Kentucky law authorizes county health departments to implement harm reduction needle exchange programs given that the county receives approval from all governing authorities including the local and/or district boards of health, the county government, and the city government in the jurisdiction in which the exchange is intended to operate. As of April 2016, five county health departments operate needle exchange programs and around 20 other county health departments are seeking approval from their governing authorities or beginning to discuss engaging in this process.
I conducted qualitative interviews with key stakeholders in the implementation process to determine the facilitators and barriers of needle exchange program implementation. In counties that have implemented programs, the political climates were supportive or became supportive after being educated about harm reduction. However, in two counties that are currently stalled in implementation efforts, education alone has not proven to be an effective facilitator at all levels of government. Instead, the political leaders either will not agree that the program is needed or cannot agree on the logistics of the intended program. This is due in part to the influence of the political climate.
The implications of this study are that disseminating knowledge about evidence-based policies and the process of implementation is complex, particularly with needle exchange program implementation, due to a lack of understanding or a lack of acceptance of evidence based research and due to debate among governing authorities. The findings of this study show that implementation facilitators such as presenting evidence-based research and gaining support from key partners alone do not cause approval. Other factors such as acceptance by all stakeholders, recognition of the drug issue, the climate, and the views of the electorate are more influential in policy decision-making
