03/26/17 Doug McVay

This week: The Indiana State Senate holds a hearing on syringe exchange, plus Philippine Vice President Leni Robredo speaks out against the campaign of murder and bloodshed being carried out by Philippine president and dictator Rodrigo Duterte.

Century of Lies
Sunday, March 26, 2017
Doug McVay
Drug War Facts
Download: Audio icon col032617.mp3



MARCH 26, 2017


DEAN BECKER: The failure of drug war is glaringly obvious to judges, cops, wardens, prosecutors, and millions more now calling for for decriminalization, legalization, the end of prohibition. Let us investigate the Century Of Lies.

DOUG MCVAY: Hello, and welcome to Century Of Lies. Century Of Lies is a production of the Drug Truth Network for the Pacifica Foundation Radio Network, on the web at DrugTruth.net. I'm your host Doug McVay, editor of DrugWarFacts.org.

Now, this is a show about drugs, drug policies, and the drug war. We talk a lot on this program about hard drugs and injection drug use. I was born in the early 60s, I grew up in a small factory town in rural Iowa, and those were things that we didn't really think about. When HIV and AIDS came along, like a lot of people, I still thought that was something you'd find in the cities, not in the rural parts of the country. That was before Ryan White.

Ryan White was a kid from Kokomo, Indiana. Kokomo's not exactly a really small town, there are currently there are about fifty-six thousand people living there -- it's not exactly a metropolis either. Ryan had hemophilia, that's a genetic condition where your blood doesn't clot properly. People who suffer from hemophilia may require blood transfusions. Well, that was the case for Ryan. Ryan White was born in 1971. In December of '84, when he was just thirteen years old, Ryan was diagnosed with AIDS, which he got from a transfusion. See, back in those days, we didn't regularly screen blood for HIV.

When Ryan was diagnosed, he was given six months to live. He tried going back to school, wanted to have a life but he faced incredible discrimination. His, and his mother's, fight to get him back in school, and to live a life, gained national attention. Ryan became the face of this disease. He shocked his doctors by surviving for five more years. He died in April of 1990, it was just a month before his high school graduation. In August of 1990, Congress finally passed the Ryan White Comprehensive AIDS Resources Emergency Act.

Well, let's fast forward to 2015. Austin, Indiana is just 135 miles south of Kokomo, it's a straight shot down Interstate 65. Austin is in Scott County, and it's a much smaller town than Kokomo, the population of Austin's just over four thousand. In 2015 in tiny Austin, Indiana, there was a massive outbreak of HIV, transmitted through injection drug use. Doctor Tom Frieden, director of the federal Centers for Disease Control, said at the time that tiny Austin, Indiana, quote, “had more people infected with HIV through injection drug use than in all of New York City last year.” End quote. They had a higher incidence of HIV in Austin than any country in sub-Saharan Africa.

And that's just one hundred and thirty five miles away from the home town of Ryan White.

The situation was so bad that an unreconstructed drug warrior like then-Governor Mike Pence, our current Vice President, was compelled to declare a state of emergency and to approve the operation of a syringe exchange.

The Indiana state legislature and state health department have been working to make syringe service programs a reality throughout the state, without the need for cities and counties to declare a public health emergency and to go through all kinds of hoops just to start saving people's lives.

A few weeks ago, we listened in on an Indiana House committee hearing that was looking at a syringe exchange bill, House Bill 1438. Well that bill passed the committee, and it passed the House. It is currently in the Indiana Senate. On March 22, the Indiana Senate Committee on Health and Provider Services held its hearing on House Bill 1438. We're going to listen to part of that hearing now.

The first speaker is Indiana's drug czar, Jim McClelland. Mister McClelland was formerly the CEO of Goodwill Industries of Central Indiana, he was appointed to the newly-created post of Executive Director of Drug Prevention, Treatment and Enforcement by the new governor of Indiana, Eric Holcomb. McClelland will be followed by Indiana State Health Commissioner Jerome Adams MD.

