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inside a storage room clark county The health department has boxes with tape on them that say, “Do not use.” They contain cookers and sterile water that people use to flush out drugs.
The supplies, which came from the state and paid for with federal money, were for a program where drug users exchange dirty needles with clean ones, part of a strategy known as harm reduction. But under the President’s executive order of July 1 donald trumpFederal substance abuse grants cannot pay for supplies like cookers and tourniquets, which it said “only facilitate illicit drug use.” The needles already could not be purchased with federal money.
In some places, the order is rallying support for syringe exchange programs, which decades of research shows are highly effective at preventing disease among intravenous drug users and getting them into treatment.
In others, it is fueling opposition that threatens the programs’ existence.
Republican-led Indiana A law allowing the exchange was passed after the small town of Austin became one of the worst drug-fueled hubs a decade ago hiv Outbreaks in American history. Unless lawmakers extend it, that law is set to expire next year, and the number of exchanges is declining. State officials told remaining programs to follow Trump’s order — and even to forgo federally funded supplies like cookers and tourniquets.
For now, Clark County health workers have found a way to distribute cookers and other items: Buy them with private money and package them in “mystery bags,” which are assembled by workers who are not paid with state or federal funds.
Meanwhile, Democratic-led California has continued to use state funds for supplies like pipes and syringes. California is home to a growing number of exchanges, with 70 of the more than 580 exchanges listed by the North American Syringe Exchange Network.
Some public health experts say syringe service programs have become the subject of increasing politicization and discontent.
Clark County Health Officer Dr. Eric Yazel says IV drug users will likely inject themselves with or without clean supplies. The exchange prevents people from sharing needles and spreading disease, he said, thereby “reducing the public health risk to the entire population.”
But Curtis Hill, a Republican former Indiana attorney general, is among the critics who express similar concerns over Trump’s order: “We don’t want to get into a situation where we are promoting drug use.”
help without judgment
When participants arrive at the Clark County Health Department, they look at a list of services and say they are there for “number 1.”
They choose from a cart containing needles, bandages, sharps containers and the overdose reversal drug naloxone. They can get tested for HIV and hepatitis C; Information on drug treatment; and flyers on food banks, housing and job placement. There are even handmade knitted hats with encouraging notes on them, like “You’ve got this!”
“We spend a half hour, 45 minutes or more talking to them about where they are, whether they want treatment, whether 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’re being treated.”
It is the closest exchange to Austin, a 35-minute drive away. Scott County, where Austin is located, has already ended its program.
When Joshua Gay used the Clark County Exchange he lived in an apartment across the street. He shot meth daily.
,Addiction, it took away everything. It took away my life. It took away my job, took away my health. I mean, it messed up my mind so much I wouldn’t even be able to take a shower,, said the 44-year-old, who now lives in Austin. ,God Telling me, ‘You need to do something,’ and he took me to change the needle.
He is calm today. He sought drug treatment at LifeSpring Health Systems after encouragement from health workers and now encourages others to stay healthy.
He believes the syringe exchange not only saved him, but helped him save someone else, providing the naloxone he used to revive a friend who had overdosed on heroin.
keep the program going
Following Trump’s order — which focused on homelessness — Indiana health officials, citing a letter from the U.S. Substance Abuse and Mental Health Services Administration, told the exchanges that some of the items they provided were now off limits.
Although Clark County staff have found ways to provide privately financed items for now, they are concerned about Indiana’s exchange law expiring on July 1. Despite the programs’ successes, six counties have exchanges – down from nine in 2020.
Statewide, exchanges have made more than 27,000 referrals for drug treatment and provided naloxone that has reversed nearly 25,000 overdoses, according to information collected by the nonprofit Damien Center in Indianapolis.
Since the beginning of 2017, the program in Clark County alone has administered more than 2,000 doses of naloxone; More than 4,300 referrals were made for drug treatment; and made more than 4,400 referrals for HIV or hepatitis C testing. Its syringe return rate is 92%.
Local and national public health and addiction experts point to research showing that exchanges do not increase syringe litter, crime or IV drug use — and that every dollar invested returns $7 in estimated health care costs.
The Centers for Disease Control and Prevention said last year that the exchange was associated with an estimated 50% reduction in the incidence of HIV and hepatitis C. Scott County — where an HIV outbreak ultimately sickened 235 people — reported fewer than five new cases a year in 2020 and 2021, just before the syringe program ended. The numbers have been low.
“When these programs first started, I said, ‘I don’t know.’ I don’t understand it,” Yazel said. “And then I dived deeper and started to understand the impact.”
Elsewhere, a mix of support and opposition
Indiana is one of 43 states with syringe service programs, according to health care research nonprofit KFF.
Support remains strong in many places. For example, in Hawaii this year, legislators passed a law allowing people to take as many clean needles as they need instead of exchanging them for one.
But there are proposals to eliminate syringe programs elsewhere, including two bills introduced in West Virginia this year.
This month, West Virginia’s Cabell-Huntington Health Department stopped administering injections. Naloxone and fentanyl testing strips are available, along with services such as education, disease testing, and links to care.
“People who come to visit us will get the same smiles and the same hugs,” said Health Officer Dr. Michael Kilkenny. “We are not going to distribute syringes or other things that are counterproductive.”
U.S. Department of Health and Human Services spokesman Andrew Nixon stressed in an email that federal funds can still be used for education and “life-saving services” like naloxone, reflecting “our commitment to addressing the addiction and extreme crisis affecting communities across our country.”
a dark future
Yazel expects the road ahead in Indiana will be tough.
“To put it very clearly,” he said, “we face an uphill battle this legislative session.”
Alan Witchey, CEO of the Damien Center, whose organization runs a syringe program, said he and a group of advocates have created a website with information and how to contact lawmakers. They have met with elected officials, and a state senator has introduced a bill to extend the sunset date to 2036.
“Without these programs, there would be less of a tool to combat the diseases of substance use disorders, hepatitis C and HIV,” Witchey said. “And that could lead to a very dangerous situation for us. We’ve seen where that leads.”
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