Needle exchange marches on after getting the boot

• Only 2 other exchanges in Ohio; Cleveland has had one for 20 years, Portsmouth's program is new
• 51 people participated in the Cincinnati Exchange in its 7 weeks in Springdale
• Nearly all were fully employed and a quarter asked for info about treatment
• Cincinnati Exchange will continue talking to leaders in neighboring counties and states

A dirty syringe for a clean one.

In Hamilton County, the very idea has created a firestorm.

After getting the state's third needle exchange program underway – more than two decades after efforts began – Cincinnati Exchange is without a home, its mobile van indefinitely mothballed, booted from the city of Springdale and facing the ire of leaders in a dozen other communities.

Now, lines are being drawn in Lower Price Hill, Deer Park, Mariemont, Sharonville and elsewhere even as state legislators are considering making it easier for the creation of such programs.

The disputes come as an unprecedented and well-documented heroin problem, coupled with abuse of prescription opiates, has contributed to sharp increases in hepatitis C and HIV infections in the region.

Supporters contend needle exchange programs prevent the spread of hepatitis C and HIV among drug users while also protecting members of the public – including children, police, firefighters, trash collectors and others – from the dangers represented by a discarded needle. Prevention would also save society money, they say, reducing the cost for the treatment of those infected.

Opponents say a needle exchange operation casts a negative light on a community, is bad for nearby businesses and unpopular with residents. They fear the presence of a needle exchange would attract more drug use and drug dealers to their neighborhoods and send a message that such behaviors are acceptable.

But program leaders here vow not to give up and hope to one day offer the exchange in the region.

They're in discussions with a few communities, including a church in Mount Auburn and a group in Northside.

How did the needle exchange get here in the first place?

In Ohio, a needle exchange program can be created if a board of health declares an emergency need and with permission from the local police.

They exist all over the country, are supported by the White House and most public health officials, but only two exist in Ohio: a 20-year-old program in Cleveland and a new one in Portsmouth.

The Cincinnati Board of Health made its declaration in February 2012, but then Police Chief James Craig and then City Manager Milton Dohoney were against the idea so it could not proceed, said Ann Barnum, senior program officer for Interact for Health, which funds the operation.

Chief Jeffrey Blackwell, who took over as police chief in late September, is supportive of syringe exchanges, Barnum said, and is checking with the city solicitor's office to determine if Cincinnati's municipal code will allow the program.

But not everyone is on board.

The Hamilton County Board of Health heard a presentation last summer but said it wanted to research the topic more and has not called for a vote, Barnum said.

And a group of community leaders recently signed a letter sent to Gov. John Kasich and the Hamilton County commissioners, penned by Deer Park Councilman Charles Tassell, sharing fears that include legal liabilities if someone overdoses with a needle from a program allowed by a municipality.

In Springdale, officials of its board of health, city council and police department agreed to host the program. The mobile center rolled into the parking lot of a strip mall on Northland Boulevard for four hours twice a week.

Seven weeks later, city leaders reversed their support and asked it to leave.

Cincinnati Exchange has engaged every other board of health in Hamilton County, Barnum said, and will continue to look for welcoming communities.

"Our intention was never to have it only operate in one community," Barnum said.

The program is being paid for with a $50,000 grant from Interact for Health, a nonprofit formerly known as the Health Foundation of Greater Cincinnati. That amount could operate the program for about six months.

By comparison, the estimated lifetime treatment cost for one HIV-infected individual is $379,668, according to the Centers for Disease Control and Prevention, which supports needle exchange programs.

What happened in Springdale, Lower Price Hill?

Springdale Mayor Doyle Webster and a majority of city council members agreed last summer to allow Cincinnati Exchange in their community, but public outcry from nearby residents and businesses led city council to change its tune – despite the police department reporting no problems or arrests related to the program.

Webster said council was initially "spellbound" by public health officials' presentations about the heroin and prescription drug problem and how a needle exchange program might help.

"I changed my mind. I can admit that I made a huge mistake," Webster said at the March 19 meeting where council reversed its support of the program. "I completely underestimated the stigma that's attached to this program and I apologized to this community for that mistake."

Cincinnati Exchange then looked to Lower Price Hill, where it seems the community is split on the issue.

Eileen Gallagher, Lower Price Hill Community Council member and treasurer, said the group is not welcome and is unneeded.

Several residents disagree, including former council President Jim Gooding.

"There are some people that just can't get past admitting that there is a problem here, and that is not exclusive to Lower Price Hill," Gooding said. "To turn away and pretend like it doesn't exist will not take care of this problem."

Gooding said he used to organize cleanups with help from a group of Elder High School students.

"The needle problems got so bad ... we had to suspend the cleanup efforts because it was too risky," Gooding said.

Hepatitis C can live on the tip of a needle for more than two weeks, Barnum said.

Her group hasn't given up on bringing the van to Lower Price Hill once a week, as they'd hoped, but will not press the issue if they don't get approval from the majority of the residents.

They are also talking to communities outside of Hamilton County and in Northern Kentucky.

Exchange participants grateful, coming more often

Cincinnati Exchange Program Director Libby Harrison said it's too bad the plug was pulled in Springdale because the program was just starting to see more participants, more frequently.

"I feel terrible," Harrison said. "I fear for their health, for their lives."

Fifty-one people, all white, participated in the first seven weeks, Harrison said. Eighty percent were men; the median age was 32. One person came seven times, most came once or just a few times.

Mostly, they came from around Springdale, its neighboring communities and parts of Butler County. A couple of individuals drove up from Over-the-Rhine.

Nearly all were employed, mostly full-time, Harrison said, and each agreed to never bring drugs with them, engage in drug use or buy drugs anywhere near the exchange location.

A quarter of them asked for information on getting addiction treatment, Harrison said.

Cincinnati Exchange also offered free HIV, hepatitis C and pregnancy testing. If desired, staff could provide participants with a dose of Narcan, a drug that revives someone who is overdosing by blocking opioid receptors in the brain and forcing immediate withdrawal.

They always require a one-for-one needle exchange.

Former heroin addict Ronald Haynes was looking forward to volunteering with the needle exchange, hoping he could keep at least one person from his reality. Haynes has HIV and hepatitis C, both believed to have been transmitted from a dirty needle.

"We simply want to give (addicts) the opportunity, that if they decide to get sober, they don't have to carry around the baggage of these diseases, which changes your life and makes things that much harder," said Haynes, who has been sober since 2005.

At the very least, Haynes said, the program shows addicts that someone cares about them and that, he said, can mean the difference in saving someone's life. ■

Hepatitis C and HIV on the rise in Hamilton County

The total number of cases of hepatitis C in Hamilton County rose from 721 in 2009 to 1,136 in 2013, a 58 percent increase.

The rate of HIV, 288.6 cases per 100,000 residents in 2011, is also up over 50 percent from 191 cases in 2007, the most recent data available.

Source: Hamilton County Public Health