JIM MCCLELLAND: Chairman Charbonneau and members of the committee, thank you for the opportunity to speak on behalf of House Bill 1438. I want to thank Representative Kirchhofer for carrying this Governor's Agenda bill, Senators Merritt and Charbonneau for sponsoring it, and all committee members for hearing it today.

My name is Jim McClelland, I'm the Executive Director for Drug Prevention, Treatment, and Enforcement for the state of Indiana. You all understand the opioid crisis is a complex problem. Many pieces to it. There are no easy answers or quick solutions. But I'm convinced that we can end this epidemic and we're developing a comprehensive plan to do so.

Syringe exchange programs play an important role in reducing additional harm that can result from the use of illicit drugs. They're also an effective means of helping people connect with treatment programs. Results from the state's first syringe exchange program, now in operation for more than one and a half years in Scott County are impressive, dramatically reducing additional cases of HIV and hepatitis C.

By the way, I just heard a report about a week ago, there have been no new HIV cases reported in Scott County in the last three months. So we've gone from, prior to the implementation of this program, an average of 22 a month, in the 18 months subsequent to the implementation of the program, down to two a month, and now in the last three months we've had no new cases of HIV reported. In addition to that, over a hundred people in Scott County, who are battling addiction, have entered treatment programs.

The opioid crisis and problems associated with it require action on numerous fronts simultaneously. Syringe exchange programs, while certainly not a total solution, are an important part of an overall effort to substantially reduce the magnitude of the scourge that every day is destroying lives, devastating families, and damaging communities in many parts of our state.

With your permission, I'd like to defer to my colleague, Doctor Jerome Adams, commissioner of the Department of Health, for some additional remarks, and I thank you for your time, and I urge you to support this legislation.

JEROME ADAMS, MD: Today's hearing is extremely timely. It marks the two year anniversary of Indiana's first syringe exchange program, which Governor Pence allowed under an executive order, to respond to an explosion of HIV cases tied to needle sharing in Scott County, Indiana.

Many of you were instrumental in turning that executive order of March 2015 into a law that allowed Indiana counties to operate syringe exchanges in response to epidemics of HIV or hepatitis C, with the approval of the state health commissioner.

Thank you for your courage and for allowing me to help keep Hoosiers safe, and I can't say that enough. I remember being here two years ago, in a meeting with Representative Clere and with Senator Miller, hashing this out. I know you all put a lot of deliberation in it, and I quite frankly think you got it right and gave us the flexibility we needed.

A lot has changed in Indiana in the past two years. We've seen the number of cases slow to a trickle, so now that we can go months as you heard Director McClelland talk about, without a new case. The viral suppression rate in Scott County is 73 percent, which is well above the national average of 25 to 50 percent. Viral suppression means people with HIV who have been taking their medications have such low levels that it's virtually undetectable and very unlikely that they can transmit disease to others.

So the -- literally, the syringe exchange program and the touchpoints it has created has allowed us to halt this outbreak in a significant way. About 150 people, so it's even more than what Director McClelland mentioned, I got an up -- updated numbers last night, have been engaged for substance use disorder treatment. We've seen hundreds of people get connected to health insurance and medical care and other services they might not have otherwise accessed without the syringe exchange program that's in place.

So I say all that because it's important that you know the good that's coming of this. I had a discussion with the attorney general and with Matt, and we're committed to working together.

This is messy. Substance use disorder is messy. Needles are messy. We -- it's always going to be a balance of the pros and the cons, but there are some definite pros that I think far outweigh the cons as part of this outbreak, and it doesn't mean we're not going to continue to work with law enforcement and the rest of the community to make this the best possible program it can be, and ultimately, as Jim mentioned, to make it unnecessary to have a syringe exchange program.

That's my dream, to have a day when we don't need it. But right now, we do need it, and it's working.

Excuse me. Eight other counties have been approved for SEPs. Seven of those are currently operational. I'm on the upswing from a cold, I'm not contagious anymore, but, excuse me. Nearly 2,300 people statewide now participate in SEPs, and these sites are not about just handing out syringes. Again, they provide touchpoints for battling chronic disease. While these programs currently operate under the authority granted by the state, they're all locally run, and they all can look different from county to county, and that's by design. That's by your design. That is on purpose.

