The Kentucky Office of Attorney General released an opinion Monday morning stating that Louisville’s syringe exchange program is not restricted from giving its participants more new syringes than they receive in used ones, saying new legislation passed by the Kentucky General Assembly this year does not require a one-for-one exchange.
Republican Senate President Robert Stivers requested the opinion from the attorney general’s office, questioning whether SB 192 — legislation passed in this year’s session allowing local governments to institute a syringe exchange program — only permitted health departments to give out the same number of new syringes as used ones that a participant returned. Stivers was specifically critical of Louisville’s exchange, which is needs-based, giving the amount of syringes the participant will need to use over the next week, though urging the user to bring back all of the used needles.
According to assistant attorney general Matt James, SB 192 did not specifically define “exchange” to mean one syringe returned for one new syringe given, and this term can refer to the transfer of new syringes for the promise of their return. The Kentucky Department of Public Health issued guidance to local governments establishing harm reduction and syringe exchange programs (HRSEPs), saying they could choose between a needs-based negotiated model, a strict one-for-one exchange, or a model in which a the one-for-one exchange can be expanded — as is similar to the exchange program in Lexington.
“As applied in this context, ‘exchange’ does not require a quid pro quo exchange of syringes; it only requires a benefit to the party promising or a loss to the party to whom the promise is made,” reads the opinion. “An HRSEP may exchange the loss of a needle for a promise to participate in the program, and that is sufficient for an exchange in the ordinary sense of the term.”
The opinion goes on to state that the legislature could have limited such exchanges to a strict one-for-one model, but they chose not to do so.
“If the legislature had wished to limit HRSEPs to a specific type of program, rather than allowing flexibility in determining which type of HRSEP to offer, it could have done so,” reads the opinion. “In the absence of a more explicit definition of ‘exchange’ in KRS 218A.500(5), we advise that an HRSEP may exchange syringes for whatever consideration it deems appropriate, such as participation in the HRSEP program, and does not require a quid pro quo exchange of syringes.”
No legislation was pre-filed for the 2016 session of the General Assembly to explicitly restrict the exchange rate of syringes in local health departments, though it could be filed once the session begins in January.
While Louisville’s syringe exchange program initially had a very low return rate when it began this summer, over the past few months it has leveled out at roughly 50 percent. The Metro Department of Public Health and Wellness has a goal of ultimately reaching a 90 percent return rate and cites studies showing that needs-based models are most effective at preventing the spread of blood-borne infections like HIV and Hepatitis C among intravenous drug users through the use of shared needles.
Dr. Sarah Moyer, the interim director of the Louisville Metro Department of Public Health & Wellness, released the following statement on the attorney general opinion:
“We are happy that the state Attorney General has held that the Louisville Metro Syringe Exchange Program complies with KRS218A.500 (HB 192), as well as with the guidelines established by the Kentucky Department for Public Health. The ‘need-based negotiation model’ is a best practice across the country proven to reduce the spread of HIV and hepatitis C. Our goals are to prevent the spread of those diseases in our community and to stop people who inject drugs from sharing and reusing needles. The program is working. Since it began we have served more than 1,500 participants. More than half of those testing for hepatitis C have been found positive, and we are connecting them with treatment. Our syringe exchange ratio is down to 2:1. We have referred 93 participants to drug treatment.”
Story updated with additional comment at 2 p.m. on Dec. 21.