Trump Blocks Syringe Funds: Indiana’s Last Lifeline Faces Extinction

Paul Riverbank, 12/23/2025Federal cuts threaten Indiana's last syringe exchange, risking public health and addiction recovery progress.

Clark County, like many places in Indiana, suddenly found itself unable to use federal money for parts of its harm reduction toolkit. President Trump’s signature was on the order. A blunt move, the White House argued, to prevent taxpayer dollars from supporting anything that might be seen as enabling drug use. Out went cookers and tourniquets — not needles themselves, but still essential to safe injection.

Local staff, undeterred, looked for workarounds. Sterile gear now slips into discrete brown bags paid for by private dollars. Employees who assemble the kits? They’re there on their own time, since federal and county pay can’t cover the work. Sometimes, a visitor at the window might not realize how much ingenuity is keeping the exchange alive.

Indiana’s path to syringe exchanges was rocky from the start. It took an HIV crisis in Austin to get lawmakers together a decade ago, just enough momentum to legalize programs like this — but not without an expiration date. Since 2020, their numbers have faded from nine counties down to six. Some days, it feels like Clark County’s program is the last lifeline in the region.

The process on a busy afternoon looks almost routine. Folks walk in and quietly ask for “No. 1” at the front desk; the code for supplies. The list includes more than just needles: bandages, containers for used sharps, naloxone for overdoses. Testing, too — for HIV, hepatitis C — plus information on how to get into drug treatment. There's even a table with a pile of handmade hats, each tagged with a handwritten note, "You’ve got this." Not everyone's need is strictly medical.

Joshua Gay, once tangled deep in meth addiction, remembers the spiral well. “It stripped everything,” he said. “My job. My family. I stopped even taking care of myself.” For him, showing up at the exchange marked a turning point, first for clean needles, then for a way out. A chat with staff steered him toward treatment. One naloxone kit helped him save a friend. He says the program saved them both.

Dr. Eric Yazel, the county’s health officer, candidly sums up what’s at stake: “People will inject. Clean or not. Exchanges mean they’re less likely to share, less likely to spread HIV or hepatitis. That’s just reality. Protecting everyone is the goal.”

None of this sits easily with critics. Curtis Hill, a past Indiana attorney general, speaks for those who backed the new federal order. “There’s a line,” he insists. “Government shouldn’t cross into supporting drug use.” Voices like his helped drive opposition to harm reduction across much of the country. In West Virginia, several counties have closed their own programs entirely.

Politics plays no small part. Blue states, like California, still pour state money into expanded exchanges. Elsewhere, it’s a scramble. Federal officials point out that naloxone and testing are still covered by grants, but for front-line workers, the gap is unmistakable.

Yet, in the ledger of outcomes, the numbers tell a clear story. Indiana’s exchanges have steered more than 27,000 people toward treatment. Naloxone distributed through these programs has reversed nearly 25,000 overdoses. In Clark County, returned syringe rates hit 92 percent, far above national averages. CDC research points to dramatic drops — up to 50 percent — in new HIV and hepatitis C cases, tracing those results straight back to exchanges. The story in Scott County is instructive: after exchanges started, HIV numbers fell and have stayed low.

Even Dr. Yazel wasn’t a true believer at first. “Honestly, I didn’t get it,” he confessed. “But I started looking at the data, watching what happened on the ground. It turned me around.”

Change swirls elsewhere. Hawaii recently dropped all limits, allowing people to collect as many clean needles as they want. In contrast, a handful of states are moving bills to shut down exchanges completely.

Back in Indiana, the next legislative session holds everyone’s attention. The law that enabled these programs is set to expire. No one — not Dr. Yazel, nor Alan Witchey at Indianapolis’ Damien Center — can say yet what happens after that. Witchey’s organization is lobbying hard for an extension to 2036, arguing that without exchanges, Indiana risks a repeat of past public health disasters.

“We know what happens if these programs go away,” Witchey warns. “We’ve lived it. It’s not a risk. It’s a certainty.”

For now, the program endures, stocked with what resources staff can muster. Every day, uncertainty looms a bit larger. And for many in Clark County and beyond, the stakes couldn’t be more personal.

