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The tracks on Kevin Polly’s arms tell the story of his long struggle with intravenous drug abuse.
“Most of this is Oxycontin track marks,” he says, his fingers tracing the scars. “The part with my neck, that’s new. That’s Opana.”
Opana, also known as Oxymorphone, is a highly addictive opiate and the drug of choice among IV drug users in Austin, Indiana.
“There ain’t nothing like it,” says Polly. “It’s sick, but true.”
Polly is also the face of a new epidemic: an explosion of HIV infections among IV drug users in Scott County, near the Kentucky border and one of the poorest counties in the state. The Indiana State Department of Health says that over 100 people have tested positive for the disease in the last four months, 20 times the normal rate for a whole year.
Nearly all of the new cases are linked to IV drug users sharing dirty needles. Polly says that clean needles are hard to find. Under Indiana State Law, possession of a needle without a legitimate medical use is a felony punishable by up to three years in prison.
“We had to use the same needle over and over again because you just couldn't find them,” says Polly.
The lack of needles contributed to practices that ultimately spread disease.
“It was nothing to share a needle," he says. "As long as we got the Opana in us, it didn’t matter.”
Polly found out that he was HIV positive six weeks ago.
On March 26, Indiana Gov. Mike Pence declared a health emergency in Scott County. The federal Centers for Disease Control and Prevention also persuaded him to authorize a 30-day needle exchange in the affected county, suspending state and local laws against the possession of drug paraphernalia there.
“As I read the executive order, I think it says that we can’t enforce the possession of the paraphernalia statute," said Scott County Prosecutor Jason Mount at a gathering of local, county and state police in Scott County earlier this month. “So that doesn’t mean just needles, that means all paraphernalia.”
But while the needle exchange started on April 4, there are already signs that it is running into significant resistance from local authorities.
Indiana asked Dan Bigg, director of the Chicago Recovery Alliance, to come to Austin to advise officials starting the needle exchange. His organization exchanges over 3 million syringes each year, and relies heavily on addicts to pass out syringes to others whose illegal drug habit often leads them to avoid authority.
Once in Austin, he started handing out needles liberally to IV drug users. “We know from all evidence gathered over the last 25 years that you need to be very generous with syringes," he said. "And you need to empower people to reach others.”
But Bigg says his efforts to get clean needles to addicts were blocked by local authorities who he says remain fixated on enforcing Indiana anti-paraphernalia laws. “They didn't want to hear what we had learned,” he says.
Kevin Polly is one of the addicts who has since been targeted by law enforcement. On April 8, four days after the needle exchange began, Polly says nine county and state police officers showed up at his house.
“I had received 1,500 syringes approximately a week before that I was giving out to people in the community that are afraid to go get help for repercussions like this,” says Polly. “And I was down to about 130 of them. They confiscated those from me.”
Polly says a woman in the house was also arrested and taken to the county jail when a single needle was found in her room. A Scott County clerk confirmed that a woman had been arrested at Polly’s residence on the date in question and was being held on $1,500 bail for possession of a syringe. The county prosecutor, the Scott County Sheriff’s Department and the Indiana State Troopers did not respond to requests for comment.
“Most of the people are afraid to go over. It’s supposed to be confidential and I don’t believe it’s confidential. The ones that are afraid to go to jail are going to use dirty syringes."
IV drug user
As a result of the raid, Polly says many addicts believe that if they sign up at the needle exchange, then they'll be targeted by police, deterring many addicts from taking advantage of the clean needle supply.
“Most of the people are afraid to go over. It’s supposed to be confidential and I don’t believe it’s confidential," he says. “The ones that are afraid to go to jail are going to use dirty syringes. They are going to continue to share, and the HIV is going to continue to be in Scott County on a very high basis."
Deputy Health Commissioner Jennifer Walthall, who's leading the state’s response to the epidemic, said she hadn’t heard of the incident, but defended local authorities.
“We have had extraordinary cooperation with law enforcement here," she said. "Of course, they are conflicted. They are supporting this needle exchange program in the best way that they can.”
The official exchange is limited to Scott County residents, and each user is given a number of needles based on his or her need for the week.
Walthall insisted that a measured hand-out was appropriate for Austin.
“Remember that Chicago is an urban setting, and this is not,” she said. “This is a place that has never had a needle exchange program before, and they are implementing a model they are comfortable with and will work for the population here.”
Much of the cost of treatment, both in Scott County and in other parts of the state, will ultimately be borne by taxpayers. And it's a shame to spend money on something that could have been prevented.
Indiana State Representative
Despite dozens of government-sponsored studies showing that needle exchanges are extremely effective in reducing HIV infections with no increase in drug abuse, they are banned in nearly half of the states. Austin’s Chief of Police Donald Spicer, who was interviewed before the police crackdown, admitted he was torn over the idea.
“If it’s going to save lives, I have to support what they're telling me will work because they know more about it than I do,” he said, referring to state health care workers. “From the law enforcement side of it, I can’t support it, because we’re not able to do what we need to do. We’re giving people things to use drugs with."
Infectious disease experts, who had expected the next HIV outbreak to occur in a densely populated urban area, are struggling to determine the true scale of the epidemic in a county with historically few HIV testing clinics.
“We haven’t reached the peak yet,” says Walthall. “We don’t know where that peak will be, but we are hopeful that it will be soon.”
Based on a spike in Hepatitis C infections, which are often a co-indicator of HIV, Indiana's own statistics show that up to 25 percent of its counties are at risk of a similar outbreak.
“The numbers have been increasing weekly. And we don’t know how far this has already spread,” says Republican state Rep. Ed Clere, who represents a nearby county. “And that's why it's so important to get in front of it now."
Clere, who chairs the House Public Health Committee, is pushing to expand the needle exchange to the 22 other counties at risk of an HIV outbreak. He says expanding the needle exchange isn’t only the moral thing to do; it also makes fiscal sense.
“Much of the cost of treatment, both in Scott County and in other parts of the state, will ultimately be borne by taxpayers,” he says. “And it's a shame to spend money on something that could have been prevented.”
Clere's amendment passed the state house by a vote of 54 to 39 and is now in committee. The governor has threatened to veto such measures in the past, but Clere remains optimistic that his will pass. Austin, he says, should be a wake-up call.
“Where there's smoke, there's fire," he says. "And if we can identify those areas where there's smoke, we can keep the fire from spreading.”
The governor’s emergency order expires in two weeks. Once that happens, he can decide to renew, expand or cancel the needle exchange.
Polly has his own urgent deadline. His doctor warned that if he doesn’t stop using drugs, he’ll likely die within the year.
“I'm going to stop,” he says. “And I’m getting some in-patient treatment starting next Friday. I’m looking forward to it. I just hope it isn’t too late.”