The alarm bells started to sound five years ago when public health officials in northern Kentucky noticed a dramatic increase in the rates of individuals who contracted Hepatitis C from sharing used needles to inject heroin.
Then local emergency rooms saw more heroin-related overdose patients while police reported more crimes connected to heroin use.
Soon drug treatment centers saw a surge in clients seeking help with heroin addiction, and pediatricians noted a rise in the number of babies suffering the effects of being born to drug-addicted mothers.
Community leaders in Boone, Campbell, Grant, and Kenton Counties realized that their region was at the epicenter of a heroin epidemic that touched a range of demographic and socio-economic groups.
“It really transcends all of our communities,” says Dr. Lynne Saddler, “and I think that that’s what has helped folks come together to address this as a community.”
Saddler is district director of health at the Northern Kentucky Health Department in Edgewood. She appeared on KET’s Connections to discuss the drug problem in the region and her department’s efforts to combat the public health crisis. The conversation is part of KET’s year-long initiative, Inside Opioid Addiction.
Heroin is a cheap and readily available opioid that provides a potent high to users who inject, inhale, or smoke the drug. Saddler says many people become addicted to heroin after having taken a prescription painkiller for a sports-related injury or some other medical issue. But she says those with a substance use disorder, especially younger individuals, often have other underlying problems that lead them to turn to drugs.
“There may be some unresolved issues that they really need some mental health counseling and constructive ways of dealing with the issue rather than self-medicating with things that take them down the path to heroin,” Saddler says.
Those issues may be personal or they may reflect larger societal changes. Saddler says the rise of smart phones and social media have come at the expense of face-to-face interactions that can help young people develop resilience and deeper connections to their communities.
Arresting the Spread of Blood-borne Diseases
After five years, the heroin epidemic has taken a significant toll on northern Kentucky. St. Elizabeth Healthcare reports that its emergency departments in the region have seen heroin overdose patients rise from 252 in 2011 to nearly 1,200 in 2015. Intravenous injection of heroin has also led to a spread of Hepatitis B and C as well as HIV among users in northern Kentucky. In 2014 alone, the region had one of the highest rates of Hepatitis C infections in the country, with a case rate of 10.9 per 100,000 people, compared to a national rate of 0.55 per 100,000.
“Our Hepatitis C rates continue to increase, however our HIV rates to this point have remained relatively stable,” Saddler says. “So if there’s any good news in any of this it’s that we are in that window of opportunity to prevent the HIV epidemic from happening here.”
Austin, Ind., saw a dramatic increase in HIV cases among intravenous drug users in the small town about 40 miles north of Louisville. In 2015 the state granted the community special permission to implement a needle exchange program in hopes of slowing the spread of the virus.
Kentucky lawmakers approved legislation in 2015 that allows local communities to decide whether they want to offer syringe exchanges. In her area, Saddler says Grant County launched an exchange about a month ago, and she says an exchange has been approved for Kenton County, though it is not yet operational.
The Northern Kentucky Health Department has faced opposition to the program from critics who contend that the exchanges facilitate drug use. Saddler says the evidence on the issue is clear.
“Having a clean [needle] doesn’t encourage drug use, doesn’t increase drug use,” Saddler says. “The nature of a substance use disorder, which is a chronic disease, is they’re going to continue to use whether they have clean or used needles.”
Another point of debate over the programs is whether users should only receive as many clean needles as dirty ones they surrender. Saddler says the Covington program will be a one-to-one exchange, while the Grant County program does not have that requirement. She contends the programs are meant to help slow the spread of blood-borne diseases so the more clean needles in circulation the better. She adds that the exchanges also protect citizens and first responders from the dangers of dirty needles left in public spaces.
When users visit a needle exchange program, Saddler says they are instructed how to protect themselves and others from transmitting Hepatitis and HIV. As participants become comfortable with the exchange process, Saddler says counselors are able to discuss treatment options with the users. Statistics indicate that needle-exchange clients are five times more likely to enter treatment and recovery programs.
“I think it’s an important touch-point with the health care system that many of them do not have, other than overdosing and ending up in the emergency room,” Saddler says. “So it’s about that non-judgment relationship that helps them believe in themselves enough to take that next step.”
Medically Assisted Treatment
In addition to combating the spread of infectious disease related to IV drug use, Saddler’s agency is helping to coordinate a regional coalition of citizens, health professionals, and public officials through the Northern Kentucky Heroin Impact Response Task Force. The department is also exploring treatment options for pregnant women with a substance abuse problem. The babies born to those mothers can suffer from neonatal abstinence syndrome from having been exposed to opiate drugs while in the womb. Saddler says that population of children many need special medical, behavioral, and developmental services as they age.
Saddler says she supports medically assisted treatment programs for those with an addiction. That combines counseling with medications to help an addict overcome the physical aspects of a chemical dependency. Some policymakers favor 12-step or abstinence models of treatment, but Saddler says medically assisted approaches significantly increase the chances of long-term recovery.
“You’re not going to go into a 28-day program and come out and be miraculously cured [in most cases],” Saddler says. “This is such a complex disease, there’s no one cookie-cutter approach and each person will need to have a treatment plan and recovery plan individualized to their particular situation.”
Saddler says it’s important for civic leaders and public health officials to invest in more prevention and treatment options for northern Kentucky, not just for the current epidemic but for the future as well. She says addiction problems cycle through different substances, so today’s heroin crisis will likely evolve to different drugs in the coming years.
Regardless of the particular substance that may hold a user in its grip, Saddler says there’s always hope for recovery
“You’re never too far gone,” says Saddler. “All of us as humans have that capacity to change, all of us have that capacity to heal.”