To sum up the drug problem in Brown County, Sheriff Scott Southerland says: It’s bad.
“It weighs on my mind. Every day I think about it because I fear that we’re losing a large percentage of an entire generation,” he told the Brown County Commissioners on March 2.
“I’ve known people who are good, solid Brown County human beings that I care about and we all care about. They’re just people who are struggling with a grandchild that’s gotten left of center,” added commissioner Dave Anderson, a former state trooper and former sheriff who’d asked Southerland to speak about the narcotics problem in Brown County.
For those reasons, members of the Indiana Naloxone Project hosted a training session in Brown County on March 5. About 28 people learned how to administer the medicine that can reverse an overdose of opiates such as heroin.
Some even took a test to become trainers, said Christy Thrasher, a member of the Indiana Naloxone Project.
“It’s a hard one for people to show up for, depending on your circumstances. There were people there who knew of other people who could use it who didn’t feel comfortable coming, so they took the test to be trainers,” she said.
“That’s what I hope happens — that we just keep training trainers so that the community can become self-sufficient.”
Thrasher and others believe another component to combating drug abuse would be to establish a syringe access program.
It would give clean needles to drug addicts. About eight people meet regularly to discuss that possibility here, she said.
Reaching out to addicts would give a group like the Indiana Recovery Alliance a way to connect to those who need medical care or want to seek treatment to end their addiction, Thrasher said.
“People don’t go to the doctor, and they don’t go to the ER because they’re ashamed and they’re scared, and they get treated really badly sometimes,” she said.
“It’s enabling them to access health care and other services in our community that they’re presently not connected to. It is enabling them to be healthy and to be reintegrated into our community,” Thrasher said.
Reducing risk
Before Brown County could establish a syringe access program, also known as a needle exchange program, several conditions would need to be met.
One condition is to have two treatment referrals available for addicts who want to quit.
Centerstone in Nashville can link addicts to a psychiatrist who can prescribe medication-assisted treatment, which uses suboxone or methadone, both synthetic opioids, said David Powell with Centerstone public relations.
He said the agency coordinates with physicians throughout southern and central Indiana who also prescribe that treatment.
However, none of those doctors are in Brown County, Thrasher said.
“If somebody comes to get clean needles and says, ‘You know, what I really want it is to quit,’ we want to be able to say, ‘OK, we can help you right now,’” she said.
“It’s really important to all of us that the two treatment referrals we have really translate to actual treatment and care for our community members, not just things we can write down.”
Clinics in Indianapolis have offered to take Brown County patients, but Thrasher said that’s not realistic because many addicts lack the means to get there.
Brown County Health Officer Dr. Norman Oestrike said getting local physicians certified to do medication-assisted treatment isn’t likely because of the requirements and restrictions on doctors. “In my opinion, it is so onerous that I would never do it, personally, and if I wouldn’t do it, I doubt most other doctors would do it,” he said. Oestrike said those doctors are limited on how many patients they can see.
“It’s an enormously complex problem of communication,” he added, mentioning a need for coordination with the prosecutor’s office and law enforcement to perhaps not charge a person with possession of paraphernalia if they are found with a needle.
If addicts are not ready to get clean, Thrasher said, a syringe access program would at least be one way to reduce their risk of contracting a disease that can be spread through sharing needles — such as HIV or Hepatitis C — until they are ready to quit.
“They may never be ready to quit, but at least we can help keep them safer,” Thrasher said.
Thinking ahead
Another condition of establishing a syringe access program is for Brown County to show an increase in Hepatitis C and HIV cases. Then, Oestrike would have to declare a health emergency.
In the 2015 health department annual report, Oestrike said the county needs a better testing system for these diseases so an epidemic can be caught before it happens.
“I personally believe that it is not a matter of if, but a matter of when we will have to act here in Brown County,” he wrote.
“All areas that have faced an epidemic have had to initiate a needle exchange program to mitigate the situation.”
Last May, Scott County declared a public health emergency after an increase in reported Hepatitis C and HIV cases.
Monroe County also declared a local public health emergency last year after an increase in reported Hepatitis C cases. The Indiana Recovery Alliance established a syringe access program there.
