In 2015, Austin, Indiana faced one of the worst plagues to ravage the rural America in years. The disease? HIV. In the years leading up to the outbreak, two signals were starting to crop up in patients across the state. Scott County in Austin was seeing some of the highest rates of hepatitis C in the state along with a rise in intravenous opioid and methamphetamine drug usage. By the time health officials could organize an adequate response, the total number of cases had peaked at a little over 200 confirmed instances of HIV. The ratio of infections was only slightly lower than some countries in Africa.
Lee County is one of 54 counties in Kentucky that has recently been named by the Centers for Disease Control for being at risk for a similar outbreak. Wolfe County nearby has been named the number one most likely to become the next Austin. The Appalachian region has been one of the hardest hit regions in the country when it comes to opioid addiction, doctor shortages, and economic despair. Of the 54 counties at risk in Kentucky, 33 are lacking needle exchange programs where addicts can use clean needles to safely inject and get referrals for treatment centers.
To figure out which cities and counties were most at risk, researchers at the Centers for Disease Control looked at figures such as overdose deaths, injection rates, income, unemployment, and more. From there they created a statistical sample of possible locations most at risk. 2015 saw a 4% rise in total national cases of HIV. In Wolfe County, the number one most likely candidate in the nation, per-person income is less than half the national average with more than 30% of residents living in poverty.
HIV in Kentucky
From the period of 2008-2015, Kentucky became the state with the nation’s highest rate of new Hep C infections, over 1000. In one study by University of Kentucky researcher Jennifer Havens, data revealed that most users who start shooting up are likely to contract Hepatitis C within a year. Scientists from the Centers for Disease Control have reached out to high risk counties and cities to give them a warning about the possible spread of HIV looming on the horizon. The most high risk states, Kentucky, Tennessee, and West Virginia, would argue that their doing the best they can, but critics think they can do better.
The lack of availability and public support for needle exchange programs makes the likelihood of an outbreak all the more threatening. Public health officials have advocated for their implementation, but voters and lawmakers can have difficulty overcoming the bias of allowing drug users to openly inject with taxpayer money. Tennessee recently approved $1.4 million a year to boost HIV and Hepatitis C testing, and also received an additional $250,000 from the Centers for Disease Control to help track new cases.
In 2016, the state health department for Kentucky helped by giving free HIV test kits to local healthcare entities and donated over $450,000 for HIV testing and prevention, plus another $46,000 for Hepatitis C. The state also received funding support from the CDC to the tune of $50,000 to go towards testing. 2016 to 2017 saw one of the sharpest increases in HIV cases in the last three decades for Kentucky, causing alarms to sound off for healthcare officials, citizens, and lawmakers.
Healthcare officials are encouraging these high risk areas to implement safe injection sites for addicts, but progress has been slow in actually getting these facilities off the ground. More resources and public education could help get these facilities going which would ideally lead to a decline in overdoses, HIV cases, reduced healthcare costs, and more referrals to get addicts the treatment they need.
Pros of Safe Injection Sites
Proponents of safe injection sites say that you can’t force people to stop taking drugs, whether that be through criminalizing possession, harsh consequences, or simply telling them to stop. Therefore, it’s best to offer drug users a safe way to inject these drugs and minimize their risk of contracting a disease or overdosing. It humanizes drug addicts and provides an alternative to the “War on Drugs” mentality.
Unfortunately, while the majority of SCF’s are located in Europe, we have a dearth of knowledge when it comes to how effective these facilities are. The biggest studies we have come from facilities in Vancouver, Canada, and Sydney, Australia. Based on collected evidence gathered from studies over the past twenty years, there are a number of measurable benefits to these programs along with more nebulous statistics that will require better research methodologies for future implementation.
Data compiled from Philadelphia based report on Supervised Consumption Facilities from December 2017 and data from the Massachusetts Task Force on Opioid Therapy and Physician Communication published in April of 2017.
Reduction in number of overdose deaths
Multiple studies of supervised consumption facilities (SCF’s) show that they reduce the number of fatal overdoses in their regions. For example, in a study on an SCF facility in Vancouver, Canada researchers documented a 35% reduction in mortality within 500 meters of the facility within three years of opening. Another study in Spain showed that overdose deaths were halved from 1991 to 2008. A similar study in Sydney, Australia showed that ambulance calls for opioid-related overdoses decreased by 68% during the times the facility was open.
Reduction in unsafe injection practices
There is no evidence that the total number of HIV infections in the area is reduced. However, evidence from both the SCF’s in Vancouver and Sydney have shown a reduction in the number of new HIV infections. This is because in all locations the facilities are only able to serve a small percentage of the population. In Vancouver, researchers estimated that the clinic prevented more than 80 HIV infections annually, resulting in annual savings of about $13.7 million in HIV medical care. Evidence from Spain showed a reduction in new HIV infections from 19% to 8.2% from 2004 to 2008. In 45 studies carried out in Europe, the majority showed a positive relationship between SCF’s and HIV prevention. Currently, the mortality rate for intravenous drug users is eight times higher than the rest of the population. By reducing the risk of overdose and risk of infection, this number could be lowered. Plus all, studies have shown that attendees significantly reduce their engagement in unsafe injection methods.
