County health department, local law enforcement debate harm reduction service


A new study committee plans to address a disagreement between the county health department and a local law enforcement agency.

During a recent Jackson County commissioners meeting, Lt. John Watson with Seymour Police Department and Dr. Christopher Bunce, public health officer for the Jackson County Health Department, discussed a service that has affected both agencies.

The subject involves the distribution of safety supply bags by the health department’s harm reduction program, called the CARES Clinic.

CARES, which operated out of a location on North Chestnut Street before moving back to the health department this past spring after changes in leadership, offers a variety of services. It provides screenings for HIV and hepatitis C and distributes the opioid overdose reversal drug naloxone to those who need it as well as serves as a resource of education for those battling drug addiction. 

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The CARES program expands beyond the health department’s doors.

Each Thursday, Carla Wright volunteers to bring the CARES services to The Alley, a church at 1107 W. Towne Plaza in Seymour.

An additional service, that started being offered in July, is what has stirred debate.

At The Alley, Wright has two different bags filled with various items that are used for smoking/snorting and injecting/shooting drugs. Some of the items include cut draw straws, sterile water, containers called “cookers” used to heat hard drugs and cotton swabs along with other sterilization items.

The health department distributes the bags to help prevent the spread of diseases such as HIV and hepatitis C.

Watson, who also spoke on the issue at a recent county council meeting, said he is concerned about the distribution of the bags.

None of the items within the bags are illegal, but Watson said under state law, they can be considered paraphernalia.

According to Indiana Code, possession of paraphernalia is defined as “a person who knowingly or intentionally possesses an instrument, a device or another object that the person intends to use for introducing into the person’s body a controlled substance; testing the strength, effectiveness or purity of a controlled substance; or enhancing the effect of a controlled substance.”

Possession of paraphernalia is a Class C misdemeanor, carrying a maximum sentence of 60 days in jail and a maximum fine of $500; however, if a person has a prior conviction for possessing paraphernalia, the offense is enhanced to a Class A misdemeanor with a maximum sentence of 356 days in jail and a maximum fine of $5,000.

Watson said officers recently found one of the bags while checking in on someone who was on probation.

“We first came across it when we were doing a home visit,” Watson said during the commissioners meeting. “We were checking in on a client and found the paraphernalia in the house. The client was arrested and taken to jail. We found later that she had gotten it from the health department.”

Watson said while he understands the program aims to prevent disease and he doesn’t believe there’s any bad intention behind it, officers have to go by the law.

“I have to enforce state law,” he said. “By state law, if you have the intent to inject, it is paraphernalia.”

Bunce then spoke at the meeting and said the health department’s job is to help stop the spread of disease and that it’s a non-law-and-order approach they are taking.

“What we’re interested in as a health department is reducing harm,” Bunce said. “We know that drug use is an illegal activity. We know that the distribution, use and possession of drugs is illegal. What we’re trying to do is intervene in a health way to try and help drug users reduce the transmission of infectious diseases.”

Bunce said Jackson County has seen an uptick in disease because of the sharing of instruments used for making and injecting drugs.

In Jackson County, 55 residents were diagnosed with HIV as of 2017 when data was last available from the Indiana State Department of Health. That number includes those who lived in other areas but have since moved to the county.

The county had 74 cases of hepatitis C in 2017, according to the state.

According to the county health department, it had administered 164 hepatitis C tests and 181 HIV tests since 2017.

There were four cases of hepatitis C reported in 2017, nine for 2018 and five so far in 2019. There has been one HIV positive test in that time frame as of Wednesday.

“Our emergency rooms have been inundated with people who have abscesses, endocarditis, all kinds of infections due to infections,” Bunce said. “We also have a huge number of hepatitis C and a growing number of HIV cases. The goal is to reduce the transmission of disease by using clean equipment.”

Local monies are not being spent on the bags distributed by the health department, Bunce said. He said all of the items are funded through a grant and similar harm reduction programs are being used all across the United States, including Indiana.

Since the county doesn’t have a needle exchange program, Bunce said he feels the bags are the next-best option. He said the World Health Organization, Centers for Disease Control and Prevention and Department of Health have all proven harm-reduction plans, including syringe exchanges, work.

