02/05/20 James Meritt

This week on Century of Lies: The city of Baltimore considers supervised consumption facilities; the state of Indiana takes a step backward in public health; and we hear from the US Dept. of Health and Human Services about the benefits of syringe service programs.

Program: 
Century of Lies
Date: 
Wednesday, February 5, 2020
Guest: 
James Merritt
Organization: 
Drug War Facts
Indiana Session
Download: Audio icon COL020520.mp3
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CENTURY OF LIES

FEBRUARY 5, 2020

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

DOUG MCVAY: Hello and welcome to Century of Lies. I am your host, Doug McVay, Editor of www.drugwarfacts.org.

The Indiana State Senate is trying to take a giant leap backward in public health. Syringe service programs were approved by the state in 2015, but Indiana legislators decided that approval for these programs had to be renewed every other year. A measure to fix this frankly stupid rule was defeated on the floor of the state senate on Tuesday, February 4th. We will hear more about that in a moment.

The City of Baltimore is moving closer to opening a supervised consumption facility on January 13th, the Baltimore City Council approved a Resolution to schedule a hearing on establishing overdose prevention sites in Baltimore. We are going to be hearing some audio from that meeting. The Resolution was sponsored by Council President Brandon Scott. We hear from Council President Scott right after the clerk reads the Resolution.

CLERK: City Council Resolution 20-0189R Informational Hearing on Overdose Prevention Sites for the purpose of inviting representatives from the Health Department, the Baltimore Police Department, the Fire Department, the Mayor’s Office of Criminal Justice, and the Law Department to provide information about Overdose Prevention Sites and how they could be established in Baltimore City. Sponsors: President Scott, Henry, Costello, Burnett, Pinkett, Cohen, Dorsey, Clarke, Middleton. Co-sponsors: Stokes, Sneed, Bullock, Reisinger.

PRESIDENT SCOTT: Please add Councilman Bullock, Councilman Reisinger, Councilman Stokes, and Councilwoman Sneed as co-sponsors. Thank you to all of my co-sponsors. Let me be clear – Baltimore has had an overdose crisis my entire life and what we have been unafraid or unwilling to do is address it as a public health issue that it is. Since 2015 there has been 3,500 fatal overdoses in Baltimore and that outweighs the number of people that we lost to gun violence in Baltimore City. We have to take a deeper look at the city’s needle exchange program that is administrated by the Health Department and the role of community based, direct role service providers in providing these services. I am also calling for a hearing to explore overdose prevention sites, the services that they provide, and how they fit in to an evidence-based harm reduction approach to address Baltimore’s overdose epidemic. This is also personal for me because it is a part of my personal growth. When you grow up in Baltimore City in neighborhoods like the one I grew up in which was Park Heights, culturally you are taught to look at people who are struggling with addiction as less than human. This is about us humanizing people and understanding that our brothers, sisters, mothers, and sons who are struggling with addiction are human and they deserve treated fairly and to get the help that they need. The number one responsibility of any government is to save and protect the lives of its citizens. Overdose prevention sites have been proven to do this across the globe and is becoming something that is coming slowing and surely in to America and what we are going to do at these hearings is not only build momentum, but also educate all of us here on the Council and all of the public about what Baltimore could be doing to join the rest of the world in how to deal with addiction and overdose in a different way because we know that we have a problem and we know that the way we are currently attacking that problem is not working. This is just the beginning of a lot of work that we have ahead of us to get ahead of this crisis. I want to also take time to ask some very special guests to stand and be recognized for being a part of this effort in Baltimore. OSI Baltimore is here with a delegation of harm reduction advocates from other countries. I want to recognize Beverly Lightfoot and Russell Maynard who are here all the way from Vancouver, Canada and Ora Roick who is all the way here from Barcelona, Spain which is one of my favorite international cities to visit. I also want to recognize the Baltimore Harm Reduction Coalition, CHARM City Care Connection, Power Recovery Center, Parents (UNINTELLIGIBLE), and the many people who serve our communities in need each day and advocate on behalf of harm reduction. Thank you for your great work and please stand to be recognized.

(CLAPPING)

Thank you so much. I look forward to working with each and every one of you. This has been assigned to the Health Committee.

DOUG MCVAY: That was Baltimore City Council President Brandon Scott. The City of Baltimore is working to establish legal, supervised consumption sites in order to reduce the number of overdose deaths and prevent the spread of Hepatitis C, and HIV. You are listening to Century of Lies. I am your host, Doug McVay.

