In the heart of Evansville, Indiana, Lavender Timmons opened the trunk of her weathered 2007 Ford Focus, parked strategically near the city’s homeless shelter. Regular visitors gathered around, including a known drug user who had previously sourced sterile syringes from the illegal market. Timmons, the executive director of the Evansville Recovery Alliance, aimed to provide new needles to prevent the transmission of HIV, hepatitis C, and various other infections. However, her efforts were overshadowed by the presence of a police car idling just a couple of blocks away. “The cops are watching us,” Timmons expressed, highlighting the tension surrounding harm reduction efforts.
A decade after an alarming outbreak of HIV linked to prescription painkillers in a nearby southern Indiana county, programs that distribute sterile needles are dwindling. There are fears that they may completely vanish by next year. Nationally, the situation mirrors this decline, fueled by the Trump administration's declaration that no federal funding could support supplies that “promote or facilitate drug use.” This stance contradicts decades of research demonstrating that syringe programs effectively reduce disease transmission rates without increasing the frequency of drug use or crime in neighborhoods.
In Evansville, the absence of authorized needle exchange programs has left advocates like Timmons disheartened. Despite ongoing lobbying efforts, the implementation of these programs faces significant hurdles. Indiana law mandates that a county health officer must declare an emergency concerning HIV or hepatitis C before any action can be taken. Timmons noted that insufficient testing hampers the quantification of this need, although there is some backing from local officials.
Under Indiana law, possessing a syringe without a prescription is classified as a low-level felony. On a recent weekday, outside the homeless shelter, Timmons distributed essential items from her trunk, including opioid overdose reversal medications, hygiene kits, and fentanyl testing kits. “I don’t want to give them anything that’s going to get them in trouble,” she emphasized, demonstrating the delicate balance between providing necessary resources and navigating legal constraints.
The concept of syringe service programs emerged in the United States during the 1980s HIV/AIDS epidemic, as public health experts recognized the role of shared needles in facilitating the spread of the virus. As the opioid crisis evolved, particularly with the rise of fentanyl, the absence of syringe programs had devastating consequences, particularly in rural White communities. For instance, in Scott County, Indiana, just under an hour's drive from Louisville, an HIV outbreak in 2015 infected 235 individuals, drawing nationwide attention and prompting federal health officials to intervene.
Critics of the delayed response pointed fingers at then-Governor Mike Pence (R), who took two months to declare a state of emergency. Although he eventually established an emergency syringe program in Scott County, he opposed the widespread implementation of these programs statewide. Lawmakers later authorized syringe services only under specific conditions, further complicating access.
Amidst the challenges, stories of recovery emerge. Becky Wells, 34, recounts her experience with the syringe program during the HIV outbreak. After starting to inject drugs following her father's death, she received new needles from program staff, which ultimately led her to rehab in 2020. Now sober and working at Holding Space Recovery Project, a nonprofit focused on harm reduction, Wells is an example of how syringe programs can facilitate recovery and reduce the stigma surrounding addiction.
At a recent fundraiser in Austin, Indiana, hundreds gathered to support the nonprofit founded by former syringe program employees. They celebrated victories in reducing open drug use on the streets and the success stories of individuals in recovery. However, the closure of the syringe program in 2021 poses a significant setback, leaving many vulnerable to the consequences of using non-sterile needles.
Research conducted by former Indiana health commissioner Jerome Adams, who served as U.S. surgeon general during Trump’s presidency, highlights the efficacy of syringe programs. Data indicates that new users of these programs are five times more likely to enter drug treatment compared to those who do not utilize them. The Centers for Disease Control and Prevention (CDC) reported a dramatic decrease in the sharing of injection equipment among participants, leading to a 96% reduction in new HIV infections and a 76% decrease in new hepatitis C cases in Scott County by 2018.
Despite these successes, the closure of syringe programs has left individuals like Matthew Colwell, 24, vulnerable. After losing access to sterile syringes, he resorted to using dull, discarded needles, ultimately contracting endocarditis, a severe condition caused by injecting contaminated substances. “My heart is still messed up to this day,” Colwell lamented, underscoring the severe health risks associated with the absence of harm reduction services.
Nationally, the landscape of syringe programs remains uncertain. The Biden administration has expressed support for these initiatives; however, federal funding restrictions continue to complicate matters. Reports indicate that HIV diagnoses among injection drug users increased by 5% between 2018 and 2022, highlighting the urgent need for accessible harm reduction services.
Communities across the country are witnessing similar pushbacks against needle exchange programs. For example, in Bangor, Maine, health officials halted the distribution of sterile needles due to a recent spike in HIV cases. In Lewis County, Washington, the American Civil Liberties Union filed a lawsuit against restrictions barring syringe distribution, while West Virginia continues to impose limits on needle exchanges.
Back in Evansville, Timmons remains committed to her cause. She tirelessly searches for discarded syringes, emphasizing the need for safe disposal options to protect the community, especially children. Her personal journey through addiction and recovery fuels her determination to provide essential resources to those in need.
As Timmons navigates the complexities of harm reduction in Indiana, she faces an uphill battle against legal restrictions and societal stigma. Yet, her unwavering dedication to reducing the spread of infections and connecting individuals with recovery services continues to inspire hope in a challenging landscape.
