ANOTHER VIEWPOINT: An irresponsible, but not surprising, decision on public health

This editorial was originally published in the South Bend Tribune.

The needle exchange program in rural Scott County — which helped contain what a Centers for Disease Control and Prevention official called “one of the worst documented outbreaks of HIV among IV users in the past two decades” — is coming to an end.

That’s thanks to the vote of county commissioners, who ignored the guidance of health workers and law enforcement officials and the pleas from members of the community — not to mention the evidence that the program works.

Supporters call the program, which offers addicts medical care, testing and people who could assist them in recovery, a model for the rest of the country. Health officials credit it with helping drive down the county’s number of new HIV cases to fewer than five last year.

Among those voicing support for the program is Dr. Jerome Adams, the former U.S. surgeon general who served as Indiana’s health commissioner during the HIV outbreak. Adams has been credited with persuading then-Gov. Mike Pence, a long-time opponent of needle exchange programs, to allow Indiana counties to create such exchanges to contain the spread of the disease.

“We wouldn’t have syringe exchange if it wasn’t for him,” Carrie Lawrence, a public health researcher at Indiana University who helps implement syringe exchange programs throughout the state, said at the time.

Adams wrote on Twitter that he was “heartbroken” by the commissioners’ decision. “I’ve shared toil and tears with the many harm reduction advocates in this community,” he wrote. “We’ve got to keep working to win over hearts and minds.”

Back in 2015, Scott County attracted national attention for the outbreak, which was linked to intravenous drug use. At the time, needle exchange programs, which allow drug users to swap dirty needles for clean ones, were illegal in the state. Pence issued an executive order allowing syringes to be distributed in Scott County. That same year, the legislature passed, and Pence signed, a law that allows counties to apply for syringe exchange programs in Indiana.

The Centers for Disease Control and Prevention endorses the programs as a way to reduce harm and prevent people who use intravenous drugs from contracting HIV. According to the World Health Organization, there’s no evidence that needle exchange programs exacerbate “injecting drug use at either the individual or societal level.”

Rick Williams was among several people who said during last week’s meeting that they were once addicted but got treatment through the exchange as they got clean needles.

“It kept me clean,” Williams said. “And it directed me to recovery.”

But in voting to eliminate the program by the end of this year, the southern Indiana commissioners said they don’t want to enable dangerous behavior. One commissioner questioned the extent to which the syringe program drove a dramatic HIV turnaround. Another said he wouldn’t want to supply the needle that someone used to overdose.

The decision leaves health officials worried that another outbreak could happen. Last month, Dr. Kristina Box, Indiana’s health commissioner, said that ending the exchange would inevitably lead to a rise in HIV and hepatitis C cases.

Michelle Matern, administrator of the county’s health department, told The Washington Post that it’s “extremely disappointing” that calls are being made “by people who are not experts in the health field or public health field.”

That the commissioners would overlook the advice of health experts and the data supporting that advice is outrageous and irresponsible — and it should be shocking. Unfortunately, given the events of the past year, as the country has grappled with a pandemic, it isn’t.

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