Addiction-stricken community struggles to keep a syringe program going after Trump’s order

JEFFERSONVILLE, Ind. — Inside a storage room at the Clark County Health Department are boxes with taped signs reading “DO NOT USE.” They contain stoves and sterile water that people use to inject drugs.

The supplies, which came from the state and were paid for with federal money, were intended for a program in which drug users traded dirty needles for clean needles, in a strategy known as harm reduction. But under an executive order from President Donald Trump in July, federal drug addiction grants cannot fund supplies such as stoves and tourniquets that the government says “only facilitate the use of illegal drugs.” Needles already could not be purchased with federal money.

In some places, the order galvanizes support for needle exchange programs, which decades of research shows are highly effective in preventing illness among intravenous drug users and getting them into treatment.

In others, it fuels opposition that threatens the existence of programs.

Republican-led Indiana passed a law allowing the exchanges a decade ago, after the small city of Austin became the epicenter of the worst drug-fueled HIV epidemic in U.S. history. Unless lawmakers extend it, that law is set to expire next year and the number of exchanges has declined. State officials have asked remaining programs to comply with Trump’s order — and even get rid of federally funded supplies, such as stoves and tourniquets.

For now, Clark County health workers have found a way to continue distributing stoves and other items: buying them with private money and packaging them in “mystery bags,” assembled by employees who are not paid by the state or federal government.

Meanwhile, Democratic-led California continued to use public funds to purchase supplies such as pipes and syringes. California is home to a growing number of exchanges, with 70 of the more than 580 listed by the North American Syringe Exchange Network.

Some public health experts lament that needle service programs have become the subject of increasing politicization and dissent.

Clark County Health Officer Dr. Eric Yazel says intravenous drug users will likely inject with or without clean products. The exchanges prevent people from sharing needles and spreading disease, he said, “thus reducing the public health risk for the entire population.”

But Curtis Hill, a former Republican attorney general in Indiana, is among the critics who raise the same concerns as Trump’s order: “We don’t want to find ourselves in a situation where we’re promoting drug use.” »

When participants arrive at the Clark County Health Department, they look at a list of services and say they’re there for “No. 1.”

They choose from a cart filled with needles, bandages, sharps containers and the overdose-fighting drug naloxone. They can be tested for HIV and hepatitis C; drug treatment information; and leaflets on food banks, housing and job placement. There are even hand-knitted hats with encouraging notes like “You’ve got it!” »

“We spend about a half hour or 45 minutes talking to them about where they are, if they want treatment, if they’re ready,” said program director Dorothy Waterhouse. “These are our brothers, our sisters, our mothers, our fathers. … We need compassion to make sure they get treatment.”

This is the closest exchange to Austin, a 35-minute drive. Scott County, where Austin is located, has already ended its program.

Joshua Gay lived in an apartment across the street when he used the Clark County Stock Exchange. He used meth daily.

“Addiction, it took everything from me. It took my life. It took my job, my health. I mean, it got me so bad that I didn’t even want to shower,” said the 44-year-old, who now lives in Austin. “God was telling me, ‘You have to do something,’ and he led me to the needle exchange.

He is sober today. He underwent drug treatment with LifeSpring Health Systems after encouragement from health care workers and now encourages others in recovery to stay healthy.

He believes the needle exchange not only saved him, but also helped save someone else, providing him with the naloxone he used to revive a friend who had overdosed on heroin.

After Trump’s order — which focused on the homeless — Indiana health officials told the exchanges that some items they provided were now prohibited, citing a letter from the U.S. Substance Abuse and Mental Health Services Administration.

Although Clark County workers have found ways to supply privately financed items for now, they are concerned about the July 1 expiration of Indiana’s interchange law. Six counties have exchanges – up from nine in 2020 – despite the programs’ success.

Statewide, the exchanges have made more than 27,000 referrals to drug treatment and provided naloxone that has helped reverse nearly 25,000 overdoses, according to information collected by the nonprofit Damien Center in Indianapolis.

Since its launch in 2017, the Clark County program alone has distributed more than 2,000 doses of naloxone; made more than 4,300 referrals to substance abuse treatment; and has made more than 4,400 referrals for HIV or hepatitis C testing. Its syringe return rate is 92%.

Local and national public health and substance abuse experts point to research showing that exchanges do not increase needle waste, crime or intravenous drug use — and that every dollar invested returns about $7 in avoided health care costs.

The exchanges are associated with an estimated 50% reduction in the incidence of HIV and hepatitis C, the Centers for Disease Control and Prevention said last year. Scott County — where the HIV outbreak ultimately sickened 235 people — recorded fewer than five new cases per year in 2020 and 2021, just before that syringe program ended. The numbers remained low.

“When these programs started, I was like, ‘I don’t know. I didn’t understand,” Yazel said. “And then I dove deep and started to understand the impact.”

Indiana is one of 43 states with syringe services programs, according to KFF, a nonprofit health care research organization.

Support remains strong in many places. This year in Hawaii, for example, lawmakers passed a law allowing people to get as many clean syringes as needed rather than just one for one.

But bills elsewhere, including two introduced in West Virginia this year, propose eliminating needle programs.

This month, the Cabell-Huntington, West Virginia, health department stopped handing out syringes. Naloxone and fentanyl test strips remain available, along with services such as education, disease screening and links to care.

“People who come to see us will have the same smiles and the same hugs,” said health officer Dr. Michael Kilkenny. “We’re just not going to hand out syringes or other things that are out of favor.”

Andrew Nixon, a spokesperson for the U.S. Department of Health and Human Services, emphasized in an email that federal funds can still be used for “vital services” like education and naloxone, reflecting a “commitment to combating the addiction and overdose crisis affecting communities across our country.”

Yazel expects a tough road ahead in Indiana.

“To be very blunt,” he said, “we have an uphill battle ahead in this legislative session. »

Alan Witchey, CEO of the Damien Center, whose organization runs a syringe program, said he and a group of advocates created a website with information and a way to contact lawmakers. They met with elected officials and a state senator introduced a bill to extend the expiration date to 2036.

“Without these programs, there will be one less tool to combat illnesses related to substance use disorders, hepatitis C and HIV,” Witchey said. “And that could lead to a very dangerous place for us. We’ve seen where that takes us.”

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