Author: Barrett J. Brunsman
Cincinnati Business Courier

Needle-exchange programs can dramatically reduce both the spread of Hepatitis C and the rising financial cost of the heroin epidemic in Northern Kentucky, says Garren Colvin, CEO of St. Elizabeth Healthcare.

“I can tell you the burden to the taxpayers is in the billions of dollars,” Colvin said of the annual cost of treating Hepatitis C in the United States.
“No CEO of an organization should know as much about heroin as I know,” Colvin said during a gathering that included local business leaders at St. E’s flagship hospital in Edgewood. 

“There are two paths we’re working on (to combat) heroin,” Colvin said of St. Elizabeth, which also operates hospitals in Florence, Fort Thomas and Williamstown as well as a Falmouth drug and alcohol treatment center. “The first and I think most important is a needle exchange or syringe exchange.”
Under a new Kentucky law, the city and county government in which a needle-exchange program would be operated must approve of it. Covington and Kenton County have agreed to implement a needle-exchange program, and now St. Elizabeth is working with Newport officials to try to win approval in Campbell County.

“I would prefer calling it disease management because a true syringe-exchange program is trying to stop the spread of Hepatitis C and HIV,” Colvin said.

“From my perspective, it’s a spread of disease,” Colvin said. “From our community’s perspective, it should be about the cost that patient class puts on the system. It’s remarkable. For every Hepatitis C treatment, it is about $86,000 to $90,000.”

Following a tour of St. Elizabeth’s Edgewood hospital that included myself and several local CEOs, Colvin was asked what the hospital system was doing to help combat the heroin problem. The epidemic has been fueled by the abuse of prescription opioid drugs.

In addition to advocating for needle exchanges, St. Elizabeth is involved in a medically assisted therapy program. St. E provides Vivitrol shots to block the pleasurable effects of opioids.

“We’re not dispensing methadone or Suboxone, we’re just treating and giving prescriptions,” Colvin said.

Suboxone is a prescription medicine used to wean people off of addictions to heroin or prescription opioid drugs. Methadone is a narcotic pain medicine used to treat such addiction.

St. Elizabeth is treating nearly 300 people addicted to heroin or other opiates through its medically assisted therapy program, and 90 percent have Hepatitis C, Colvin said.

It would cost at least $23 million to treat the 270 in the medically assisted therapy program who have Hepatitis C, a virus that is the leading cause of cirrhosis, liver cancer and liver transplants.

“That’s one treatment,” Colvin said. “If you relapse and get Hepatitis C again, typically they won’t provide the treatment for you because it’s not as effective. So if you need a liver transplant, you’re looking at $600,000 (per person).”

In addition, every HIV patient costs $600,000 a year “just for the medications,” Colvin said. “That’s not counting any acute care stays associated with their HIV.”

Other medical costs of treating drug abusers are also significant.
“Every time an IV user gets infected and comes in for IV antibiotics, our physicians cannot treat them on an outpatient basis (because of liability concerns),” Colvin said. “They actually admit them. So they are in our hospital for 30 days. Each one of those costs $120,000 for 30 days, and really the only thing they are getting is antibiotics through an IV.”

Last year, 1,132 people in Boone, Campbell, Kenton and Grant counties and were diagnosed with Hepatitis C, according to the Northern Kentucky Health Department. That was a 27 percent increase from 2014, when 891 cases were reported. Northern Kentucky has the third-highest rate of diagnosed HIV cases in the state with 750.

Needle-exchange programs implemented in some Indiana and Ohio communities greatly reduced exposure to Hepatitis C and HIV, which is the virus that causes AIDs, Colvin said.

Concerns that needle-exchange programs enable drug users are unfounded, Colvin said.

“All the statistics bear out that it’s is the right thing to do,” Colvin said. “There is not one statistic that will reflect we’re enabling drug utilization through a needle-exchange program.”

The programs simply enable intravenous drug users to use sterile needles rather than contaminated ones. Virus-born diseases such as hepatitis C and HIV can be spread when drug users share needles.

“What we try to do is educate the community on these issues, but there are certain individuals who think enabling is far more of an issue than the burden it is going to put on the taxpayers,” Colvin said.

In 2014, Kentucky reportedly spent more than $50 million to provide Hepatitis C drugs to 861 people. That was about $86,000 apiece – and about 7 percent of the state's total Medicaid budget. Medicaid is a state-run program that helps pay for health care. The federal government reimburses states for a percentage of the cost.

A needle exchange program launched in Hamilton County in 2014 met a barrage of criticism from some who feared it would exacerbate the heroin problem. A University of Cincinnati doctor who served as medical director of the program in an effort to combat the spread of HIV and hepatitis said the public backlash was spurred by sensational TV news coverage.

Colvin addressed each point of criticism that opponents have raised about such programs.

For example, “this is not going to create a black market,” Colvin said. “Dirty needles on the street are about $5 a pop, so there’s already a black market.”
Another criticism from some is that such programs might provide more than one needle for each dirty one turned in, Colvin said.

“But when you have a household with six individuals all sharing the same needle, they can’t bring six dirty needles in because there’s only one,” he said.

St. Elizabeth advocated a needle-exchange program in Williamstown, and the one created at the Grant County Health Center earlier this year has shown impressive results, Colvin said.

“The first 11 patients that came in all had jobs and insurance, so they were working in decent jobs,” Colvin said. “Four of those 11 are now in treatment. That’s just under 40 percent. A good national average would be 20 to 25 percent.”

Colvin added that St. Elizabeth doesn’t favor letting criminals escape justice just because they might have a drug problem.

“I don’t think you can police your way out of this problem, but we are strong supporters of putting people in jail who need to be in jail,” Colvin said.