“We do not have a syringe service program in this county. Eight (of 92 counties) in the state do,” he said. “We’ve had this discussion before (at commissioners meetings) and elected to not receive a syringe service program, which is where you provide clean needles and syringes and you collect them in a safe manner to prevent people from reusing them and sharing them.”

Bunce said the bags the health department are handing out aren’t going to increase drug use in the area, which is a misconception that many have toward harm reduction programs.

“I do not think the items here will increase the use of drugs in our county,” he said. “I think the only thing they can possibly do is make it a little more safe. Not as much as giving out syringes or needles, but a little bit (more safe).”

While Bunce wants a needle exchange program, pointing to the successes in Clark County, he said he understands why one isn’t in place.

“I understand it’s a very politically sensitive thing,'” Bunce said. “In the end, that’s what I would like to do. I am also sensitive to the morays of the community and what they expect.”

Seymour Officer Ben Miller also attended the meeting with Watson and asked if those taking the bags are being informed of the possible legal ramifications.

“It’s a separate charge. You are getting possession of drugs and the paraphernalia,” Miller said. “When you have a home visit and they are really restricted, they are going to get picked up on it. Are we explaining that they can be charged and telling them they can’t hide behind the health department?”

Wright, who has volunteered for about one and a half years with CARES, said many people have refused to use the services because of fear of getting punished by the law.

Both Wright and Bunce said if the community doesn’t have a solid harm reduction plan in place, it could have an outbreak of disease like Scott County did from 2011 to 2014.

“We are trying to help stop the spread of disease,” Wright said. “We don’t want what happened in Scott County to happen here. We are trying to be proactive and reactive. Scott County had no choice but to be reactive. We have to figure out how to make the legal aspect mesh a little closer with what we are trying to do and make it safe.”

Wright estimated she gives out about 16 of the bags per week, but the number increases to 20 to 24 when the food pantry is open at The Alley.

She said the goal is education, and many drug users don’t realize all of the different illnesses and diseases that can spread because of drug use.

She said statistics show those involved in harm reduction programs are 40 to 45% more likely to get help or treatment for their drug use.

“I’m not just slinging paraphernalia,” Wright said. “I have treatment resources. I can get people signed up for insurance and I have hygiene-type things, among other things.”

Bunce said he doesn’t plan on stopping the current program for the time being.

“It’s not just my passion here,” he said. “It is my duty because as a physician and public health official, I have to represent what is considered the highest standard of public health policy in the United States.

“I have to look at the state health department, Centers for Disease Control, National Institutes of Health and the World Health Organization all giving me data. In the same way you have to uphold the law, I have to follow what dictates my profession.”

During a recent briefing on drug use in the county, Bunce reiterated the importance of having harm reduction services.

“You can’t do harm reduction unless you believe three things,” he said. “Harm reduction is a complex medical and mental health problem that’s simply not a matter of criminal behavior. You have to take a drug user and sort of think of them more like an alcoholic. It’s not illegal to be an alcoholic or drink.

“Individuals who suffer from addiction are family and community members worthy of our efforts. They’re citizens,” he said. “You might not like them, but they are someone’s family member. You have to believe that. If you don’t, the health department, community, nobody is going to buy into harm reduction. Drug addiction recovery is a long process with frequent relapses. If a little bit of failure on the way to success disturbs you, you can’t do harm reduction.”

County Prosecutor Jeffrey Chalfant said he has talked to Watson about the issue and is trying to get more information on the program. He said drug residue is not required for an officer to arrest a person for paraphernalia, and multiple parties need to meet to address the issue at a county level.

Commissioners President Matt Reedy came up with a suggestion during the meeting earlier this month to address the topic.

He said a committee needs to be formed involving local law enforcement agencies, county council and commissioners and the prosecutor to discuss the issue.

Both Watson and Bunce agreed with Reedy, and a motion to form the committee was approved.

Free HIV, Hepatitis C, and STD testing is offered by the health department. For information on the agency’s programs, call (812) 522-6474.

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