Mound Park has been plagued by growing opiate use in their area, where their lawns and parks have recently become a haven for drug users and a dumping space for used needles. This situation led to the creation of the needle exchange program in 2011 by the Health Department. Within one year, the area went from cluttered with needles to relatively needle free.
Since then, the needle exchange program has continued to grow as more individuals become addicted to opiates. Last year the Portsmouth program exchanged over eighty-five thousand needles-enough to provide four needles to every adult and child in the area.
This is not the only site that resides in Ohio State, either. The first was created in Cleveland in 1995 to meet the needs of a growing opiate epidemic. Now, there are five needle exchanges across the state with more planned. These responses come not just from discarded needles, but from the obvious need of users, as the death toll from opiate overdose deaths climbs.
Bobbi Bratchett, the rural AIDS coordinator in Mound Park says that there may be opposition to the program, but that others should remember what it has done for the community.
“I call it the good-bad program. It is good that we have it, but bad that we have to have it. But, that’s the reality,” Bobbi stated.
Portsmouth is located in Scioto County, where drug overdoses have been increasing rapidly. Additionally, Portsmouth has been at the top of a growing list of areas with high rates of Hepatitis C. Their rates were 556.5 cases per every 100,000 people, with other areas reporting far less infection.
Hepatitis C is commonly transmitted through intravenous drug use, as is HIV. While HIV rates have stayed relatively stable across Ohio, rates of Hepatitis C have grown 400% in four years. This is not just a public health crisis, as the cost of treating a single case of Hepatitis C can be upwards of $100,000. In 2015 alone, there were over 51,000 people with Hepatitis C who were receiving treatment covered by Medicaid.
This issue was reported as a public health emergency in January of 2011. This was what spearheaded the needle exchange program in Portsmouth, with the clinic running off of donations from private and public sectors. While this program was getting off the ground, Bratchett learned that the program was being watched closely to see the effect on the rural area.
This is due to the lack of needle exchanges in rural areas, with only 204 across the entire United States. The CDC has released information showing that most needle exchanges are located in urban areas and are not meeting the needs of rural residents. At least half of intravenous drug users reside in rural and suburban areas. The CDC released recommendations stating that these areas should consider needle exchange programs to lesson rates of HIV and Hepatitis C transmission.
In Portsmouth, the process went quickly and smoothly, which is unusual for most needle exchanges. Political pressure and community concerns about exchanges usually halt the process, as officials and residents worry about the ways that such programs enable the continuation of drug use. Although Bratchett was surprised by the quick process, she believes that part of it was the awareness of the community regarding the opiate crisis.
“We were willing to tear off the Band-Aid to clearly show the wound underneath. That helped us to get the help we needed,” Bratchett said.
Cincinnati attempted to follow in Portsmouth’s footsteps with their own needle exchange program, but the process was not as smooth. While a state of emergency was declared by the Cincinnati Board of Health in 2015, there was local opposition from the police chief. This halted the programs creation until the fall of 2013.
Even after it was started, there were struggles. Communities resisted visits from their mobile clinic as opponents worried about their community’s reputation. There were concerns that a mobile needle exchange would attract more drug users to their neighborhood and send a message to youth that drug use was acceptable.
Even with the opposition, the Cincinnati Exchange Project is now operating across four sites and serves more than 700 people across the area. There are hopes that recent federal and state law changes could make this process easier for other exchanges.
The Ohio budget included language that removed the requirement that health departments had to declare an emergency before programs could start. While programs still have to consult with officials and communities, this change will cut through a level of red tape. Additionally, it removes fears that changes within the community could lead to a declaration of emergency being removed with clinics being shut down.
Nationally, Congress recently used the federal budget to remove the ban on using federal tax dollars to fund needle exchange programs. The only exception is that programs cannot use federal funds to purchase needles. This change is crucial for continued growth around the country and in Ohio, as money for these programs is often hard to come by.
This shift in the political attitude has come as the typical users have changed. There are no more white children from affluent neighborhoods being affected by the opiate epidemic. In addition, the change has come after a recent outbreak of HIV in small counties. There is a need for clean needles to attempt to stem the growing tide of HIV and Hepatitis C.
“There is no quick fix to this problem. It is going to take a long time but we are moving in the right direction,” Bratchett said.