Just weeks ago no Southern state had ever legalized syringe exchange. Not only that, but most of the Bible belt looked years or even decades away from ever doing so. Then on March 25th 2015 Kentucky shocked the country by passing a comprehensive bill to address heroin use that includes, among other things, authorization for syringe exchange.
Most of us were left not knowing whether to cheer or to scratch our heads in confusion. All of us had burning questions. To get some answers, I spoke with Jason Merrick, an advocate for Senate bill 192, about how such remarkable legislation passed in Kentucky.
Tessie Castillo: Congratulations on S. 192! Can you describe the bill?
JM: This bill will allocate money for substance use treatment, including in jails. It allows first responders and school nurses to carry naloxone. It will help eliminate the hesitation to call for help during an overdose situation by granting immunity from arrest and prosecution to those who call for help. It distinguishes between a dealer and a person trying to self-medicate and manage their disease. And needle exchange is made legal. I feel like this legislation is moving Kentucky into a state of addressing heroin addiction from the medical perspective rather than the criminal perspective.
TC: How have you been raising awareness?
JM: It will take a lot of outreach and education with law enforcement and drug user communities to teach them about the law, but we have already begun. Since the bill became law, I have been to 16 different police departments to train them about naloxone and avoiding needle-stick injury. We provide each officer with stick-resistant gloves, sharps containers and evidence tubes for syringes. The conversations have been heated. It is difficult to convince them [to carry naloxone], but we just plant the seed and keep them informed.
TC: Describe the advocacy process of getting syringe exchange included in the bill. Was anyone against it?
JM: Initially syringe exchange was a throwaway piece in the bill. The House (controlled by Democrats) was for it, but the Senate (controlled by Republicans) was not. Syringe exchange was a leverage point that could be compromised to get other things. But once the outbreak in Indiana occurred, where HIV through injection drug use skyrocketed, syringe exchange became a necessity in the bill. We had already been using grassroots efforts to develop a streamlined message about syringe exchange so that everyone was saying the same thing. Then the news from Indiana broke just two weeks before the bill passed and it became this perfect storm. Suddenly everyone was for syringe exchange. Republicans included it in exchange for some increase in penalties for drug dealers. We had people outside the legislature day and night advocating for this bill. The governor attributed the passage of such a comprehensive bill to the folks who showed up to fight for it.
TC: Anything you would change about the bill?
JM: I'm not happy that we are not covering methadone under Medicaid. Methadone is proven to stabilize somebody at high risk for substance use or engaged in criminal activity. Methadone can move them from hustling for the next fix to stability under a doctor-prescribed medication.
TC: Why is this a big deal in the South? Do you think it is replicable in other states:
JM: I think that the grassroots effort, the organized voice, teaching people to speak the same language, encouraging law enforcement take part, is very replicable. There is such a strong case to allow access to syringe exchange. Syringe exchange can connect people to housing, insurance, health care, etc. It's about shifting the culture from drug glorification and unrest to one of recovery. We want syringe access programs to become a hub of healing, to infiltrate affected areas and provide services to create healthy communities, help poverty, pregnancy, alcoholism, etc. Exchanges are shown not to increase crime or encourage drug use. We also described the savings. Preventing one case of hepatitis C could fund the entire project for a year.