Now let’s stay with harm reduction and turn to the state of Indiana where they are about to get things very, very wrong. Syringe service programs were finally approved by the state of Indiana in 2015 in response to a declared public health emergency. Indiana legislators approved this harm reduction intervention but a lot of them didn’t like it so they decided that approval for these programs had to be renewed every other year. Currently, Indiana’s Syringe Exchange Program is scheduled to expire on July 1, 2021. SB207 was a measure sponsored by State Senator James Merritt who is a Republican. The measure would eliminate that renewal requirement but the bill was defeated on the state senate floor on Tuesday, February 4th. There was a hearing on SB207 before the State Senate’s Committee on Health and Provider Services on January 29th and the bill was approved by that committee on a vote of 9 – 1 and went on to the senate floor with a ‘do pass’ recommendation. There were two witnesses who testified before the committee on SB207, Senator Merritt who is the bill’s lead sponsor and Madison Winetrout who is the Program Director of the Marion County Public Health Department’s Safe Syringe Access and Support Program.

Today we are going to hear part of that hearing. The next voice you hear will be that of State Senator James Merritt.

SEN. MERRITT: Good morning everyone. Mr. Chairman, members of the Senate, members of the Committee thank you very much for hearing SB207. As you can see from the digest this deals with the Syringe Exchange Program we have in this state which is local in nature. I wrote this bill in a broad sense. There is consensus that we are not ready for a lot of the information in the bill. You might have an amendment in front of you that just leaves in the bill itself but removes the sunset of the Syringe Exchange Program so that we don’t have to look at this again every few years. SEPs (Syringe Exchange Program’s) in nine counties are going well. There are 50 SEPs in the Commonwealth of Kentucky and they are doing very well. I have come here today to talk to you and ask you for your support for the amendment which deletes the sunset in the law regarding SEPs.

CHAIRMAN CHARBONNEAU: I think you’ve explained the Amendment well. I will move the Amendment.

FEMALE VOICE: Second.

CHAIRMAN CHARBONNEAU: Okay. Can we take the Amendment by consent?

COMMITTEE: Consent.

CHAIRMAN CHARBONNEAU: Okay. Just a reminder since this is the first time we are going to get testimony. We have listed on every one of the bills that there will be limited time for testimony so I want to refresh everyone’s memory if they have forgotten that. We will be adhering to that admonishment as we move through this day. Senator Merritt, Madison Winetrout.

MADISON. WEINTRAUT: Thank you, Mr. Chairman and members of the Committee. My name is Madison Winetrout and I am the Program Manager for the Safe Syringe Access and Support Program at Marion County Public Health Department. I am here today to voice our strong support for SB207. I want to sincerely thank Senator Merritt for his efforts to support syringe services in this state. As you may know, syringe service programs are a vital component to addressing the drug epidemic here and across the nation. Such programs are one of the most effective ways to prevent Hepatitis C and HIV cases as well as providing support to influence positive behavioral change that will reduce risky behaviors. People who participate in syringe service programs are five times more likely to enter in to drug treatment programs and they are three times more likely to stop using drugs altogether. Through these programs we get people in the door to provide teachable moments as well as services that reduce risky behaviors and help open the door for rehabilitation. Thanks again to Senator Merritt. I would like to support this bill and I am open for any questions.

CHAIRMAN CHARBONNEAU: Thank you very much. Senator Leising?

SENATOR LEISING: You head up the program in Marion County? In Marion County is it primarily an exchange – needle for needle – or not?

MADISON. WEINTRAUT: It is not. One for one needle exchanges are proven to be the least effective way to prevent HIV and Hepatitis C. The primary goal of the program is to reduce infectious diseases related to injection drug use. The secondary goal is to promote the health of people who use drugs through other services such as getting them in to rehabilitation, getting them in to infectious disease treatment. When you limit the number of syringes a person has access to, you are encouraging syringe reuse and sharing.

SENATOR LEISING: Do you have an average number of syringes that are doled out per person at your facilities?

MADISON. WEINTRAUT: It varies greatly. People may inject anywhere from one time to ten times a day. We try to tailor the number of syringes that a person receives based on their need.

SENATOR LEISING: If I am a drug user do I come back every day? Do I come back every week? How many approximately would you give me if I was a heavy drug user?

