The numbers are startling.

Last year, Hamilton County alone averaged six fatal opiate overdoses a week. That’s more than 300 families a year planning a funeral and burying Cincinnati’s sons and daughters, most of them in their 20s and 30s. Nationally, the drug claims more than 8,000 lives a year.

According to the Centers for Disease Control and Prevention, heroin-related deaths tripled from 2010 to 2013, and the bodies are piling up at the highest rate in Midwestern and Appalachian areas. The Wall Street Journal called it the “scourge of the heartland.”

Feinberg was among the first in Cincinnati to pick up on the area’s heroin issue when a cluster of serious heart infections surfaced among her patients in 2005. The common denominator: injection of opioids. The epidemic, experts say, was fueled when opioid painkillers such as Percocet, OxyContin and Vicodin became harder to obtain — a result of government efforts to curtail prescription drug abuse and to shut down illegal pill mills. Eleven such clinics were shut down in nearby Portsmouth, Ohio, where doctors were doling out pain meds like M&Ms. But the public was already addicted, and dealers — ever the entrepreneurs — moved in with black-tar heroin from Mexico as the next cheap and available fix. A tenth of a gram, usually a dark goo wrapped in a balloon or plastic, brings $10 on the street.

Feinberg approached the dope surge the only way she knew how — as an infectious disease expert. She knew from past experiences at Johns Hopkins in Baltimore that both hepatitis C and HIV would skyrocket if heroin truly took hold in Greater Cincinnati, and she was right. Users in the Tristate were shooting up more and more, but they were also sharing needles and injection paraphernalia, which meant they were spreading disease rapidly. From 2009 to 2013, Hamilton County’s hepatitis C cases increased from 721 to 1,136, a 58 percent increase in four years.

 Still, due to political challenges, it took nearly a decade for Feinberg to get a needle exchange approved, funded and on the road. Health departments didn’t want to give the OK, and government officials didn’t want the mobile unit on their streets.

“It should not have taken nine damn years to tell people, ‘Look, we’ve got a public health problem here,’” the former New Yorker says in her direct style. “I can’t tell you what all people said to me, but people in public office that we had elected would say, ‘They are junkies. If they die — fewer junkies.’ I mean that’s what people said about gay men, too. ‘If they die — fewer gay men, the world will be a better place.’

“But here is the problem, the oath I took when I graduated medical school was not the ‘just-let-’em-die oath.’ When you see a patient with lung cancer from smoking, you don’t go in there and say, ‘You deserved this.’ It is not our job to judge. It is our job to take care of sick people.”

The key to reducing the spread of these diseases among injection drug users, experts maintain, is to educate users and equip them with clean needles. In addition, the exchange provides users with “cookers” and bits of cotton used to heat and filter the drug because hepatitis C lives on inanimate surfaces for days to weeks. The state of Indiana reversed its ban of syringe exchanges this year after a spike of 170 new cases of HIV among drug users in one southern county within a six-month period. And Northern Kentucky is pursuing an exchange after hospitals there reported more than 700 heroin overdoses in 2014.

While some maintain that handing out clean needles and paraphernalia encourages drug use, Feinberg scoffs, and points to dozens of studies that show syringe exchanges decrease drug use and get people into drug treatment.

“That is like saying that the existence of a mug facilitates alcoholism,” she says as she holds up the coffee cup from her desk. “If people want to drink straight from the bottle, they can. If an addict wants to shoot up, they will shoot up whether they have a clean needle or not. They will find needles in the street or whatever it takes.”

Harrison knows a thing or two about doing whatever it takes. She has even accompanied 20 or more of their clients to treatment. In those instances, the addict is normally “dope sick” and in withdrawal because treatment centers typically require them to be clean at least 24 hours before arriving.

“It is like the worst flu you have ever had, then multiply that by 10,” says Harrison. “It is a really rough place to be. It is awful, and your brain is misfiring because it is missing certain chemicals, and it is only telling you to go get drugs.

“I want them to have somebody who is taking care of them and shows up and holds their hand and makes sure they actually get there. They are sweating and throwing up. They can’t think and are generally crying, even the big burly men, because their emotions are so screwed up.”

Harrison sees the exchange as an opportunity to help people own their health care, but she also knows of seven former clients — those she cared for and cared about — who have died of an overdose. “We have lost some,” she pauses.

“Most of them are amazing wonderful people, and they deserve a chance. Heroin addicts are usually treated horribly. We get to be the place where they are loved, and having someplace where they can come and be loved knocks down some of the shame barrier.

“They are not going to go to treatment if they hate themselves. Nobody wants to be an addict.”

LINK:
Learn more about the Cincinnati Exchange Project