What works in Scott County may not work in Fayette or Allen County, there's different obstacles, there's different resources. Resources and public sentiment can vary widely, and there is no one size fits all approach to helping people overcome addiction.

Under current law, communities seeking a syringe exchange program must ask the state health commissioner, me, for a public health emergency declaration. This, and I want to be clear, this was a necessary step. I talked about those negotiations with Senator Miller and with Representative Clere, this was a necessary step two years ago, when SEPs were first launched, because this was uncharted territory in Indiana. Counties weren't as aware of their HIV, hepatitis C, and overdose rates as they are today. Now any of you all can go online and find out the hepatitis C and HIV rates for your counties.

But today, I believe, the extra step of requiring state permission for programs that are already locally run is quite frankly an unnecessary bureaucratic hurdle that can slow a communities ability to respond to a rapidly evolving health crisis. That is why I support Representative Kirchhofer's bill, giving local communities control over the decision to launch a syringe exchange.

This isn't a new concept. Public health starts at the local level, and that's especially true as you know in Indiana, us being a home rule state. The state health department has, and always will, serve as a consultant, providing data, best practices, and other assistance to our local health departments as corrected.

I want to be clear, this bill does not change our state role in that capacity. We will continue to provide that assistance and collect data from the SEPs, and we will retain our authority to shut down an SEP that violates state law. You all gave us that ability before, we still keep that.

In addition, counties that feel more comfortable seeking approval from the state health commissioner can still do so, the way this bill is written. In an ideal world, Indiana would never need syringe exchanges, because there would be no opioid epidemic and no needle sharing. We don't live in an ideal world, and the costs of this opioid epidemic are literally mounting every day.

Some of you all have reached out to ask for figures. A new study in the Journal of Medical Care says each person diagnosed with HIV or AIDS can incur more than $600,000 in medical costs in a lifetime. For the 215 people in Scott County, that amounts to roughly 129 million dollars. Treatment for hepatitis C, which often signals that injection drug use is occurring, can cost up to $80,000 per person, because the medications are still extremely expensive. More than 93 percent of the people infected with HIV in Scott County also have hepatitis C. That's potentially another sixteen million dollars in treatment costs.

These costs only account for the people already infected with HIV or hepatitis C. We know we have about 400 other people in Scott County who inject drugs, but who have tested negative for both diseases. If half of them were diagnosed with hepatitis C, that showed another sixteen million dollars in treatment costs.

Keeping those same 200 people free of both hepatitis C and HIV could save the state 136 million dollars. That's the real cost for not having these touchpoints available in the future, and not encouraging people, creating an environment where they come in and utilize those touchpoints.

And again, this is just one of Indiana's 92 counties.

House Bill 1438 is not intended to debate the merits of syringe exchange programs. I'm happy to ask questions, but you all debated those merits two years ago. Nor will it sway those who do not support syringe exchange. That's only going to happen through education and experience, but this bill is not going to do that, and I'm not going to do that today.

I'm gratified that we continue to discuss these programs so we can improve them in ways that put the health of our citizens first. I have no doubt, and not only do I have no doubt, I've talked to the CDC, they have no doubt, that we could be staring at 500 cases of HIV in Scott County today if not for the syringe exchange program, and the hard work being done at the local level to ensure that people get the medical care and support services they need.

Giving the local communities that are doing the work the power to decide if a program is the appropriate thing for their county is the right thing to do.

You've all heard Governor Holcomb talk about his five pillars of his administration, one of which is to deliver great government service. Sometimes, providing great government service means getting out of the way. This bill does that, and I thank you for considering it.

DOUG MCVAY: That was Jim McClelland, Executive Director of Drug Prevention, Treatment and Enforcement for the state of Indiana, and Doctor Jerome Adams, Indiana State Health Commissioner, testifying before the Indiana State Senate Committee on Health and Provider Services in support of House Bill 1438, to allow counties and municipalities in Indiana to operate syringe service programs. We'll have more from that hearing in a moment.