MADISON. WEINTRAUT: Approximately anywhere from 50 – 80.

SENATOR LEISING: 50 – 80 at one time. How many dirty syringes do you anticipate that I might give you back?

MADISON. WEINTRAUT: Typically anywhere from 60 – 80. We conducted a study with IMPD and IMPY where we found that officers are supportive of people who inject drugs having access to clean needles. We also found that 66% of our participants in our data collection are homeless, which means that they don’t always have a lot of access to their supplies at any given time and this is why we might not have a 100% return rate and cannot expect that.

SENATOR LEISING: I was a strong proponent for needle exchange a few years ago when we implemented this because one of my areas had a big addiction problem and they still do. I really thought that I was supporting needle for needle exchange and I now have real reservations about the number of syringes doled out at one time. I have had law enforcement in my area and neighboring counties tell me that they busted a drug dealer and in his backseat was a box of clean syringes that he has probably gotten from the needle exchange program so that when you buy your drugs he hands you a few clean needles. I have to admit that this sounds more like enabling rather than – and I am an old nurse and I really wanted to deal with Hepatitis C but I really have concerns about how it is being managed. I think most of my constituents would be shocked at how many syringes are being given out to drug addicted. Isn’t there a better way to deal with the drug addicted than this? I don’t know, but I wanted to express my concern.

MADISON. WEINTRAUT: I absolutely understand those concerns and I think that we could do a better job promoting what syringe exchange is. I would argue that when you bust somebody and they have clean syringes in their backseat that it is a good thing because it is preventing HIV and Hepatitis C. As I said, somebody coming to the syringe exchange is five times more likely to enter treatment because we are providing a non-coercive environment for them and we know that self-motivation is the greatest predictor of a person’s recovery success. While I understand the concerns about enabling drug use, I wish that I had a projector so that I could show you pictures of needles that we collected that people have made themselves out of straws, duct tape, and hot glue guns. Access to clean syringes has never prevented anyone from injecting drugs.

SENATOR LEISING: You don’t think there is a big problem with used syringes in parks and public places as a result of not requiring the syringes to be returned?

MADISON. WEINTRAUT: I think it is a problem in the sense that people that don’t have access to syringe exchange and they fear being prosecuted because of possessing syringes due to the unlawful possession of a syringe law, it encourages them to discard those syringes inappropriately because they are afraid of being caught with them. Syringe exchanges have existed in the United States for 30 years and multiple research studies have shown that inappropriate syringe disposal does not increase when you have a Syringe Exchange Program, it actually decreases.

CHAIRMAN CHARBONNEAU: Senator Brough?

SEN. BROUGH: Thank you, Mr. Chairman. I know this bill doesn’t deal with this aspect but aren’t there wraparound services available to individuals who participate in Syringe Exchange Programs and have you tracked the success rate of those who participate in this program by taking advantage of the services and then are able to seek help and start on a straighter path?

MADISON. WEINTRAUT: Yes. Absolutely. We are not just a syringe exchange. We offer Hepatitis C and HIV testing and pretty well all of our participants utilize that service. The ones that don’t already know that they are infected with HIV or Hepatitis C. We also provide insurance enrollment for people who are ready to go in to treatment so that barrier is eliminated as far as being able to get in to a treatment program. We provide vaccine services to people as we are in the middle of a Hepatitis A outbreak. Syringe exchange is one of the most effective ways to vaccinate that vulnerable population. At Marion County staff Peer Recovery Coaches and most of the other programs throughout the state also staff Peer Recovery Coaches where we can help guide somebody towards recovery by removing the barriers and helping to facilitate their success moving forward.

SENATOR BROUGH: To your knowledge is that typically how most Syringe Exchange Programs are fashioned?

MADISON. WEINTRAUT: Absolutely. Yes.

SENATOR BROUGH: Okay. Senator Merritt this question is for you. What is the benefit of removing that a public health emergency must be declared as a prerequisite?

SENATOR MERRITT: Madison can probably answer that better than I, but from what I can see from the SEPs we are able to reach out to those that need our help and it is just another bureaucratic hurdle to surmount that I don’t believe is necessary any more.

SENATOR BROUGH: So does that mean that we will see the institution of more Syringe Exchange Programs across the state where there are none now?

