Many Republicans have long accused such programs of inciting addiction, despite years of study showing that they reduce the number of infectious diseases without promoting drug use. Their opposition was softened in the last decade when the opioid epidemic destroyed communities and Trump promised to defeat the crisis. But public health experts fear the country is witnessing the start of a broader Republican uprising against these programs – one driven in part by anti-scientific setbacks to Covid restrictions.
“There’s a very retrogressive mood,” said Judith Feinberg, a professor of infectious diseases at West Virginia University. “The mood that experts know nothing about 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 is also an element of fatigue among Republicans who are more likely to believe That addiction is a moral failure. than a treatable disease. After seeing the drug crisis continue despite Congress and states committing billions of dollars to treatment and prevention, there is a sense that people need to take responsibility for their actions, Adams said.
“Many in conservative America feel that we have given the opioid crisis the full court press,” Adams wrote in an email. “The attitude is that we have turned to these controversial harm reduction measures and given people a chance – now it’s their fault if they do not get better.”
Many needle exchange programs still enjoy the support of both parties, with some Republican governors supporting 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, which was first passed in 2017. And Indiana Gov. Eric Holcomb’s administration was critical of Scott County’s planned closure of its program, although it signed legislation earlier this year, confirming that local governments alone have the power to make such decisions.
Public health experts say what is particularly worrying about the recent wave of closures is that they occur in areas that are particularly susceptible to disease outbreaks. In West Virginia, the number of HIV cases among people using injectables more than doubled between 2018 and 2020, according to the state Department of Health. Scott County is among the 10 in Indiana that are most vulnerable to an HIV outbreak, according to the Centers for Disease Control and Prevention.
“It’s one thing to throw gas on a vacant lot,” said Gregg Gonsalves, an HIV researcher at Yale University. “It’s another to throw it on a smoldering fire.”
Needle exchange, which has been around for decades, also provides 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 start drug treatment and three times more likely to stop using drugs than others who do not use the program, according to data collected by the CDC.
Despite the reported benefits of needle exchange, critics across the country are united in a belief that giving needles enables drug use and drives overdose deaths. It’s the same type of sentiment that maintains federal bans on funding exchanges through the mid-2010s.
“I know people who want to kill themselves, I’m not buying them a bullet for the gun,” Scott County Commissioner Mike Jones said before voting to end the county program. Jones did not respond to a request for comment.
It was Scott County’s HIV outbreak in 2015 – when over 150 people became infected primarily using spotted needles to inject the powerful synthetic opioid Opana – that prompted many Republicans to reconsider 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 proponents of drug treatment said the pandemic changed attitudes toward these programs. Homelessness and injecting drug use increased, as did discarded needles in public places. Republican lawmakers in West Virginia, for example, cited the growing problem of needle scattering as part of their rationale for cracking down on exchange programs.
A. Toni Young, executive director of Community Education Group, a nonprofit organization in West Virginia that works to tackle the opioid epidemic, said that although needle spray is not new, people are at the forefront after a year of isolation and patience for people who use drugs. used 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 question the usefulness of needle exchange. Democrats in Atlantic City, NJ, are pushing to end their city’s program, and Pennsylvania State Senator Anthony Williams said his legislation, which would legalize needle exchanges across the country, has been subject to two-party opposition.
“There are some moderate Democrats who are definitely worried about drug abuse who have significant questions about what this will mean – is it increasing drug use?” Said Williams, representing a district spanning the counties of Philadelphia and Delaware.
County commissioners in Grays Harbor and Scott said local officials and community groups should continue to provide other services that had been offered through needle exchange programs, such as links to addiction treatment programs, counseling and STD testing. Proponents of drug treatment are skeptical, these services can be maintained at the same levels.
When California’s Orange County closed its only needle exchange program in 2018, those wrapping services also fell off, said Philip Yaeger, CEO of Radiant Health Centers, which is focused on ending the HIV epidemic. His organization had been working on 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 the needle exchange was helpful in connecting people to drug treatment programs who otherwise would probably not come forward for help.
“These people are not going to knock on the door and seek 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 injecting drug use, according to county health data. The closure of a needle exchange program the same year in West Virginia’s Kanawha County is also likely to be more than doubled per year in HIV cases. Years around Charleston, the state’s largest city, some experts believe.
“There is a direct connection,” said Feinberg of West Virginia University, who fears the state’s new limits on needle exchange will exacerbate the problem.
“The seeds for this have been sown,” she said. “Things will definitely get worse.”