Only syringe exchange in Lincoln Trail health district is a point of pride for Nelson County, Bardstown newspaper says in editorial

Photo illustration by The Kentucky Enquirer

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This editorial appeared in The Kentucky Standard, Bardstown, on Oct. 25.

Nelson County should take pride in its syringe exchange.

That might sound strange, at first. After all, a community sets up an exchange when it has a problem with substance abuse.

But the truth of the matter is that Kentucky has a substance abuse problem throughout the state. It can be hard for an idyllic historical town such as Bardstown or as bucolic a county as Nelson to admit that such a modern problem as intravenous drug abuse is just under the surface.

But that is just what Nelson County did when it authorized the needle exchange with the Lincoln Trail Health Department, the only one in the eight-county region.

Staff from the health department and the exchange visited Nelson County Fiscal Court recently to provide an update following its first annual report.

One number on that report had caught some attention — the return rate of syringes, which was only 36 percent. That means that for every almost three syringes given out, only one was exchanged. At first blush, that does not come off as good.

But, part of that reason is simple math, as Sara Jo Best, the department’s director, explained to the magistrates.

Only a little more than half of the 96 people who sought out services last year ever came back for a second visit. And the vast majority of substance abusers don’t show up the first time with used needles.

The simple fact is that collecting used syringes is not the primary mission of the exchange. Syringe exchanges are about controlling communicable diseases among a population that is highly susceptible to them. And protecting intravenous substance abusers against hepatitis, HIV and other diseases also shields the wider population, because these diseases are not only transmitted through needles. Part of preventing the spread is taking dirty needles off the streets and out of homes, but that is just one part, and arguably not the most important.

One of the biggest advantages of having a syringe exchange is the ability of public health workers to reach a population that can be hard to find.

And these substance abusers are some of the ones where there lies the most potential to make a difference.

“People who come to a syringe exchange program are fundamentally different than those who are not,” Kentucky Commissioner for Public Health Dr. Jeffrey Howard told The Standard recently. “If you are a substance abuser and you say, ‘I’m going to go to a syringe exchange program and get clean syringes,’ then you have acknowledged there’s something negative to what you’re doing and you’re going to take an action about that negative aspect. So in the psychology of that person, they are further along the addiction recovery pathway than someone who is not. We really need to take advantage of that.”

That’s why Howard said he wants to rebrand “syringe exchanges” into “harm reduction” centers, where substance abusers are linked to services such as testing and health screening and addiction recovery programs.

Best told Fiscal Court that is the approach the local exchange is looking to take. She acknowledged they had identified needed areas for improvement, and had already made some changes. One was finding a disease screening that returned faster results. In its first year, 34 percent of clients were tested for Hep C, but staff hope the faster results will improve that rate.

The number of participants could also improve, especially on the returns. Part of that is building trust with the participants, and some of that will involve time. It also means outreach, as Best said, so that those who need the services know where to find them.

Syringe exchanges in this state are new. While exchanges have been around in more densely populated areas for many years, operating one in a smaller and more rural area brings a host of new issues as well as insights.

But too often, fear of failure or the unknown stops organizations or agencies from trying something new. Those fears could be partly to blame for surrounding counties’ refusal to start their own. But if they think turning a blind eye will make the problem go away, they are wrong.

At least here in Nelson, we have acknowledged the problem, and after a year we understand it better. That goes a long way toward dealing with it.