Boxes line the walls of a back room at the Clark County Health Department. They’re unremarkable, labeled only with a plain warning: "DO NOT USE." Inside, a heap of supplies sits forgotten — the kind that once supplied the local syringe exchange program. Cookers, sterile water, tourniquets. Quiet evidence of a shift that rolled in last July, when federal rules on funding changed.Clark County, like many places in Indiana, suddenly found itself unable to use federal money for parts of its harm reduction toolkit. President Trump’s signature was on the order. A blunt move, the White House argued, to prevent taxpayer dollars from supporting anything that might be seen as enabling drug use. Out went cookers and tourniquets — not needles themselves, but still essential to safe injection.Local staff, undeterred, looked for workarounds. Sterile gear now slips into discrete brown bags paid for by private dollars. Employees who assemble the kits? They’re there on their own time, since federal and county pay can’t cover the work. Sometimes, a visitor at the window might not realize how much ingenuity is keeping the exchange alive.Indiana’s path to syringe exchanges was rocky from the start. It took an HIV crisis in Austin to get lawmakers together a decade ago, just enough momentum to legalize programs like this — but not without an expiration date. Since 2020, their numbers have faded from nine counties down to six. Some days, it feels like Clark County’s program is the last lifeline in the region.The process on a busy afternoon looks almost routine. Folks walk in and quietly ask for “No. 1” at the front desk; the code for supplies. The list includes more than just needles: bandages, containers for used sharps, naloxone for overdoses. Testing, too — for HIV, hepatitis C — plus information on how to get into drug treatment. There's even a table with a pile of handmade hats, each tagged with a handwritten note, "You’ve got this." Not everyone's need is strictly medical.Joshua Gay, once tangled deep in meth addiction, remembers the spiral well. “It stripped everything,” he said. “My job. My family. I stopped even taking care of myself.” For him, showing up at the exchange marked a turning point, first for clean needles, then for a way out. A chat with staff steered him toward treatment. One naloxone kit helped him save a friend. He says the program saved them both.Dr. Eric Yazel, the county’s health officer, candidly sums up what’s at stake: “People will inject. Clean or not. Exchanges mean they’re less likely to share, less likely to spread HIV or hepatitis. That’s just reality. Protecting everyone is the goal.”None of this sits easily with critics. Curtis Hill, a past Indiana attorney general, speaks for those who backed the new federal order. “There’s a line,” he insists. “Government shouldn’t cross into supporting drug use.” Voices like his helped drive opposition to harm reduction across much of the country. In West Virginia, several counties have closed their own programs entirely.Politics plays no small part. Blue states, like California, still pour state money into expanded exchanges. Elsewhere, it’s a scramble. Federal officials point out that naloxone and testing are still covered by grants, but for front-line workers, the gap is unmistakable.Yet, in the ledger of outcomes, the numbers tell a clear story. Indiana’s exchanges have steered more than 27,000 people toward treatment. Naloxone distributed through these programs has reversed nearly 25,000 overdoses. In Clark County, returned syringe rates hit 92 percent, far above national averages. CDC research points to dramatic drops — up to 50 percent — in new HIV and hepatitis C cases, tracing those results straight back to exchanges. The story in Scott County is instructive: after exchanges started, HIV numbers fell and have stayed low.Even Dr. Yazel wasn’t a true believer at first. “Honestly, I didn’t get it,” he confessed. “But I started looking at the data, watching what happened on the ground. It turned me around.”Change swirls elsewhere. Hawaii recently dropped all limits, allowing people to collect as many clean needles as they want. In contrast, a handful of states are moving bills to shut down exchanges completely.Back in Indiana, the next legislative session holds everyone’s attention. The law that enabled these programs is set to expire. No one — not Dr. Yazel, nor Alan Witchey at Indianapolis’ Damien Center — can say yet what happens after that. Witchey’s organization is lobbying hard for an extension to 2036, arguing that without exchanges, Indiana risks a repeat of past public health disasters.“We know what happens if these programs go away,” Witchey warns. “We’ve lived it. It’s not a risk. It’s a certainty.”For now, the program endures, stocked with what resources staff can muster. Every day, uncertainty looms a bit larger. And for many in Clark County and beyond, the stakes couldn’t be more personal.