Reduced Healthcare Costs
There have been no definitive studies on the exact relationship between health care cost savings associated with SCF’s, but multiple theoretical studies by cities have predicted considerable savings based on mathematical models. In Vancouver, the savings were estimated at $13.7 million annually. Proposals in Philadelphia, Maryland, and San Francisco all predict cost savings returns from SCFs.
Increase in Treatment Referrals
In Vancouver, the Safe Consumption Facility was associated with increased rates of referral to addiction care centers, increased detox facility referrals, and more methadone clinic referrals. Enrollment in all of these facilities raised by an average of 30%. In Vancouver, studies found that there was no statistically significant increase or decrease in the number of local people injecting drugs. In other words, the sites don’t decrease or increase the number of addicts, but they do get more people in treatment.
Operation UNITE stands for Unlawful Narcotics Investigations, Treatment, and Education. The organization was originally launched in 2003 in response to the growing opioid problem in the Appalachian region. The organization is 501c3 non profit that approaches the opioid problem with three prongs: Purpose, to create hope and change the culture. Vision, to reduce the abuse of drugs and facilitate recovery. Mission, to create strategic partnerships, provide leadership, promote education, coordinate treatment, and support law enforcement.
One of the programs the Operation UNITE puts on is the Shoot Hoops Not Drugs basketball skills camp available for youth through the summer. The camp is a fun way for kids learn how to play basketball while interacting with positive role models like Jared Polson, an all star former point guard for the University of Kentucky. Polson says about the program:
"I love basketball but I believe it has so many parallels with life. Work ethic, character development. It's fun to teach kids about basketball but you realize oh wait, this really has to do with real life. It's the shoot hoops not drugs prevention program but really more importantly trying to tell the kids they have a purpose in life and drugs and alcohol can take away that purpose."
SPARK is a christian organization in Kentucky that stands for Special People Advocating Recovery in Kentucky. SPARK Ministries was started to help local communities heal from the destruction of drug addiction and crime. The program is aimed to address four main components of the addiction epidemic. This includes the lives taken by drug overdose, the increase in incarceration and unemployment rate, the shattered family structures left behind, and the loss of spirituality and church attendance.
SPARK hosts recovery meetings as well as private meetings and interventions for those who need help with an addiction or addicted friend or relative. They also spread awareness on Casey’s Law in Kentucky and provide volunteer and mentoring opportunities. SPARK also hosts a 24/7 365 phone line for people to call trained specialists who can help walk addicts through finding inner strength, staying sober, and finding treatment options such as inpatient treatment centers, outpatient and detox programs.
What to Know About Infections from IV Drug Use
Intravenous drug use is one of the most dangerous ways that a user can get high from illicit substances. This is because any unclean needle or syringe can potentially push a bacterial contaminant past the skin membrane and inject directly into the bloodstream, practically guaranteeing that an infection will occur. There are all sorts of dangerous infections that can occur from injecting unclean needles.
Staph infections are one of the more common infections to occur from intravenous drug use. This type of infection looks like a bump or bug bite, but could potentially become much more harmful. If the staph is not treated quickly, it may spread to the lungs, and cause serious damage to the lungs and chest. It is treatable with antibiotics.
This is a viral infection that is easily spread and difficult to diagnose. 80% of people who carry this disease show no symptoms. It quickly spreads through sexual intercourse and sharing needles, and some signs include fatigue, itchy skin, sore muscles, dark urine, and pain. This disease affects the liver and can induce bleeding and jaundice.
HIV (known as human immunodeficiency virus) can lead to chronic autoimmune disease, or AIDS. The primary symptoms are flu like at first, with nausea, fever, vomiting, chills, sore throat, diarrhea, and body aches. As it progresses, the disease becomes more distinguishable and may result in oral thrush, shingles, weight loss, and memory loss among other symptoms. The progression of HIV varies from person to person. Someone may be asymptomatic for as long as 10 years.
Abscesses are recognizable by the large, pus filled masses they create on sufferers. These masses contain bacteria, pus, and debris. It can be accompanied by fever symptoms. Abscesses generally require a physician to drain and properly treat with antibiotics and care.
Symptoms of this common skin infection include red streaking of the skin, pain, swelling, tenderness, swollen lymph nodes, leakage of yellow fluid from blisters and fever. Treatments for cellulitis include oral antibiotics and elevation of the affected areas. Severe cellulitis may require a hospital admission for intravenous antibiotics.
This is a flesh eating disease that can occur from infection. Necrotizing of the flesh can occur suddenly, within 24 hours of first coming into contact with the bacteria. Skin becomes red and swollen to the touch, with fever, nausea and chills accompanying. Skin blackens and becomes gangrenous. Infections spreads to major organs and can become fatal if not treated quickly and properly through antibiotics, surgery, and oxygen therapy.
If you are seeking a drug and alcohol rehabilitation center, contact Landmark Recovery today. At Landmark Recovery, we are committed to offering high-quality treatment in an environment based off of trust, treatment, and intervention. With treatment programs catered to individuals needs, we are passionate about finding what works best for you as you begin your road to recovery and happier life. When you are ready to learn about what's an intervention or even the process of inpatient rehab, call one of our dedicated admissions consultants. Our staff is a team of passionate, authentic, and courageous individuals who are uncompromising in our pursuit of excellence. Start living the life you dreamed, and begin recovery at Landmark today!