Many Republicans have long accused such programs of encouraging addiction, despite years of studies showing they reduce rates of infectious diseases without promoting drug use. Their opposition softened in the last decade as the opioid epidemic devastated communities and Trump pledged to defeat the crisis. But public health experts fear the country is witnessing the start of a broader Republican rebellion against these programs — one that’s partly fueled by anti-science backlash to Covid restrictions.
“There is a very retrogressive mood afoot,” said Judith Feinberg, a professor of infectious diseases at West Virginia University. “The mood that experts know nothing is deepening.”
Trump surgeon general Jerome Adams, who as Indiana health commissioner pushed for the creation of Scott County’s needle exchange and unsuccessfully lobbied local officials to save it, said there’s also an element of fatigue among Republicans, who are more likely to believe addiction is a moral failing than a treatable disease. After seeing the drug crisis persist despite Congress and states committing billions of dollars for treatment and prevention, there’s a feeling that people need to take responsibility for their actions, Adams said.
“Many in conservative America feel like we’ve given the opioid crisis the full court press,” Adams wrote in an email. “The attitude is we turned on these controversial harm reduction measures and gave people a chance – now it’s their fault if they don’t get better.”
Many needle exchange programs still enjoy bipartisan support, with some Republican governors backing legislation this year to expand their use. Arizona Gov. Doug Ducey last month signed a bill making Arizona the 38th state to allow needle exchange, while North Dakota Gov. Doug Burgum signed legislation expanding the state’s program that was first enacted in 2017. And Indiana Gov. Eric Holcomb’s administration was critical of Scott County’s planned closure of its program, though he signed legislation earlier this year reaffirming that local governments alone have the power to make such decisions.
Public health experts say what’s particularly worrying about the most recent wave of closures is they’re happening in areas especially susceptible to disease outbreaks. In West Virginia, the number of HIV cases among people using injectable drugs more than doubled between 2018 and 2020, according to the state health department. Scott County is among the 10 in Indiana most vulnerable to an HIV outbreak, according to the Centers for Disease Control and Prevention.
“It’s one thing to throw gasoline on a vacant lot,” said Gregg Gonsalves, an HIV researcher at Yale University. “It’s another to throw it on a smoldering fire.”
Needle exchanges, which have been in existence for decades, also provide a link to other services, such as drug counseling, as well as public health measures to reduce the spread of disease. People who use their services are five times more likely to begin drug treatment and three times more likely to stop using drugs than others who don’t use the program, according to data compiled by the CDC.
Despite the reported benefits of needle exchanges, critics across the country are united by a belief that providing needles enables drug use and is driving up overdose deaths. It’s the same type of sentiment that sustained federal bans on funding exchanges through the mid-2010s.
“I know people who want to kill themselves, I don’t buy them a bullet for the gun,” said Scott County commissioner Mike Jones before voting to end the county’s program. Jones did not respond to a request for comment.
It was Scott County’s 2015 HIV outbreak — when over 150 people were infected primarily by using tainted needles to inject the powerful synthetic opioid Opana — that led many Republicans to rethink their opposition to needle exchange. In just the next two years, six states passed legislation allowing such programs: Louisiana, Kentucky, North Carolina, Ohio, Tennessee and Virginia.
Some drug treatment advocates said the pandemic changed attitudes about these programs. Homelessness and injection drug use increased, as did discarded needles in public places. Republican lawmakers in West Virginia, for instance, cited the growing problem of needle litter as part of their rationale for cracking down on exchange programs.
A. Toni Young, the executive director of Community Education Group, a West Virginia nonprofit working to address the opioid epidemic, said although needle litter isn’t new, people are on edge after a year of isolation and patience for people using drugs has worn thin.
“People used up all their empathy with the pandemic,” Young said.
Some Democrats in other parts of the country have also complained about discarded needles and are questioning the usefulness of needle exchanges. Democrats in Atlantic City, N.J., are pushing to end their city’s program, and Pennsylvania state Sen. Anthony Williams said his legislation that would legalize needle exchanges statewide has faced bipartisan opposition.
“There are some moderate Democrats who are certainly concerned about drug addiction who have substantive questions about what this would mean — does it increase drug use?" said Williams, who represents a district spanning Philadelphia and Delaware counties.
Commissioners of Grays Harbor and Scott counties said local officials and community groups should continue to make available other services that had been offered through needle exchange programs, such as links to addiction treatment programs, counseling and STD testing. But drug treatment advocates are skeptical those services can be maintained at the same levels.
When California’s Orange County closed its only needle exchange program in 2018, those wraparound services also fell off, said Philip Yaeger, CEO of Radiant Health Centers, which is focused on ending the HIV epidemic. His organization had worked with the needle exchange to provide hepatitis C testing to people who came for clean syringes, but that effort stopped when the exchange shut down. He also said that the needle exchange was useful in connecting people to drug treatment programs who otherwise likely wouldn’t come forward for help.
“Those individuals are not going to knock on the door looking for preventive services,” he said.
The number of HIV cases in Orange County has increased every year since 2018, as has the percentage of cases related to injection drug use, according to county health data. The closure of a needle exchange program that same year in West Virginia’s Kanawha County is also likely responsible for HIV cases more than doubling per year around Charleston, the state’s largest city, some experts believe.
“There’s a direct connection,” said Feinberg of West Virginia University, who fears the state’s new limits on needle exchanges will exacerbate the problem.
“The seeds for this have been sown,” she said. “Things will definitely get worse."