enforcement for the state of Indiana. Chairman Bacon, members of the committee, I want to thank you for this opportunity to speak on behalf of House Bill 1438, and thank you, Representative Kirchhofer, for carrying this Governor's Agenda bill, and hearing it today.

Recognizing that the drug epidemic is reaching into all corners of our state, Governor Holcomb's first act was to sign Executive Order 17-01, which created this position as part of his new administration. Dealing with this drug crisis is one of the governor's top priorities, and we have a lot of work to do, including increasing access to treatment across the state.

Over the next several months, working with a lot of others who are very interested in this, and -- we are going to develop a -- we are going to develop a comprehensive strategic approach to effectively and substantially reduce the damage being caused by substance abuse in our state.

I just want to emphasize, and it's been said two or three times here already, but this legislation will enable the decisions about syringe exchange programs to be made at the local level by people who know their communities best. I'm not going to repeat the information on the bill that Representative Kirchhofer gave earlier. Let me just emphasize again, as you know, this legislation was approved and signed in 2015 to establish needle exchange programs. We are now one of 34 states, including all of our neighboring states, that allow for some form of syringe exchange program.

Nationally there have been no studies that indicate syringe exchange programs increase drug use. Indiana's effort has been effective in slowing the spread of HIV and hepatitis C in the state. You heard the numbers before. In the eight months, from December 2014 through July 2015, there were 176 confirmed cases of HIV in Scott County. That's 22 a month, on average.

And in the year and a half since the program was established, there have been only 36 additional cases diagnosed in that county. That's two, an average of two per month. From 22 per month, down to two per month. Now, two is still too many, but you've got to admit, that is a huge improvement. Unfortunately there remains a strong risk for more outbreaks in our state. Ten Indiana counties were among 220 counties in the entire United States that the Centers for Disease Control and Prevention have listed as the most vulnerable to rapid dissemination of HIV and HCV.

Currently, nine Indiana counties have state-approved syringe exchange programs, and 15 other counties are engaged in active community efforts to establish approved syringe exchange programs.

Here's what we know. This problem is not going to be resolved by inaction. Syringe exchange programs are saving lives, they are helping to connect addicted individuals to other needed services, although we certainly, I certainly acknowledge, we need more. They reduce the spread of infectious disease, and they are providing a measure of safety overall for communities throughout the state.

These programs are not a complete solution. There's no question about that. But they are a vital part of an overall effort to substantially reduce the magnitude of a scourge that every day is destroying lives, devastating families, and damaging communities in many parts of our state. And I urge your support of this legislation. Doctor Adams?

JEROME ADAMS, MD: Chairman Bacon, members of the committee, Representative Kirchhofer especially, thank you all very much for the opportunity. I'm Jerome Adams, I'm the State Health Commissioner, even though I think most of you all know me. I know all of you all. I go to the same barber as the Attorney General, we even shop at the same suit supplier, but I'm not as good of an orator as he is, so I'm going to quickly read from my notes to make sure we stay on track.

I do want to correct some things that were mentioned earlier, though. First of all, the state of Indiana does not give out needles. The needles are supplied locally through nonprofit groups, and so I think it's important that folks realize the state of Indiana does not, and under this change would not pass out needles.

Another important aspect, and I wish Attorney General Hill was still here, but to answer your question, sir, I've had that same concern about needles in versus needles out. I've looked at the numbers, and Scott County, Indiana, 96 percent of the needles that go out come back in. And that number has been steadily increasing since we started the syringe exchange program.

So I have been following those numbers, because we recognize how great of an opportunity you all afforded us when you first passed the syringe exchange legislation. We recognize that the people of Indiana have concerns. And we recognize that public safety is one of those concerns. And so we are constantly, when we talk to the local communities, discussing the fact that we need to have those syringes come back in.

