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Health board shoots down SSP

BY Katharine Calabro - kcalabro@perutribune.com

The Miami County Board of Health held a meeting Tuesday evening to discuss and examine harm reduction through the utilization of a syringe service program.


Presenting to the board was Systems of Care Governance Coalition Systems Coordinator Antonia Sawyer, who explained the goals of the SSP.


“The goals of the SSP are to reduce the health consequence of IV drug use within the community, to reduce the financial consequence of IV drug use, and to reduce community consequence in general,” Sawyer said.


She also stated SSPs have been studied over the past 30 years by the Centers for Disease Control and Prevention, and the program aims to provide sterile syringes and other equipment to people who inject drugs.


According to the Indiana State Department of Health, a community must identify three components before they can implement an SSP. The first component is to show an epidemic of Hepatitis C, Hepatitis B or human immunodeficiency virus (HIV).


Sawyer stated there has been a 178.9 percent increase in overall chronic Hepatitis C in four years, excluding the Indiana Department of Corrections. She also said there has been an increase in HIV over the last four years, totaling 11 total Miami County cases from 2015-2016.


“25 percent of HIV and AIDS cases will become a co-diagnosis of Hepatitis,” she said. “According to the CDC, 75 percent of that co-diagnosis population is due to IV drug use.”


The second component, according to the ISDH, is determining the epidemic is directly related to IV drug use.


While Sawyer recognizes the IDOC can skew some results, she was able to find data dealing with the increase in drug use prior to incarceration.


“Between 2014 and 2016, there was a 50 percent increase in IV drug use, prior to incarceration,” she said. “Meaning 36 of the 73 cases of Hepatitis that are currently at the correctional facility between 2014-016 were due to IV drug use.”


The last component the ISDH needs is to determine the SSP is part of a comprehensive public health response, an issue Sawyer explained the community has been working towards.


“I’m on a grant from the division of mental health and addictions, who will have invested over a $150,000 in this community,” she said.


She also stated the YMCA received an $800,000 block grant over four years to be able to attack primary prevention measures within the community, and the United Way has also invested nearly $13,000 to focus on the opioid epidemic.


In total, nearly $1 million has been pledged to focus on drug abuse in the community.


In order for Sawyer to start the process of getting an SSP, the Public Health Officer Dr. Rafik Farag must write a declaration proving the county has an epidemic. Farag said he doesn’t think Miami County has as big as a drug problem as other counties in the state.


“Where is the biggest focus of these drugs?,” he asked. “In Marion. The number we have here is 90 including the correctional facility, which makes half of that.”


He also brought up issues that could arise if there were to be an SSP, including the size of the health dept.


“We have very limited personnel working, we only have one nurse,” he said.”The program is fine if it works, but how come we are still getting an increased number of people on drugs?”


According to Sawyer, the SSP has only been legal in Indiana for three years, in which eight out of 92 counties participate.


Farag said he is also convinced an SSP will only make the drug problem worse if brought into the county.


“This means that people who want the needle will come to Miami County from outside to get the needle,” he said.


Because there are only eight counties that offer the SSP,  Sawyer said there is only the more reason to acquire this resource.


“If people are coming from different counties to get resources, wound care, hepatitis testing and clean syringes--they need help,” she said. “They are accessing something that is so limited. If there were only eight wells of water, would you want them to turn you away if you were thirsty?”

She explained some benefits from an SSP include the reduction the of Hepatitis C virus, the ability to provide access to the supplies needed to prevent Hepatitis C, to provide education to users on why they shouldn’t share or reuse syringes or improperly dispose of them, a decrease in the tax burden to the community and opportunity to shift to a progressive and proactive responsive mindset.

The proposed program would be given nine months till the opening, and woudl be set up to last two years.


In order for IV users to receive sterile syringes, they must return the products back to the Health Department. While Sawyer suggested the SSP program will help reduce Hepatitis and IV drug use, Farag questioned if the program would have the intended results.


“Any person who knows that he is injected the poison inside his own body, every day, do you think he knows the responsibility to come back and say, ‘hey, I used that needle, give me a clean one,’” he asked. “90 percent of them don’t even know what they are doing.”


A decision on the program was tabled because Farag did not agree that Miami County is in an epidemic. He did say that, when it becomes an issue, he will write one.


Sawyer still has the support from the governor, SOC, individual agencies and Mayor Gabe Greer. 


She said Tuesday's meeting was only the beginning.


“We aren’t going to give up. I am going to keep pressing for this because it’s not going anywhere,” she said. “This is nearly part of the process and SOC has done what they can and provided the data that they can. It’s ultimately the health officer’s decision on how he protects community health."