Many Republicans have long accused such programs of encouraging drug addiction, despite years of studies showing that they reduce rates of infectious disease without promoting drug use. Their opposition has faded over the past decade as the opioid epidemic devastated communities and Trump pledged to overcome the crisis. But public health experts fear the country may witness the start of a broader Republican rebellion against these programs – a rebellion that is in part fueled by an anti-scientific backlash to the Covid restrictions.
“There’s a very regressive mood brewing,” said Judith Feinberg, professor of infectious diseases at the University of West Virginia. “The mood that experts don’t know is deepening.”
Trump’s surgeon general Jerome Adams, who as Indiana’s health commissioner pushed for the creation of the Scott County syringe exchange and lobbied local officials unsuccessfully to save it, said there was also an element of fatigue among Republicans, who are more likely to believe addiction is a moral failure. than a treatable disease. After watching the drug crisis persist despite Congress and states committing billions of dollars for treatment and prevention, it feels like people need to take responsibility for their actions, Adams said.
“Many in conservative America feel like we’ve given the opioid crisis all the legal press,” Adams wrote in an email. “The attitude is that we activated these controversial harm reduction measures and gave people a chance – now it’s their fault if they don’t improve. “
Many needle exchange programs still enjoy bipartisan support, with some Republican governors backing legislation this year to expand their use. Arizona Gov. Doug Ducey signed a bill last month making Arizona the 38th state to allow needle exchange, while North Dakota Gov. Doug Burgum signed legislation expanding the state program that was first enacted in 2017. And the administration of Indiana Gov. Eric Holcomb has criticized the planned closure of its program by Scott County, despite signing a law earlier this year reaffirming that only local governments have the power to make such decisions.
Public health experts say what’s particularly concerning about the most recent wave of closures is that they are occurring in areas particularly susceptible to epidemics. In West Virginia, the number of HIV cases among people who inject drugs more than doubled between 2018 and 2020, according to the state health department. Scott County is among Indiana’s 10 most vulnerable to an HIV epidemic, according to the Centers for Disease Control and Prevention.
“It’s one thing to throw gasoline on a wasteland,” said Gregg Gonsalves, HIV researcher at Yale University. “It’s another to throw it on a smoldering fire.”
Syringe exchanges, which have been around for decades, also provide a link to other services, such as drug addiction 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 those who do not use the program, according to data compiled by the CDC.
Despite the reported benefits of needle exchanges, critics across the country are united in the belief that the provision of syringes enables drug use and increases overdose deaths. It is the same type of sentiment that maintained federal bans on financing exchanges until the mid-2010s.
“I know people who want to kill themselves, I don’t buy 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 the HIV epidemic in Scott County in 2015 – when more than 150 people were infected primarily by using contaminated needles to inject themselves with the powerful synthetic opioid Opana – that led many Republicans to rethink their opposition. to the exchange of syringes. Over the next two years, six states passed laws allowing such programs: Louisiana, Kentucky, North Carolina, Ohio, Tennessee, and Virginia.
Some drug treatment advocates have said the pandemic has changed attitudes towards such programs. Homelessness and injection drug use have increased, as have needles thrown in public places. Republican lawmakers in West Virginia, for example, have cited the growing problem of needle waste as part of their rationale for cracking down on exchange programs.
A. Toni Young, executive director of the Community Education Group, a West Virginia nonprofit fighting the opioid epidemic, said that while needle waste is nothing new, people are at their wit’s end after a year of isolation and patience for slim addicts.
“People have used all of their empathy with the pandemic,” Young said.
Some Democrats in other parts of the country have also complained about the discarded syringes and question the usefulness of needle exchanges. Democrats in Atlantic City, New Jersey, are pushing to end their city’s program, and Pennsylvania State Senator Anthony Williams has said his legislation that would legalize needle exchanges across the country. The state has encountered bipartisan opposition.
“There are moderate Democrats who are certainly concerned about drug addiction and have substantive questions about what that would mean – does it increase drug use?” Said Williams, who represents a district covering the counties of Philadelphia and Delaware.
Grays Harbor and Scott County Commissioners said local officials and community groups should continue to offer other services that had been offered through needle exchange programs, such as links to programs. drug treatment, counseling and testing for STDs. But drug treatment advocates are skeptical about the possibility of maintaining services at the same levels.
When Orange County in California shut down its only needle exchange program in 2018, those wrap-around services also fell, said Philip Yaeger, CEO of Radiant Health Centers, which is focused on ending the epidemic of HIV. His organization had worked with the needle exchange to provide hepatitis C testing for people who came to pick up clean needles, but that effort came to a halt when the exchange was closed. He also said the needle exchange was helpful in connecting people to drug treatment programs who would otherwise likely not show up for help.
“These people 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 linked 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 the fact that HIV cases have more than doubled per year around Charleston, the largest city in the world. State, according to some experts.
“There is a direct link,” said Feinberg of the University of West Virginia, who is concerned that the state’s new limits on needle exchanges may exacerbate the problem.
“The seeds for this have been sown,” she said. “Things will definitely get worse. “