You're listening to Century of Lies, a production of the Drug Truth Network for the Pacifica Foundation Radio Network, on the web at DrugTruth.Net. I'm your host Doug McVay, editor of DrugWarFacts.org.

Now we'll get back to Indiana in just a moment. First ….

Recently, the Commission on Narcotic Drugs held its annual meeting in Vienna, Austria. As usual, there were a number of side events organized by member states and by participating nongovernmental organizations. One of those side events, organized by my friends at the Drug Reform Coordination Network and StopTheDrugWar.org, examined the campaign of terror and murder being perpetrated in the Philippines by that nation's president and dictator, Rodrigo Duterte, #BoycottThePhilippines #DumpDuterte.

Philippine Vice President Leni Robredo has had the courage to speak out against the dictator Duterte, and contributed a short statement via video for that DRCNet side event. In retaliation, Robredo has been harassed by Duterte and his cronies, and a supporter of the former Philippine dictator Ferdinand Marcos has filed impeachment charges against her. So let's hear what Vice President Robredo had to say:

PHILIPPINE VICE PRESIDENT LENI ROBREDO: David Borden, executive director of the DRCNet Foundation; Marco Perduca, former member of the Italian Senate; Chito Gascone, chairperson of the Commission on Human Rights; Alison Smith, legal counsel and director of international criminal justice programs, No Peace Without Justice; all the other sponsors of this event, ladies and gentlemen, a good day to all of you.

We are heartened that the issue of extrajudicial killings in the Philippines today is being discussed in an event such as this.

To know that the international communities eyes are on us, and to feel that human rights advocates are watching over our country, gives us comfort, courage, and hope.

It is already February 2017, and the body count due to drug-related killings keeps growing. We are now looking at some very grim statistics. Since July last year, more than 7,000 people have been killed in summary executions. We agree that our people deserve nothing less than a safe environment, so that anyone can walk the streets safely, whether in daylight or at nighttime, but drug abuse should not be treated as one that can be solved with bullets alone. It must be regarded as it truly is: a complex public health issue, linked intimately with poverty and social inequality.

As it is, in some areas in Manila, where poverty is rampant, residents tell us that communities are rounded up in places like basketball courts, women separated from men, those with tattoos asked to stand in a corner, their belongings searched. People are told that they didn't have any right to demand for search warrants because they were squatters and did not own the properties on which their houses were built.

They told us of the "palit-ulo" scheme, which literally means exchange heads, where the wife or husband or relative of a person in a so-called drug list will be taken if the person himself could not be found. Some of those have told us that they, when there's crime, they normally go to the police. Now they don't know where to turn to. Our people feel both hopeless and helpless, a state of mind that we must all take seriously.

This is why the office of the vice president supports the rehabilitation of drug dependence. You cannot kill addicts and declare the problem solved. The solution is to design the proper health, education, and psychosocial interventions to prevent further drug use and help them transition into productive members of society.

Another challenge is to drum up legal and psychological support for those who may have undergone trauma due to extrajudicial killings. We believe that when the public knows its rights under the Philippine constitution, when the community is united in this knowledge, our people will be better protected.

We must tread carefully on this, however, because in some cases reported to us, those who ask for a search warrant for instance have been beaten and physically abused for doing so. We must all demand greater transparency in the government's war on drugs. Because this is a major publicly funded campaign, our leaders must be honest about the basis of the drug war. What exactly is the scope of the drug problem? Why do numbers about the extent of the problem change as officially reported to the nation by our president inconsistent?

We believe that any campaign against illegal drugs must be founded on integrity. The public must ask why no one is being held accountable. The public must be watchful. Around 500 complaints have been filed at the Commission on Human Rights, and recommended to the Department of Justice for filing of cases, but until now, seven months into the administration's drug war, no information has been filed.

