Republicans rebel against a powerful anti-opioid tool
Many Republicans have long accused such programs of promoting addiction, although years of studies have shown that they lower infectious disease rates without promoting drug use. Their opposition subsided over the past decade as the opioid epidemic devastated communities and Trump promised to get out of the crisis. However, public health experts fear the country is seeing the beginning of a broader Republican rebellion against these programs – one fueled in part by anti-science backlash to Covid restrictions.
“It’s a very retrograde mood,” said Judith Feinberg, professor of infectious diseases at West Virginia University. “The mood that experts know nothing is deepening.”
Trump’s Surgeon General Jerome Adams, who as Indiana health commissioner pushed for the creation of the Scott County’s needle exchange and unsuccessfully worked with local officials to save it, said there was also an element of fatigue among Republicans who are more likely to believe Addiction is a moral failure as a treatable disease. With the drug crisis continuing despite billions of dollars in pledge from Congress and the state to treat and preventive care, there is a feeling that people need to take responsibility for their actions, Adams said.
“Many in Conservative America feel we have given the opioid crisis all the judicial press,” Adams wrote in an email. “The attitude is, we’ve activated these controversial harm reduction measures and given people a chance – now it’s their fault if they’re not better.”
Many needle exchange programs still enjoy bipartisan support, with some Republican governors supporting legislation this year to expand their use. Arizona Governor Doug Ducey signed a bill last month making Arizona the 38th state to allow needle exchanges, while North Dakota Governor Doug Burgum signed a bill that expands the state’s program for the first time was adopted in 2017. And Indiana Government Governor Eric Holcomb criticized Scott County’s proposed shutdown of its program despite signing a bill earlier this year affirming that local governments alone have the power to make such decisions.
Public health experts say what is particularly worrying about the recent wave of closings is that it is taking place in areas particularly prone 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 Department of Health. Scott County is among the 10 most susceptible to an HIV outbreak in Indiana, according to the Centers for Disease Control and Prevention.
“Throwing gasoline on vacant lot is one thing,” said Gregg Gonsalves, an HIV researcher at Yale University. “Throwing it into a smoldering fire is different.”
The exchange of needles, which has existed for decades, also establishes a connection to other offers such as drug advice and public health measures to curb the spread of the 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, according to data compiled by the CDC.
Despite the reported benefits of needle sharing, critics across the country agree that the provision of needles enables drug use and increases the number of deaths from overdose. It’s the same kind of sentiment that maintained federal bans on funding exchanges until 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 the 2015 Scott County HIV outbreak – when over 150 people became infected, primarily with tainted needles to inject the powerful synthetic opioid, Opana – that prompted many Republicans to reconsider their opposition to needle exchanges. Over the next two years, six states passed laws allowing such programs: Louisiana, Kentucky, North Carolina, Ohio, Tennessee, and Virginia.
Some drug treatment advocates said the pandemic had changed attitudes towards these programs. Homelessness and drug use increased, as did discarded needles in public places. Republican lawmakers in West Virginia, for example, cited the growing problem of needle waste as part of their rationale for cracking down on exchange programs.
A. Toni Young, the executive director of Community Education Group, a West Virginia nonprofit committed to fighting the opioid epidemic, said although needle litter isn’t new, after a year of isolation, people are nervous and the Patience for drug users is thin when exhausted.
“People have used up all their empathy for the pandemic,” said Young.
Some Democrats in other parts of the country have also complained about discarded needles, questioning the usefulness of needle swapping. Democrats in Atlantic City, NJ are pushing to end their city’s program, and Pennsylvania state Senator Anthony Williams said his legislation that would legalize needle exchanges nationwide has met bipartisan opposition.
“There are some moderate Democrats who are certainly concerned about drug addiction and who have substantial questions about what it would mean – does it increase drug use?” Said Williams, who represents a district spanning Philadelphia and Delaware counties extends.
Grays Harbor and Scott District Commissioners said local officials and community groups should continue to provide other services offered through needle exchange programs, such as links to addiction treatment programs, counseling, and STD testing. However, drug treatment proponents are skeptical that these services can be kept on par.
When California’s Orange County closed its only needle exchange program in 2018, those all-round services also declined, said Philip Yaeger, CEO of Radiant Health Centers, which is focused on ending the HIV epidemic. His organization had partnered with Needle Exchange to offer hepatitis C testing to people getting clean syringes, but those efforts stopped when the exchange closed. He also said the needle swap was useful for connecting people to drug treatment programs who would otherwise not be likely to seek help.
“These people will not 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 related to injectable drug use, according to the county’s health data. The closure of a needle exchange program that same year in Kanawha County, West Virginia, is also likely to be responsible for more than doubling in HIV cases each year in Charleston, the state’s largest city, some experts believe.
“There’s a direct link,” said Feinberg of West Virginia University, who fears the state’s new restrictions on needle exchanges will exacerbate the problem.
“The seeds for this are sown,” she said. “It’s definitely going to get worse.”