SENATOR MERRITT: I would think that the more success we have in the nine counties we have, the more Syringe Exchange Programs we will have.

SENATOR BROUGH: Removing this declaration does not remove the oversight so that if a county or city doesn’t have a Syringe Exchange Program today there is still a procedure and a process they have to go through to get –

SENATOR MERRITT: Yes. That is exactly right.

SENATOR BROUGH: --Okay. Thank you.

CHAIRMAN CHARBONNEAU: Senator Verban?

SENATOR VERBAN: Thank you, Mr. Chairman. I am curious to know if there is anything in your program or policy where there is a limitation of how long you can keep getting these new syringes.

MADISON. WEINTRAUT: I am sorry, can you please speak up?

SENATOR VERBAN: Is there a policy and a measurement of success for a wise guy who keeps coming and getting syringes over and over again? Do you have a time element or a policy that says you can only go so far?

MADISON WEINTRAUT: No, we don’t.

SENATOR VERBAN: So I could be on this program for years?

MADISON. WEINTRAUT: The current law says that syringe exchange must be renewed within the local county or city every 1 – 2 years. We will be up for renewal in June 2020 and fully expect to continue as long as we need. A part of this program is that it is reactionary to a Hepatitis C outbreak. We would like to continue this program as prevention to ensure that people do not contract Hepatitis C or HIV related to injection drug use until they can get in to treatment.

SENATOR VERBAN: Thank you.

CHAIRMAN CHARBONNEAU: Okay. One more question. What we are doing is we have cut the whole bill and just removed a date.

FEMALE VOICE: It is all about the registration of the syringe exchange. How successful has it been using participation in a Syringe Exchange Program as a defense to having the needles and the drugs that go in the needles? I know this bill says that you can use your participation in a Syringe Exchange Program as a defense to any kind of arrest procedure. Has that been done and how successful are you guys in doing that?

MADISON. WEINTRAUT: No other state has established a syringe exchange registry. To my knowledge, every syringe exchange across the United States is anonymous because injection drug use is an illegal behavior. Creating a registry would deter individuals from participating for fear that it would be used against them. It is a well-intentioned thing but trying to explain that to participants is difficult. Fear of prosecution is one of the main reasons that people do not participate in Syringe Exchange Programs, specifically if a local health department or other government entity is operating it. They worry that it would be used against them.

FEMALE VOICE: Okay. I am a little confused but I will talk to Senator Merritt. Thank you.

CHAIRMAN CHARBONNEAU: Senator Leising?

SENATOR LEISING: One last question. In Marion County where you have the ability to collect data, have you seen any improvement in your Hepatitis C rate?

MADISON. WEINTRAUT: Not yet and it is not expected because we test more people so it is the same as if you put more officers on the street, you get more arrests. Because we are testing people that have never been tested before we are going to get more diagnosis originally and as the year’s progress you will see a decrease.

SENATOR LEISING: So there has not been a decrease and how long have you had the program in place in Marion County?

MADISON. WEINTRAUT: We launched in April of 2019.

SENATOR LEISING: Thank you.

CHAIRMAN CHARBONNEAU: Thank you very much for your testimony. Senator Merritt would you like to close?

SENATOR MERRITT: Yes. Thank you very much, I appreciate you. You have a very busy schedule and you are hearing this bill, Senator Charbonneau. Thank you very much to the Members – have you adopted the Amendment? I don’t recall. Okay. Well thank you very much for adopting the Amendment. This is counterintuitive as it is working in Marion County, and it is working in the Commonwealth of Kentucky. This is just one more tool in the toolbox.

CHAIRMAN CHARBONNEAU: Thank you. We have an amended bill. Please call the roll.

(CLERK CALLS ROLL)

CLERK: 9 – 1

CHAIRMAN CHARBONNEAU: Thank you, Senator Merritt. The bill moves to the floor 9 – 1.

DOUG MCVAY: That was a hearing at the Indiana State Legislature on SB1207, which would have allowed syringe service programs in Indiana to continue operating in that state without the need for the legislature to reapprove those programs every two years. The people you heard were State Senator James Merritt who is a Republican and the bills’ lead sponsor, and Madison Weintraut who is the Program Director of the Marion County Public Health Department’s Safe Syringe Access and Support Program. As it stands now, Indiana’s Syringe Exchange Program will need to be reapproved before it expires on July 1, 2021.

