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…