And I will tell you that when we talk to the people who run these exchange programs, they are sharing that information with these substance users, and the substance users themselves are saying, we know, we know, we've got to get them back in, and that 96 percent is probably even higher because not everyone's bringing it back to the syringe exchange program. A lot of times they're disposing it in other places, but they're not leaving them on the streets, not leaving them in the parks to the extent that they used to.

So I think it's important that you all know that. I wanted to share with you some of Indiana's experiences with syringe exchange programs quickly. I have mentioned the HIV outbreak hit in 2015, and has been a wake-up call for communities across Indiana, and has shown us that the true toll of the national opioid epidemic is really hitting us hard here in the midwest.

As of today, 215 people in Scott County have tested positive for HIV with the vast majority reporting injection drug use as a risk factor. 94 percent of those 215 are co-infected with hepatitis C, which both further complicates treatment, and again demonstrates the link to injection drug use. As I explained to the committee last week, the majority of hepatitis C cases, over 80 percent, are related to injection drug use.

These 215 individuals' lives have been changed forever by these diagnoses, and I hope we don't ever lose sight of that fact. We've seen incredible progress in Scott County since an executive order and your subsequent legislation gave counties experiencing epidemics of HIV and hepatitis C a mechanism to seek authorization to be able to operate a syringe exchange program.

To receive approval for an SEP under the current law, counties must declare a local emergency, obtain approval of their local health officers, and submit a request to the State Health Commissioner for a public health emergency declaration. The process from a local vote to submission to my office sometimes can take months, as local health departments and entities navigate the process, and work their way through those requirements.

As you heard from Director McClelland, nine counties have requested and received those state emergency declarations, and all but two have syringe exchange programs up and operating. Clark County is actually going to open up tomorrow, I was on the phone with their local health officer just yesterday.

Other counties are having discussions about whether syringe exchange programs are right for them, and as you consider this legislation, that's the point that I want to emphasize. The counties are having the discussions. Research has shown that syringe exchange programs can effectively reduce harm in a community battling drug use, but we also know that a syringe exchange program will not succeed without community buy-in, without local buy-in, and Representative Davisson can speak to this as well as anyone else. You know how tough it was in Scott County to get that buy-in, that's why it's important that it be locally led.

This means your local health officials, your police department, your prosecutors, your jails, and your community leaders need to be on the same page. They need to know what the public sentiment is on the ground toward syringe exchange, and what the challenges to implementation could be, and that effort again is best led locally.

Since Indiana began allowing syringe exchange programs in 2015, I've heard several concerns about the current process, and that's why we're here today. One concern is that the procedure for requesting a state declaration requires too many steps. Another is that once a county receives that declaration, it's only good for one year. A third is that it requires an emergency to exist, an emergency declaration before a county can pursue a syringe exchange, which means it's already too late.

And I think it's important to separate the idea of an emergency from an epidemic. An epidemic is anything over the baseline. There's, as you mentioned, hardly a place in Indiana that is not experiencing an epidemic of opioid use, an epidemic of hepatitis throughout the state of Indiana. The emergency declaration was a way to help folks, quite frankly, feel better about what they were doing, but I think that the fact that we still in this law would require that there be an epidemic, is sufficient, and still helps communicate the idea that this is something that is needed in that community, that there is something happening that is out of the ordinary, beyond the baseline, to speak to some of the concerns that Attorney General Hill had.

The legislation you're considering would remove many of the barriers that I just mentioned. It doesn't mean the state health department's going to abandon counties. We provide regular technical assistance to those operating syringe exchange programs, and convene public health officials, law enforcement officials, to share their experiences with these programs.

The proposed legislation allows counties that are more comfortable with a public health emergency declaration from the state to continue following that existing protocol. So you've got a pathway that doesn't require the steps, but if you still want to do it the way that you were recommended, in the initial version of the legislation, you can. And ISDH still will collect data, and even have the authority to close a program if it violates state law.

