Addiction-stricken community struggles to keep a syringe program going
after Trump's order
[December 23, 2025]
By LAURA UNGAR
JEFFERSONVILLE, Ind. (AP) — Inside a storage room at the Clark County
Health Department are boxes with taped-on signs reading, “DO NOT USE.”
They contain cookers and sterile water that people use to shoot up
drugs.
The supplies, which came from the state and were paid for with federal
money, were for a program where drug users exchange dirty needles for
clean ones, part of a strategy known as harm reduction. But under a July
executive order from President Donald Trump, federal substance abuse
grants can’t pay for supplies such as cookers and tourniquets that it
says “only facilitate illegal drug use.” Needles already couldn’t be
purchased with federal money.
In some places, the order is galvanizing support for syringe exchange
programs, which decades of research show are extremely effective at
preventing disease among intravenous drug users and getting them into
treatment.
In others, it’s fueling opposition that threatens the programs'
existence.
Republican-led Indiana passed a law allowing exchanges a decade ago
after the tiny city of Austin became the epicenter of the worst
drug-fueled HIV outbreak in U.S. history. Unless lawmakers extend it,
that law is scheduled to sunset next year, and the number of exchanges
has been dwindling. State officials told remaining programs to comply
with Trump's order — and even to discard federally funded supplies such
as cookers and tourniquets.
For now, Clark County health workers have found a way to keep
distributing cookers and other items: buy them with private money and
package them in “mystery bags,” assembled by employees who aren’t paid
with state or federal funds.
Democratic-led California, meanwhile, has continued using state funds
for supplies such as pipes and syringes. California is home to a rising
number of exchanges, with 70 of the more than 580 listed by the North
American Syringe Exchange Network.
Some public health experts lament that syringe services programs have
become subject to growing politicization and dissent.
Clark County Health Officer Dr. Eric Yazel says IV drug users will
likely inject themselves with or without clean supplies. Exchanges
prevent people from sharing needles and spreading disease, he said,
“decreasing the public health risk for the whole population.”
But Curtis Hill, a Republican former Indiana attorney general, is among
critics who raise the same concern Trump’s order does: “We don’t want to
get into a situation where we’re promoting drug use.”
Help without judgment
When participants arrive at the Clark County health department, they
look down at a list of services and say they are there for “No. 1.”
They choose from a cart with needles, bandages, sharps containers and
the overdose reversal drug naloxone. They can receive testing for HIV
and hepatitis C; information on drug treatment; and fliers on food
banks, housing, and job placement. There are even handmade knit hats
with encouraging notes like, “You’ve got this!”
“We spend a half hour, 45 minutes or so talking to them about where they
are, if they want treatment, if they’re ready,” Program Director Dorothy
Waterhouse said. “These are our brothers, our sisters, our mothers, our
fathers. … We need compassion to make sure they’re getting into
treatment.”
It's the closest exchange to Austin, a 35-minute drive away. Scott
County, where Austin is located, already ended its program.
Joshua Gay lived in an apartment across the street when he used the
Clark County exchange. He shot up meth daily.
“The addiction, it took away everything. It took away my life. It took
away my job, took away my health. I mean, it made my mind so bad that I
wouldn’t even shower,” said the 44-year-old, who now lives in Austin.
“God was telling me, ‘You need to do something,’ and he led me to the
needle exchange.”
He's sober today. He sought drug treatment at LifeSpring Health Systems
after encouragement from health workers and now encourages others in
recovery 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
overdosed on heroin.
Keeping the program going
After Trump's order — which focused on homelessness — Indiana health
officials told exchanges that certain items they provided were now
off-limits, citing a letter from the U.S. Substance Abuse and Mental
Health Services Administration.
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Joshua Gay, a former participant in the Clark County Health
Department's syringe exchange program who is now in recovery from
substance use disorder, poses for a portrait in front of his church
Tuesday, Nov. 23, 2025, in Austin, Ind. (AP Photo/Obed Lamy)
 Although Clark County workers have
found ways to provide privately funded items for now, they worry
about Indiana’s exchange law expiring on July 1. Six counties have
exchanges — down from nine in 2020 — despite the programs’
successes.
Statewide, exchanges have made more than 27,000 referrals to drug
treatment and provided naloxone that reversed nearly 25,000
overdoses, according to information collected by the nonprofit
Damien Center in Indianapolis.
Since its 2017 start, Clark County’s program alone has given out
more than 2,000 doses of naloxone; made more than 4,300 referrals to
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 exchanges don't increase syringe litter, crime or
IV drug use — and that every dollar invested returns an estimated $7
in avoided health care costs.
Exchanges are associated with an estimated 50% reduction in the
incidence of HIV and hepatitis C, the Centers for Disease Control
and Prevention said last year. Scott County — where the HIV outbreak
ultimately sickened 235 people — had fewer than five new cases a
year in 2020 and 2021, just before that syringe program ended. The
numbers have stayed low.
“When these programs first started, I was like, ‘I don’t know.’ I
didn’t get it,” Yazel said. “And then I took a deep dive and started
to understand the impact.”
Elsewhere, a mix of support and opposition
Indiana is among 43 states with syringe services programs, according
to health care research nonprofit KFF.
Support remains strong in many places. This year in Hawaii, for
example, legislators passed a law allowing people to get as many
clean needles as needed rather than only one for one.
But bills elsewhere, including two introduced in West Virginia this
year, propose eliminating syringe programs.
This month, West Virginia's Cabell-Huntington Health Department
stopped giving out needles. Naloxone and fentanyl test strips remain
available, along with services such as education, disease testing
and links to care.
“The folks who come in to see us are going to get the same smiles
and the same hugs,” said Health Officer Dr. Michael Kilkenny. “We’re
just not going to be dispensing syringes or the other things that
are in disfavor.”
Andrew Nixon, spokesman for the U.S. Department of Health and Human
Services, stressed in an email that federal funds can still be used
for “life-saving services” like education and naloxone, reflecting a
“commitment to addressing the addiction and overdose crisis
impacting communities across our nation.”
A murky future
Yazel expects a difficult path ahead in Indiana.
“To be very blunt,” he said, “we have an uphill battle coming up
this legislative session.”
Damien Center CEO Alan Witchey, whose organization runs a syringe
program, said he and a group of advocates created a website with
information and a way to contact lawmakers. They've met with elected
officials, and a state senator introduced a bill to extend the
sunset date to 2036.
“Without these programs, there will be one less tool to address the
diseases of substance use disorder, hepatitis C and HIV,” Witchey
said. “And that could lead to a very dangerous place for us. We have
seen where this leads.”
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