On top of this, there's a brewing problem: death penalty might soon return. And the age of criminal liability might be brought down to nine. We believe this to be a huge mistake, because death penalty for nonviolent offenses violate UN treaties and international human rights norms.

Last Friday, a day before the EDSA People Power Revolution's 31st anniversary, we called the president to task on this. In behalf of the Filipino people, whose daily struggles are escalating, we asked him to focus on the war that really matters: the war against poverty, instead of just the war against drugs.

In a public statement, we asked him to direct the nation towards respect for rule of law, instead of a blatant disregard for it. We asked him to uphold basic human rights, enshrined in our constitution, instead of encouraging its abuse. We asked him to be the leader he promised to be, and evoke in our people hope and inspiration instead of fear.

We told him, do not allow the lies to distort the truth. We also asked the Filipino people to defy brazen incursions on their rights. Our people have fought long for our rights and freedoms. The Filipino nation has come so far since our country's darkest days. We are not about to back down now.

Thank you all for listening. May you have a fruitful discussion moving forward. The office of the vice president is looking forward to deepening this conversation further with you.

DOUG MCVAY: That was Philippine Vice President Leni Robredo, speaking out against the atrocities being committed by her president, the dictator Rodrigo Duterte, #BoycottThePhilippines #DumpDuterte.

Now, let's get back to the Indiana State Senate Committee on Health and Provider Services, and their hearing on March 22 regarding House Bill 1438, to allow counties and municipalities in Indiana to approve the operation of syringe service programs. We'll hear more from Indiana State Health Commissioner Jerome Adams, MD.

JEROME ADAMS, MD: I will tell you that I had a phone call with the CDC just yesterday afternoon, to ask about some of the things that the attorney general offers as suggestions, and I'm committed to working with him again to work through those, through regulation et cetera.

But, on data collection, the CDC told me last night that they recommend robust data collection initially, but that they -- actually told us that they thought we were doing too much as these programs progress in terms of data collection, because, someone's coming in to get needles, they don't want to have a 20 minute, or half hour, or 45 minute survey that they've got to take every time they come in.

Again, that's going to discourage people from coming in and taking advantage. So what the CDC told me is, our recommendations, which Matt mentioned, are for initial times when people come in, so you kind of know who's coming into your program, but not an every time sort of thing, and they told us, we actually suggest that you consider backing off a little bit on what you're collecting.

Now, as the state health commissioner, and as someone who is a public health advocate, I love data, and I want to get as much as I can, but we've got to balance that with not discouraging people from coming in at all. So, we're working to try to standardize that data collection process, make it as robust and meaningful as possible so that we can give you all the information you request, when you request it, but I certainly don't think we need to put together a 20 page survey for folks to have to do every time they come in for their syringes, otherwise they won't come in.

As far as reported increase in injection practices, this is important, because it's been out there a lot, and I want you all to understand that this was a study that was done really early in the Scott County syringe exchange process, and there were a couple of things going on. If no one ever asked you how many times you inject, you really don't know how many times you inject. And there's also stigma attached, such that people are reticent to tell you, yeah, I'm injecting 24, 25 times a day, which some of those people in Scott County are.

So again, CDC, I asked them what they thought, and they said we really believe that the increase, in five to nine, is an artifact that reflects increasing trust in folks to be able to recognize and communicate how many times they're injecting every day. They actually don't believe that that reflects an actual increase in injections.

And I was also at an FDA hearing last week, on Monday, where we were talking about Opana, and it's important to know that in Scott County, Opana is a unique drug which requires multiple injections per day, and which is also very expensive, so as part of our FDA preparations, we asked folks how many times they were injecting and why.

And one of the things we found out is those Opana pills are going now for $240 apiece. So folks now actually in some cases really are injecting more frequently, because they're just giving themselves the littlest bit of drug that they need to overcome the withdrawals, and then re-injecting again further on down the road, instead of giving themselves one big bolus of the drug at a time.

So they're not injecting any more drug, they're just injecting it in a different way, to be able to respond to the fact that these pills are costing an exorbitant amount of money and that they require multiple injections.

