When then-governor Mike Pence reversed his state's ban on needle exchange programs in 2015, it was because he had been convinced they would help stop a runaway outbreak of HIV that was ravaging counties already struggling with the opioid epidemic.
Now, just two years later, some of those counties are turning back that approach. This week, county commissioners in Lawrence County, in southern Indiana, refused to continue support for the program there.
Advocates are outraged and worried.gi
"People are going to die," said Christopher Abert of the Indiana Recovery Alliance, a group that has fought for and supported needle exchanges.
"This is the second syringe exchange to close. Madison County up north closed theirs through the efforts of the local prosecutor and helped by the state attorney general." Indiana Attorney General Curtis Hill, elected last November, has said he opposes needle exchange programs.
Rodney Fish, one of the council members who voted against keeping the needle exchange program going, said he does not approve of needle exchange programs and cannot condone the county's sponsorship of one.
"I really do oppose the needle exchange because it's not truly an exchange."
"It was a moral issue with me. I had severe reservations that were going to keep me from approving that motion," Fish said.
"I did not approach this decision lightly. I gave it a great deal of thought and prayer. My conclusion was that I could not support this program and be true to my principles and my beliefs."
Fish, a retiree who chooses his words carefully, said counties should find other ways to help opioid addicts and abusers. He says he is happy to work with local hospitals to try to make something else work.
HIV, the virus that causes AIDS, and hepatitis C both spread via shared needles. In the U.S. 2,400 people became infected with HIV in 2015 via shared needles.
"In recent years, injection drug use has also contributed to a 150 percent increase in acute cases of hepatitis C infections," the Centers for Disease Control and Prevention says.
The CDC also says there's strong evidence that needle exchange programs help.
The newly appointed Surgeon General, Dr. Jerome Adams, is the former Indiana health commissioner and led efforts to persuade Pence to allow needle exchange programs. "No matter how uncomfortable syringe service programs make us, they are proven to save lives, both by preventing the spread of diseases like HIV and hepatitis C and by connecting people to treatment that can put them on a path to recovery," Adams wrote in a blog post earlier this year.
Studies have found that if people can easily get clean needles to use, they'll wait longer in between fixes. And public health experts say getting into an exchange program takes them one step closer to getting treated for their drug abuse problems.
Needle exchange programs in big cities have helped stop the spread of both viruses in blacks and Hispanics, the CDC said.
Fish said he is not convinced the programs work as well as advocates say they do. He notes that users do not have to return their used needles and fears that the programs actually pump drug-using supplies into the population — supplies that not only feed the deadly habit, but that end up discarded on streets and in parks.
"I really do oppose the needle exchange because it's not truly an exchange," Fish said in an interview with NBC News.
"Few, if any of the health care professionals that I personally spoke with believe that the needle exchange program was an effective way of getting people into treatment programs," he added.
"I researched to the best of my ability and queried individuals all over our community to get a response from the people who deal in these issues. I spoke with physicians. I spoke with nurses, EMTs, first responders and other county officials whose opinions I respect."
Fish said he could support a hospital-based program.
Abert said it's a move backwards. The needle exchange programs are supported by grants and have science backing them up. "The program cost Lawrence County nothing," he said.
"There has already been a 50 percent decrease in hepatitis C in the county," he added. The Indiana state health department cannot quite confirm this. In 2015, 58 cases of hepatitis C were reported. In 2016, 86 cases were reported and so far this year, 40 cases have been reported, the department says.
"In the last year, the Indiana Recovery Alliance has served hundreds of Lawrence County residents, who reported over 50 overdose reversals," the Alliance said in a statement. "Dozens of people have remained hepatitis and HIV free through their involvement and testing with the program. Stopping just one case of HIV saves $450,000 in lifetime costs."
Preventing a hepatitis C case saves $90,000 in medical costs, the Alliance added.
"The opposition to them is a moral opposition," Abert said.
"It's not every day that we literally hear people using the words 'evil' and 'sinful' and 'wicked'. People are relying on their own personal flavor of Christianity as the basis for cancelling this program."
But public health experts who have studied addiction and define it as a disease are running up against firmly held opinions in Indiana.
Fish quoted the Bible — Chronicles, chapter 7 — in the meeting before the vote was held. Abert sees it as evidence of clear bias but Fish is proud of his stand.
"My constituency overwhelming responded in saying no, we do not want to support this program," he said.
Abert said the Recovery Alliance will continue to support needle exchanges in other counties.
"I hope that sane and rational heads prevail in this opioid crisis," he said.