Sharon Ricks works for the office of the Assistant Secretary of Health at the U.S. Department of Health and Human Services, she spoke in and facilitated a webinar back in November sponsored by HHS that was entitled Syringe Service Programs: The Essential Roles of Non-Governmental and Community Based Organizations. Let’s hear some of that now.

SHARON RICKS: Our department recognizes that Syringe Service Programs, or SSPs are a key component in reducing the transmission of infectious disease, preventing overdoses, and promoting long-term recovery. These programs can offer access to sterile syringes and injection equipment as well as other healthcare services such as vaccinations for Hepatitis A and B, and influenza; testing for infectious diseases such as HIV, viral Hepatitis, and other sexually transmitted infections; naloxone and training to prevent overdoses; linkage to medication assisted treatment for Substance Use Disorder and other needed services such as primary care.

We know that people who participate in SSPs are five times more likely to enter drug treatment and 3.5 times more likely to stop injecting compared to those who don’t.

Opioid and drug misuse is linked to marked increases in Hepatitis and HIV. This slide highlights 46 states including DC, and Puerto Rico which are experiencing or are at risk for significant increases in Hepatitis infection or an HIV outbreak due to injection drug use. The green areas show those jurisdictions that are experiencing or are at risk for outbreaks. The pink areas show the top 220 vulnerable communities in 25 states. For those of you who noticed that pink cluster around Kentucky, Ohio, and West Virginia please know that plans are underway at multiple levels to develop a regional framework to address infectious disease associated with drug use in that area of the country.

In 2017, HHS launched a comprehensive five-point strategy to empower local communities on the front lines of the opioid crisis. The strategy focuses on being better in five areas.

1 Better access to prevention, treatment, and recovery services and that includes SSPs.

2. Better data that is more timely and specific and improves our understanding of the crisis.

3. Better management for pain approaches that are healthy and evidence-based.

4. Better targeting of overdose reversing drugs and SSPs can help in that area as well.

5. Better research on pain and addiction.

HHS is dedicated to informing communities about SSPs as a critical public health intervention and on November 6, 2019 ADM. Brett Giroir, our Assistant Secretary for Health released a blog highlighting the fact that comprehensive Syringe Services Programs have the proven ability to help combat the opioid crisis and prevent the spread of infectious disease linked to injection drug use.

HHS has several resources available to support the implementation of SSPs. You will find a suite of materials at www.cdc.gov/ssp. Also, CDC recently awarded funding to the National Alliance of State and Territorial AIDS Directors to develop a national network that provides harm reduction and technical assistance that is responsive to the needs of state and local jurisdictions. Also Ryan White HIV/AIDS Program, and the Substance Abuse Prevention and Treatment Block grant makes additional resources available.

Today’s webinar is a part of an effort led by the office of the Assistant Secretary for Health to collaborate with federal, state, and county stakeholders to create and expand Syringe Service Programs in vulnerable communities across the nation.

DOUG MCVAY: That was Sharon Ricks with the Office of the Assistant Secretary of Health at the U.S. Department of Health and Human Services. She spoke in a November 2019 webinar from the U.S. Department of Health and Human Services entitled Syringe Service Programs: The Essential Roles of Non-Governmental and Community-based Organizations. Members of the Indiana State Senate should listen to that.

The U.N.s Commission on Narcotic Drugs will hold its 63rd Annual Session March 2 – 6 at the U.N.s Vienna Headquarters. Only a few details about the session are available so far. The program has not yet been posted. The first Intersessional Meeting of the 63rd Session will be February 17th. Once again, I will be staying up overnight with a pot of strong coffee to record the proceedings. If there is anything of note, I will bring it to you. That is it for this week. I want to thank you for joining us.

You have been listening to Century of Lies we are a production of the Drug Truth Network for the Pacifica Foundation Radio Network. You can find us on the web at: www.drugtruth.net. I am your host, Doug McVay, Editor of www.drugwarfacts.org

The Executive Producer of the Drug Truth Network is Dean Becker. The Drug Truth Network has a Facebook page, please give it a like. Drug War Facts is on Facebook as well, give its page a like and share it with friends.
You can follow me on Twitter: @DougMcVay, and @drugpolicyfacts. We will be back in a week with 30 more minutes of news and information about drug policy reform and the failed war on drugs. This is Doug McVay saying 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 are archived at the James A. Baker, III Institute for Public Policy.