ANDERSON — Before he got into the details of how officials used a syringe exchange program in reacting to an HIV outbreak, Scott County Prosecutor Jason Mount asked his audience to do an exercise with him.
Take in a deep breath slowly, he said, and then exhale while saying, “harm reduction.”
“You feel better already, don’t you?” Mount asked.
Mount and Brittany Combs, public health nurse of Scott County, talked about the controversial topic of what you do when a true outbreak happens. That’s what it was in the southern Indiana county, which went from having about seven new HIV cases per year to 180 cases. They spoke to a room of mostly health-care professionals with a few members of law enforcement at the Madison County Drug Addiction Summit on Thursday.
Kellie Kelley, HIV and hepatitis public health coordinator for Madison County’s health department, said she was looking forward to the session with the Scott County officials to learn more about what could be done here to prevent such an outbreak.
Madison County started a syringe exchange program in August. Kelley said there are about 80 users who regularly use the program.
In the beginning of the Scott County outbreak, Mount and Combs said they were nowhere near experts on HIV or transmitting diseases through intravenous drug use.
Mount said when he went into the first large meeting with state and Centers for Disease Control officials, the last thing he wanted to hear about was medically assisted treatments and a needle exchange program.
He said he was concerned because he comes from a law-enforcement background, but after the meeting, he was sold. Gov. Mike Pence was at the meeting and asked for Mount’s opinion afterward.
“He said, ‘I want to know how you, Mr. Prosecutor, feel about this.’ I said, ‘Governor, from a criminal justice perspective, this makes absolutely no sense. But from a public health policy, I think it’s a necessity.’ ”
The intravenous drug users weren’t using heroin, as some might think. They were using Opana, which is the brand name for the narcotic oxymorphone.
Combs said the drug is highly addictive, and people are often hooked after just one use. People weren’t even taking the drug to get high anymore because Opana stays in the body a very short amount of time, making the withdrawals severe and frequent.
“The withdrawals are so horrendous that they can’t stand it,” Combs said. “Most people are injecting up to 20 times a day just to keep from being sick.”
Combs said the county started interviewing these infected residents, and about all of them were intravenous drug users. They were able to draw connections between nearly all of these new infection cases, in which everyone seemed to be connected and had shared needles before.
They found that about 10 percent of the population was self-indicated intravenous drug users and about 5 percent were already infected with HIV.
The syringe exchange program was needed to not only get people clean needles to use for injections but also to educate that population, Combs said.
Some of the people who were infected knew they shouldn’t share needles and said they didn’t. Combs said she would then ask if they ever shared the same cooker for the drugs and used their own needles to split it, to which they immediately asked if they weren’t supposed to do that.
HIV and hepatitis can be transmitted by sharing paraphernalia, such as a cooker.
The program also serves as an additional connection to the drug-using community. Each time people come in to exchange needles, the staff talks to them, and it gives the user an opportunity to ask for help.
The county has received some criticism for its program since the number of people with HIV has risen from about 180 to 191 since it started. Mount said this process may not be quick and easy, but significantly fewer people are being infected.
Health problems have existed in Scott County longer than the HIV outbreak. Mount said he was jokingly jealous when he heard Madison County’s low health ranking.
“When one of the slides today said that Madison County is 79th out of 92 counties in health outcomes, I looked at Brittany and said, ‘Oh, to be 79,’ ” he said.
Scott County has ranked in the very lowest spot at 92nd for the past six years, which predates the HIV outbreak, Mount said.
Mount left the group with thoughts about how all hospital personnel should ask people who have visible track marks if they will take an HIV test and get everyone — including law enforcement — on board with how to handle addicts.