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Hepatitis C Cases on Rise in Northern Kentucky as Needle Exchange Debate Continues

Cases of hepatitis C are on the rise in Northern Kentucky, particularly in the River Cities, and the region continues to debate the necessity and potential location of needle exchange/syringe access programs.

"My concern is, if we are not with a needle exchange, (we will have) an outbreak of a disease that will destroy a community," said Garrin Colvin, the CEO of St. Elizabeth Healthcare. Colvin appeared alongside the chiefs of Newport's fire and police departments, Campbell County Judge/Executive Steve Pendery, and an official from the Northern Kentucky Health Department, at a panel discussion about heroin hosted by the Newport Business Association on Wednesday morning.

The spike in hepatitis C cases appears to be related to the sharing of needles by intravenous drug users.

"It's absolutely necessary," Colvin said of a needle exchange program, or syringe access program, as the Northern Kentucky Health Department calls it. The potential spread of disease is cause for concern, he said, but so is the cost to treat patients who contract hepatitis C or B, or HIV. "It's $90,000 for hep C treatment and typically you only get one crack at it," the leader of Northern Kentucky's largest hospital network said. He noted that HIV treatment is even costlier over a patient's lifetime at $600,000. "And that's only a pill a day."

St. Elizabeth has openly supported the needle exchange proposal. In 2015, state law allowed for the creation of such a program with various levels of approval required: First, the local board of health must approve the measure, followed by the county government and city government where the program would operate. In the Northern Kentucky Health District, which includes Boone, Kenton, Campbell, and Grant Counties, there is one needle exchange program operating, in Williamstown where the city and Grant County voted to allow it, following the lead of the board of health.

Boone County voted down the proposal.

Kenton County and the City of Covington adopted an ordinance allowing a program to operate on the condition that 3 of the 4 health district counties join them. A mobile unit would operate at St. Elizabeth's Covington campus for a limited number of hours each week, though the health department and St. Elizabeth supported a plan that would have placed the exchange at the health department's Covington office at 20th Street and Madison Avenue. 

Running the program at the health department's office is more cost efficient and provides access to other important health care opportunities, said Stephanie Vogel, director of population health at the Northern Kentucky Health Department. "It offers a lot of the services that participants in the program need to be engaging in," she said. The department's offices offer access to laboratories on site and electronic medical records. "We can utilize our existing staff in that model as well."

Though Grant County uses that model successfully, Vogel said, Covington and Kenton County officials objected to placing the program at 20th and Madison due to residents' concerns.

In Newport, there are similar concerns. The debate has centered around whether such a program should operate at the health department's office inside the Campbell County Administration Building at 11th and Monmouth Streets or possibly at St. Elizabeth's Ft. Thomas campus. 

"When people are dying, you look to science," said Pendery, who supports placing the program at the building where his own office is located. "The experts have a well-developed information base on needle exchanges. Needle exchange is not enabling. It is an effective way to knock down the incidents of blood-borne diseases. They are safe, and not dangerous to a neighborhood. That's worn out with the statistics available and the evidence available for needle exchanges that have popped up around Kentucky already.

"It saves an incredible amount of money."

Campbell County Commissioner Charlie Coleman disagreed, and the argument between Pendery and him at multiple fiscal court meetings showed up at Wednesday's forum when Coleman expressed concern about placing the exchange program at the county building, which is just blocks from an elementary school. "What about the children of Newport?," Coleman asked. 

"We have rights and responsibilities that we implement for our participants," Vogel told Coleman. Those include not using heroin on the county's property and not engaging in behavior that puts the program at risk. "Seventy people have come through the program at Grant County and we have not had an issue with that. We provide them with a sharps container so they are able to get into a protected spot, so they are not being improperly discarded."

"Let me see if I understand," Coleman shot back. "You're going to tell them that they can't shoot up at 11th and Monmouth and not near an elementary school and you think they are going to listen to that? If they were responsible, they wouldn't be heroin addicts."

"Before we accepted the health department into our building, we had community people telling us some of these same things," Pendery said. "You're within a block of an elementary school, how can you expose them to the type of clientele that they have at a health department? And we have not had a problem. If we had a problem, we would do something about it. We don't expect to have a problem based on the experience around the country."

Campbell County has given its approval to a needle exchange program but has so far not found a city partner, with Newport or Ft. Thomas being the likely candidates. 

In the meantime, as the politics of the situation play out, hep C cases continue to rise in the region. Colvin said that Northern Kentucky has twenty times the national average of hepatitis C cases, and with just ten percent of the state's population, Northern Kentucky has fifty percent of all new hepatitis C cases in the Commonwealth. In Covington, Newport, and Dayton, the number of hepatitis C cases now ranges between 1,699 and 3,438 people per 100,000 population. 

In Scott County, Indiana, where an HIV outbreak forced the state to amend its ban on needle exchanges, a program was extended for a year last spring as officials saw it as helpful in combating the outbreak.

The conversation about needle exchanges in the region continues on Thursday evening when the Northern Kentucky Health Department hosts an open house on the subject at its Newport office (1098 Monmouth Street) from 5:30 to 7:30 p.m.

Written by Michael Monks, editor & publisher