About 92 to 93 percent of HIV patients in Scott County also reported having Hepatitis C, Oestrike told the local health board March 15.
“The assumption is if you have Hepatitis C then you have more HIV. That has not been proven in our county yet,” he said.
Local stats
According to the Indiana State Department of Health, fewer than five people in Brown County were diagnosed with HIV or Hepatitis C in 2015. The total number of people living with HIV here in 2015 was 12 — down from 23 in 2014.
Thrasher believes those statistics are lower than the actual total, since Brown County does not have a hospital or doctor’s office that does testing.
“We really strongly believe that the numbers are much higher and we have people that are unidentified with Hep C and possibly HIV in the community,” Thrasher said.
“Anybody who is getting tested is getting tested out of county. It would be whether or not they reported that they live in Brown County and whether or not whoever they reported it to reported it to the state,” Thrasher said.
“We really just want to identify those people and direct them towards resources for help. They should be getting health care for those issues.”
On Tuesday, April 5, Positive Link, through Indiana University Health, will offer free HIV and Hepatitis C testing at the Southern Indiana Physicians’ office on Willow Street in Nashville.
“After the outbreak last year, we’ve been trying to reach out, particularly into the more rural communities that don’t have as many services to try and get something set up,” said Jill Stowers, Positive Link’s program manager and a Brown County resident.
“I don’t see Brown County having that level of an issue, but by the same token, I absolutely don’t want Brown County to have that level of an issue,” she said about the HIV/Hepatitis C outbreak in Scott County.
Positive Link also tests inmates at the Brown County jail as needed, but “not everybody is in jail,” Stowers added, and “we can’t catch everyone (only when they land) in jail.”
The plan is for Positive Link to visit Brown County every other month to do testing.
“I think it’s absolutely the most responsible thing you can do is just find out if there’s an issue because if there’s not, great. Let’s keep it that. But if there is, let’s address it before it gets out of hand,” Stowers said.
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All Brown County sheriff’s deputies have carried Naloxone since the latter part of 2015. They have used the antidote a couple of times, Sheriff Scott Southerland reported to the Brown County Commissioners on March 2.
“You give them a shot of that, and within seconds, they usually come up fighting. You want to have some help around if you can,” he said.
Local volunteer Christy Thrasher partnered with Chris Abert of the Indiana Recovery Alliance in Bloomington to write a grant on behalf of the Indiana Naloxone Project. That money from the Indiana Attorney General’s Office can be used to train first responders on how to administer Naloxone nasal mist.
Naloxone also can be administered through an IV or through an intermuscular injection.
In 2015, Thrasher and Abert trained firefighters at Van Buren Township and Fruitdale volunteer fire departments on how to administer the injectable form of Naloxone. Firefighters also are able to train others.
They plan to train the same departments, plus Hamblen Township Volunteer Fire Department and the Nashville Police Department, on how to administer the nasal mist and will distribute kits to all first responders.
Any first responder who hasn’t received training yet can contact Thrasher at [email protected].
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On April 5 from 3 to 5 p.m., Positive Link will offer free HIV and Hepatitis C testing at the Southern Indiana Physicians’ office on Willow Street in Nashville.
Results for HIV tests can be returned within 20 minutes. The test uses cheek cells.
Hepatitis C testing is done using a blood draw. It is sent to a state lab to get results, which takes several days.
“With Hepatitis, we can give those results over the phone. With HIV, we have to give them in person,” said Jill Stowers. Tracking people down can be difficult because of issues like unstable housing or work schedules.
If the rapid test is positive, getting a blood test is recommended to confirm the diagnosis, Stowers said.
If a person has been infected with HIV, it may take up to a month before it shows up on cheek swab test, so retesting may be necessary.
Positive Link hopes to visit Brown County every other month to do testing.
For several years, Positive Link had a testing site at Dr. Tim Alward’s office, but participation wasn’t very high, so the group started coming by request from a physician or a community group, Stowers said.
She said Positive Link works closely with the Brown County Health Department.
The health department is responsible for doing disease investigations when a person is diagnosed with Hepatitis C, letting the patient know what care is needed and where to get it.
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