Kentucky Q&A on Syringe Exchange Programs

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In early 2015 Kentucky shocked the nation by becoming the first Southern state to officially legalize syringe exchange programs. Since then the news has covered the successful roll-out of a couple different syringe exchange programs through local health departments, but has also reported some backlash coming from the legislature. I caught up with Wayne Crabtree at Louisville Metro Public Health and Wellness, who oversees the Louisville syringe exchange, to get the scoop on how the new program is going.

TC: What advice would you offer other communities looking to start syringe exchange programs?

WC: The most important lesson we learned is to involve community allies, churches, HIV/AIDS programs, social services programs, universities, health departments, police, pharmacists, and other community members. Get them into process of establishing the program so they feel ownership of it. It's also important to educate police on how it benefits them not to charge people for possession of syringes.

TC: How has the media responded to the program?

WC: About 99% of the media coverage we've gotten has been positive, which is key to helping show skeptics that syringe exchange is beneficial to the whole community. On our grand opening day we allowed the media to come in and see the site before it became available to the public. They weren't allowed to take pictures while the program was operating of course because that would deter people from participating.

TC: What services besides clean syringes and injection equipment does the program offer?

WC: We provide referrals for drug treatment, case management, HIV testing and education, and hepatitis C testing education or referrals. We also distribute naloxone and overdose prevention educational materials. We dispose of used needles that people bring back through a contract with the public health department for waste disposal. So far we've seen about 1450 people and passed out 128,000 syringes since June 10th 2015.

TC: Any logistical challenges you didn't expect?

WC: Staffing has been a challenge. We hired a Certified Alcohol and Drug Counselor and a Health Educator to staff the site, but when they go on vacation or take sick days it can be difficult to find coverage. We make sure to have two staff at the site at all times. We also contracted with Volunteers of America - MidWest to run our community sites. One site opened in October and we have another ready to start before the end of the year.

TC: The media has reported that there has been some backlash at the Kentucky legislature over your policy of exchanging syringes based on need, as opposed to a one-for-one exchange. How have you responded?

WC: We know from evidence at other exchanges that needs-based exchange is the most effective public health intervention. When you have a one-for-one exchange policy, if three people are sharing a syringe and they bring it to the exchange for a clean one, they are still sharing the syringe. We have to get enough syringes into the community so that people are no longer sharing - that is the whole purpose of the program. Even without a one-for-one policy most programs eventually collect about the same amount that they distribute once the community starts to trust the program and trust that law enforcement will not pull them over or charge them for syringes that they are trying to take back to the exchange. We have seen our distribution-to-collection ratio improve a lot in the past few months as community trust builds.

TC: What have you found to be the biggest benefits of syringe exchange programs?

WC: Syringe exchange programs are an entry point into the health care system for people who have long been outside that system. We also know that participants in syringe exchange programs are five times more likely that non-participants to enter drug treatment. These programs are about much more than just exchanging syringes. They offer a wide range of services to people who didn't have access to those services before.