I also want to say that it's not just my opinion that SEPs don't increase drug use. Two different surgeons general have put out reports stating that SEPs don't increase syringe exchange use. They actually decrease syringe exchange use [sic], because you're connecting people to addiction and recovery services. Those 150 people who I mentioned who are now connected to addiction and recovery services are 150 people down there who are injecting less and in many of them not any more at all. So we're actually decreasing drug use through the SEP.

As far as a one to one exchange program, there are 18 states that allow in their state law syringe exchanges. Well, actually there's 18 that allow them that have -- they give out as many syringes as people ask for or need. There were six states until recently that had one to one written into their legislation. Maryland actually changed that, because there's ample research out now that shows that that actually is -- goes against what you're trying to do.

So I can give you all this if you want it, but removing one to one exchange policy reduces injection practices associated with risk of transmitting blood borne infections. Needs based syringe distribution increases safer injection practices. These are two studies that the CDC sent me yesterday, which show that going to one to one policies actually increases unsafe injection practices amongst folks. It works best in the community if you give them what they tell you they need, and it also decreases injury to people who are working at the syringe exchange programs.

If you were to go to a one to one, somebody's got to determine how many there are. Right now, we have them bring them in in sharps containers, and we tell the folks in the syringe exchange program, do not try to specifically count these syringes, because if they were to count them and get a needle-stick, that's an unnecessary exposure.

Now, I know you've heard also about extra syringes being available out in the community, and I'm concerned about that too. We want to do everything we can, I've got three little kids, I'm the first to admit as a father the last thing I want is for any kid to step on a syringe. But if you look at the actual numbers, and I actually ran them here, before the outbreak, we had about 500 people who were injecting drugs in Scott County, Indiana. They were using at least two syringes a week, many more, in many cases, before the outbreak, but let's say two syringes a week.

You multiply that by, so it's 500 times two, times two syringes a week, times 52, you're looking at 182,000 syringes that were unaccounted for in Scott County before we had the syringe exchange program.

Scott County is now at a 94 percent return rate. Over the past year, there are about 20,000 syringes that are unaccounted for, and when I say unaccounted for, that doesn't mean they're out in the streets. In many cases they're putting them in the trash, they're putting them in places where they feel they can safely dispose of them, but 20,000 compared to 182,000 syringes? We're actually keeping syringes off the street through our SEP.

DOUG MCVAY: That was Indiana State Health Commissioner Doctor Jerome Adams, testifying in favor of House Bill 1438, to allow counties and municipalities to operate syringe service programs. The bill was approved by the Senate Committee on Health and Provider Services with a do-pass recommendation. It now goes to the full senate.

Indiana is not alone. The state of New Hampshire is considering a bill to allow syringe service programs. The North Dakota state legislature has just approved a syringe service program bill, which is now on the governor's desk awaiting his signature. We don't yet know what direction the federal government will go on syringe exchange programs, and at the state and local levels they're not waiting to find out. Harm reduction is moving forward.

Well for now, that's it. Thank you for joining us. You have been listening to Century Of Lies. We're a production of the Drug Truth Network for the Pacifica Foundation Radio Network, on the web at DrugTruth.net. I'm your host Doug McVay, editor of DrugWarFacts.org. The executive producer of the Drug Truth Network is Dean Becker. Drug Truth Network programming is also available via podcast, the URLs to subcribe are on the network home page at DrugTruth.net.

The Drug Truth Network has a Facebook page, please give its page a like. Drug War Facts is on Facebook too, give it a like and share it with friends. Remember: knowledge is power. You can follow me on Twitter, I'm @DougMcVay and of course also @DrugPolicyFacts.

We'll be back next week with thirty minutes of news and information about the drug war and this Century Of Lies. For now, for the Drug Truth Network, this is Doug McVay saying so long. So long!

For the Drug Truth Network, this is Doug McVay asking you to examine our policy of drug prohibition: the century of lies. Drug Truth Network programs archived at the James A. Baker III Institute for Public Policy.