State Sen. Damon Thayer, R-Georgetown, filed legislation Wednesday that would require local health departments with a syringe exchange to operate on a one-for-one exchange model, thus forcing Louisville to end its need-based model that is widely held to be the best practice among public health experts to prevent the spread of blood-borne diseases like HIV and hepatitis C among intravenous drug users.
The Louisville Metro Department of Public Health and Wellness has operated syringe exchange sites since the summer of 2015 using a needs-based model, which allows the number of new needles dispensed to be greater than the number returned and commensurate with the patient’s weekly drug use. A one-for-one model only dispenses one free needle for every one used needle returned.
The General Assembly passed legislation in 2015 that first allowed local health department’s to create their own syringe exchanges, which Metro Council quickly approved. The attorney general issued an opinion later that year that this legislation did not require a one-for-one exchange model.
In response to that opinion from the attorney general, the state Senate passed a bill in 2016 mandating local health departments to use a one-for-one model, though the House declined to pass this into law. While debating the bill on the Senate floor, Sen. Thayer stated that if their one-for-one legislation did not pass into law: “I will file a bill next year to eliminate the needle exchange altogether. I’m willing to give this one more year.”
No such legislation gained traction in the 2017 and 2018 session, but Thayer is reviving the effort in this session with his Senate Bill 69, which he is currently the lone sponsor of.
In its first three and a half years of operation, Louisville’s syringe exchange sites — now totaling six — distributed millions of clean needles to 17,729 unique clients, in addition to referring 684 patients to drug treatment and testing nearly 3,000 for hepatitis C and HIV.
While facing criticism in the program’s initial months for its high ratio of clean needles distributed to used needles returned, the Louisville exchange has maintained a ratio well below 2-to-1 each month over the last three years, with returning clients regularly turning in over 80 percent of their old needles.
Responding to some of the early backlash over the exchange and sensationalized news coverage, Republican members of Metro Council have consistently voiced support for the program and allowing the health department to continue operating under the same model.
Public health experts have criticized one-for-one exchange models, while Dr. Sarah Moyer, the director of the Metro Department of Public Health and Wellness, touts their needs-based model as a widely accepted best practice.
“The primary goal of a syringe exchange program is to stop the spread of diseases such as HIV and hepatitis C while also linking drug users to treatment, medical care, and other vital social services,” Moyer told Insider Louisville in a statement.
“A needs-based syringe exchange program, such as ours, is nationally recognized as a best-practice model recommended by the CDC,” she continued. “A one-for-one model presumes people who inject drugs aren’t already sharing syringes and therefore not sharing diseases. Research, and our experience in working with this population tells us this isn’t true. Without a source for clean syringes, they will share dirty ones.”