So we've heard concerns about enabling, and, those are continued. We do hear those concerns, and I'm constantly addressing them. However, this is not a question of enabling drug use. The statistics are clear, the studies are clear, it does not enable drug use. But it's a question of whether or not we, whether or not you all are going to give communities the tools they need to stop disease transmission, and whether or not you're going to give them the opportunity to connect folks in their community to care.

We know that when we remove barriers to care, and when we build trust, individuals and communities benefit. We also know that while a syringe exchange program reduces harm, it won't end the drug epidemic alone, and that's why I'm excited to continue working with all of you all, with the Attorney General's office, with local folks, to help figure out how we wrap around this problem, how we provide not just syringes, because that's not, it's called a syringe exchange program, but it is about so much more.

Syringe exchange programs create important touchpoints to care, insurance and treatment, and quite frankly, buy us time as we connect people to care. In Scott County, nearly 80 percent of individuals who have engaged in care through the syringe exchange program are virally suppressed. That means the level of HIV in their blood is undetectable, and they are unable to continue to transmit HIV.

As I mentioned to you all last week, the CDC expects, it says that 30 percent viral suppression is fantastic. Scott County is achieving 70 percent viral suppression. We've also seen 70 people enter treatment through the syringe exchange program, out of 210 users. So we're connecting folks to care through that syringe exchange program, and stopping that revolving door in and out of jails, in and out of the emergency room.

Without the syringe exchange program and the connections it has created, it is estimated that 400 to 500 people, not the 215 that we currently have in Scott County, would have HIV at this point, with potential spread to other counties, and with costs to the state.

My hope is that by allowing local communities to determine whether syringe exchanges are appropriate, we can create more touchpoints that prevent the spread of disease, HIV, hepatitis C, and opioid abuse, and give people battling substance use disorder a chance to rebuild their lives.

DOUG MCVAY: That again was from a hearing before the Indiana House Committee on Public Health. The hearing was on House Bill 1438, on syringe exchanges. The measure was passed by the committee with a do-pass recommendation on a vote of twelve to one. The sole vote against it was from Republican Representative Don Lehe. As a side note, I should mention, Lehe is the author of a bill this session, House Bill 1596, on the medicinal use of hemp oil.

Now, we have just enough time left in the show to hear this last exchange from the hearing. This is Representative Charlie Brown, a Democrat, who by the way is author of another bill this session, House Bill 1316, that would create a state medical marijuana program in Indiana. He had some concerns about the integrity of Attorney General Hill.

STATE REPRESENTATIVE CHARLIE BROWN: I absolutely want them to hear me. Listen, Doctor Adams, I appreciate the fact that you know AG Hill personally. I don't know him, I've only shaken his hand once, but it, I get very suspicious that he comes in here, without facts, and walks out the door, and there's a press release out on his testimony here today.

Now, does that indicate that he has an interest in the program, or he's interested in making headlines? Something is remiss, there, and I'll just leave it at that.

DOUG MCVAY: That again was Indiana State Representative Charlie Brown, asking a question of Indiana State Health Commissioner Jerome Adams, at a hearing for House Bill 1438 on syringe exchanges. The measure was passed by the committee with a do-pass recommendation.

And well folks, that's it for this week. Thank you for joining us. You have been listening to Century Of Lies. We're a production of the Drug Truth Network for the Pacifica Foundation Radio Network, on the web at DrugTruth.net. I'm your host Doug McVay, editor of DrugWarFacts.org. Drug Truth Network is on Facebook, please give its page a like. Drug War Facts is on Facebook too, give it a like and share it with friends. You can follow me on Twitter, I'm @DougMcVay and of course also @DrugPolicyFacts.

We'll be back next week with thirty minutes of news and information about the drug war and this Century Of Lies. For now, for the Drug Truth Network, this is Doug McVay saying so long. So long!

For the Drug Truth Network, this is Doug McVay asking you to examine our policy of drug prohibition: the century of lies. Drug Truth Network programs archived at the James A. Baker III Institute for Public Policy.