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What Will It Take for Conservative States to Allow Needle Exchanges?

Indiana has temporarily lifted a ban on needle exchanges to help combat an HIV outbreak. Why leave the ban intact at all?
Would you prefer drug users to exchange dirty needles on the street, or get clean ones at a certified facility? (Photo: Diego Cervo/Shutterstock)

Would you prefer drug users to exchange dirty needles on the street, or get clean ones at a certified facility? (Photo: Diego Cervo/Shutterstock)

Mike Pence was in a bind. The governor of Indiana was staring a bona fide public health crisis in the face: Scott County, which typically only has five new HIV cases a year, has seen 71 confirmed HIV cases since mid-December. The majority of those cases were linked to intravenous drug use. As most drug policy experts know, one of the most effective ways of preventing disease transmission for drug users is with needle exchange programs.

Pence has said he's opposed to needle exchange programs, which are banned in many conservative states, including his own. But with an election coming up next year, the last thing a politician wants on the record is the failure to curb a major, highly publicized local problem.

So Pence announced last week that he would lift Indiana's needle exchange ban—for a limited time only.

The hypocrisy of the move is painful. Pence has basically admitted that needle exchange is beneficial for public health, while still promising to ban the practice once national attention shifts elsewhere. Conservative distaste for needle exchange programs is tied to the idea that they can encourage drug use—something that's been disproven many times. The vast majority of studies has shown that needle exchanges decrease disease transmission without any significant change to drug usage; today, the National Institutes of Health, Centers for Disease Control and Prevention, World Health Organization, and a whole host of acronymed health groups support them. In fact, a 2005 editorial by the Washington Post found that the Bush administration had to misrepresent scientific findings in order to discredit needle exchange advocates.

For now, there's a complicated maze of regulations that applies to needles. In 2011, federal funding was barred from being used on needle exchange programs. In some states, needle exchanges are authorized, but since personal possession of needles (without prescription) is illegal, patients can be arrested after leaving the facility. Then there's the odd case of harm reduction advocates in Idaho:

Having previously been involved in underground needle exchange, Walker and his colleagues have now found a way to sidestep the law, rather than break it: At their center they created a “display” of syringes and other supplies, “for educational purposes only, of course.” If staff members happen to leave clients in the display room unattended, the syringes “tend to walk off. About 300 a week.”

The needle (pardon the pun) is moving on harm reduction, with politicians and civilians alike showing compassion—instead of disdain—toward drug users in hopes of decreasing overall drug use. Harm reduction policies prioritize saving lives and improving public health ahead of complete cessation. Advocates argue that these policies decrease stigma for drug users and can help them seek the medical and psychological help needed to kick the habit.

Even Governor Pence has emphasized the need for understanding. As he said to the New York Times: “I have deep compassion for people who have been trapped by this addiction, and we want to make sure people know they’re not alone. There is help, there is treatment and we’re surging into the county now to make that available.”

We'll have to wait and see exactly how long Pence intends to extend his compassion.