Following a request by Scott County Health Department to continue its programme for the needle exchange for intravenous drug use by addicts, State Commissioner for Health on May 2, 2016, has approved the extension of the program until at least May 24, 2017.

The program — a first of its kind in the state — for the needle exchange was approved initially to reduce the transmission of human immunodeficiency virus (HIV) outbreak in Indiana when Indiana Governor in March 2015 issued an executive order declaring the issue as a public health emergency.

Before the declaration of emergency, it was easier for people in the Scott County to obtain cheap heroin than the needles. Indiana was one of the 25 states where it was illegal to purchase a syringe without prescription along with the needle exchange programs.

Using needles for non-medical purposes was considered a felony which was punishable up to three years in jail. Declaration of emergency by the Governor Pence temporarily suspended the law and other counties subsequently.

The needle exchange program was enacted for the purpose of controlling the spread of HIV and other communicable diseases. But the program regulations have undermined the program’s own performance by requiring the drug users to register at the needle exchange centers, with their names and date of births. Many of the drug users apprehensive of this rule then, of course, do not avail the services provided. Other barriers to service include unregistered drug users being subjected to prosecution for carrying syringes and the timing of the service which only runs till 6pm.

Residents of the state are divided in their opinions regarding the implementation of these programs, despite the government insisting on their effectiveness. Some people have welcomed the step and praised the local government for it while other people are often complaining about ‘used needles in their yards and on public property’ and argue that this program is simply an ‘enabling’ measure.

Miss Brittany Combs, a local public health nurse in Scott County, commented that she thought this was a form of ‘enabling’ measures and could not have imagined working on the program last year. But her recent efforts reviewing 28 years of data on the subject changed her mind.

Even Governor Mike Pence, a Republican, is a reluctant participant in the program. But the outbreak forced the administration into a corner and he commented while signing the above mentioned law that the measure will save lives and provide public health officials with broadest range of options to confront this problem and any future emergencies. He also added, “Hoosiers may be assured that our administration will continue to work tirelessly to confront the crisis in Scott County in a compassionate and focused way until public health and public safety are restored.”

The rapidly escalating outbreak started near the region on the Kentucky border of the Scott County. An epidemiological profile of the outbreak revealed that during the recent years young people of the county had started to abuse opiates like oxymorphone, an opioid analgesic prescribed by county’s medical providers, until the tamper resistant formulation came in the market and policy changes were introduced to stop the abuse.

Till then people had already become drug dependent and driven by that dependence some of them shifted to heroin and other potent injectable opioids. Needle exchange program at once made the availability of needles limited and injection-drug users had little choice but to share. Factors such as easy transmission of HIV through needles and increase in this mode of drug use fueled the spread of HIV.

Previously, Southeast Indiana had on average five cases of HIV annually, but by June 2015 a total of 169 new cases were registered and more than 80% of those patients had also infections of hepatitis C virus (HCV), doubling the disease burden on the community. Currently, the estimated number of people living with the virus has reached 200.

Current estimations predict that the HIV outbreak can cost Indiana nearly $58 million in lifetime cost of treatment. Co-Director of Rural Center for AIDS and STD Prevention Beth Meyerson estimates the lifetime cost of treatment for HIV per person at $230,000 to $350,000.

The cost of additional infections such as hepatitis C can drive the costs even further up. However, Jerome Adams, the State Health Commissioner, tells that nearly two million have been spent in response to the outbreak, and vigilance and proper response can help keep the costs below $ 58 million.

Currently, 228 known needle exchange programs are running in 35 US states, the Commonwealth of Puerto Rico, Indian Nations, and the District of Columbia. However, the ban on using federal funds to support these programs limits the quality of service and their ability to provide ancillary services to the drug users.