Former Senate Minority Leader Gretchen Whitmer, who is a leading candidate for the Democratic nomination for governor, is calling on Republican Gov. Rick Snyder to declare a public health emergency related to the ongoing opioid crisis in Michigan. She's also demanding he free up state dollars to address a potential HIV outbreak among people who use drugs in 11 mostly rural northern Michigan counties.
"Yes," she said when asked if the GOP leader should declare an immediate state of emergency and clear the way to use state dollars fund needle exchanges.
"We can't find any instance of the Governor having been briefed on the Hep C/HIV issue," wrote Snyder Spokeswoman Anna Heaton in an email. She referred questions about the situation to Michigan Department of Health and Human Services staff.
"In response to the HIV outbreak in Scott County Indiana, from Injection Drug Use (IDU), the CDC in Fall of 2015, performed an Analysis to Identify US counties where people who inject drugs (PWID) appear especially vulnerable to the rapid spread of HIV infection if introduced, as well as new or continued increases in hepatitis C virus (HCV) infection," wrote Erica Quealy, a spokeswoman for the Michigan Department of Health and Human Services. "This assessment identified counties that had similarities with Scott County Indiana that potentially makes them vulnerable for an HIV outbreak. This assessment identified that Michigan had 11 counties in the Northern Lower Peninsula that were deemed vulnerable (top 5 percent in the US) for an HIV outbreak from IDU. To date, MDHHS HIV Surveillance has detected no statistically significant increase in HIV cases in these counties associated with PWID."
She said as a result of those findings, last year the department authorized local departments in the affected counties to use up to 15 percent of their HIV education and prevention grant dollars for syringe programs. She said two departments have agreed to start such programs, and will be receiving additional funding for that in January 2018.
Quealy stressed that the CDC assessment was model and that no cases of needle related transmission of HIV in the at-risk counties had been verified to date.
In a phone interview with Between The Lines, Whitmer called the boiling opioid crisis the "biggest public health crisis in our lifetime." Whitmer was doing the interview to discuss HIV related policy in the state in advance of World AIDS Day, Dec. 1.
The Detroit News reports that in 2015 there were 1,981 drug-related deaths statewide in Michigan, but in 2016 there were 2,335 such deaths. The majority of those deaths were opioid related the newspaper reports.
Her call for a state of emergency and release of state dollars for needle exchanges comes as state health officials have revealed a dramatic increase in Hepatitis C cases in northern Michigan. Those cases are tied to intravenous drug use, said Katie Macomber, director of the Division of HIV/STD programs at the Michigan Department of Health and Human Services.
"We know because of hepatitis rates, especially in upper Michigan, that people are likely getting infected with Hepatitis C through injection drug use," Macomber said. "We're not seeing HIV."
Unspoken was the word "yet." Macomber acknowledged that the most recent example of a massive outbreak of HIV in people who use drugs saw a dramatic increase in Hepatitis C cases before HIV made its way into the network. That was in rural Scott County Indiana in 2015. Nearly 200 people were ultimately diagnosed in the outbreak which required an emergency declaration by then Gov. Mike Pence to allow a syringe exchange program to help stem the tide of the outbreak. All the cases were tied to a network of people using the opioid Opana by crushing it up, dissolving it in water and injecting it with shared needles. Prior to that outbreak, the rural county in southern Indiana routinely registered only five new cases of HIV a year.
A study published by the New England Journal of Medicine in July of 2016 reported that of those infected with HIV during the outbreak, just over 92 percent were co-infected with Hepatitis C. That study identified the outbreak of the liver virus as a precursor to the HIV outbreak.
"Third, HCV infection was highly prevalent in this network of persons who inject drugs," the authors wrote. "Reports of new HCV infections should be noted because they can serve as markers of communities at risk for HIV, and interventions to prevent further HCV infections, such as syringe-exchange programs, could possibly contribute to reducing the risk of an HIV outbreak."
Michigan's drug paraphernalia law has a provision allowing for the distribution of sterile needles to prevent the transmission of infectious diseases. However, there are only three operating needle exchange programs in Michigan — Flint, Grand Rapids and Detroit.
Whitmer's call on Snyder comes on the heels of her first large scale policy speech since entering the race nearly a year ago. That speech was on the opioid crisis and she laid out a six point plan to address the crisis.
Late Monday afternoon, Snyder announced the formation of a permanent Public Health Advisory Council. That body was created as part of a recommendation of a task force that reviewed public health activities in the wake of the Flint water crisis. The 26-member council will advise the governor on emerging public health issues and ways to respond, according to a press release from Snyder's office.