Trump’s Crackdown on Syringe Programs: Lifelines Lost, Lives at Stake

Paul Riverbank, 12/24/2025Restricted by shifting federal rules, Indiana’s last-stand syringe exchange adapts—saving lives and connecting people to treatment amid a rising tide of political opposition. As the law nears expiration, the future of this vital harm reduction effort—and the lives it protects—hang precariously in the balance.

It was a single signature, President Trump’s, that redrew the lines on what harm reduction programs could purchase with federal funds. The intention, at least as it was explained, seemed straightforward: money would not cover anything that might look like encouragement. Cookers, gone. Tourniquets, off the list. Syringes themselves had already been banned. “We don’t want to get into a situation where we’re promoting drug use,” said Curtis Hill, Indiana’s former attorney general, summing up the prevailing logic.

Clark County’s staff didn’t wait for a savior. Instead, they scrambled. Supplies started arriving through private donations. Sometimes, an employee would piecemeal a kit together at home—after work, after hours, outside the reach of official oversight. Brown paper bags became code; a visitor asking for “No. 1” might walk away with bandages, or naloxone, or maybe just a chance to talk.

Joshua Gay remembers when those bags were all he had left. For him, addiction didn't just chip away at his routine—it bulldozed it. “I mean, it made my mind so bad,” he said, “I wouldn’t even shower.” He credits a spare exchange kit with saving not only his friend’s life but also, unexpectedly, his own. “He led me to the needle exchange,” Josh recalls, voice unsteady. He’s sober now, spending his own days pulling others back from the edge.

Indiana’s history with syringe exchanges could be described as turbulent, even twitchy. Years ago, it took a catastrophic HIV outbreak in Austin to jolt lawmakers into reluctantly allowing the programs. They were tagged “temporary” from the outset. Unsurprisingly, the number of local exchanges has since ebbed: six operating now, compared to nine a few years back. With the law’s sunset clause approaching, plenty of people, including the staff, know the ground might shift again at any moment.

Some numbers carry their own weight. Clark County, for instance, manages to get back 92 percent of the syringes it hands out—statistics that compare favorably to most places. Since the program began, over 27,000 people statewide have found their way to treatment. Close to 25,000 overdoses have been reversed with naloxone distributed through exchanges. And the CDC reports: areas with exchanges see dramatic drops—half as many new HIV and hepatitis C cases, if not even better. “People will use, whether the syringes are clean or not,” Clark County’s health officer, Dr. Eric Yazel, says with quiet certainty. “All an exchange does is make it less likely someone shares, less likely a disease spreads. It’s simple math. It’s about protecting everyone.”

But this is America—politics complicates even the obvious. California, for instance, pays out of its own pocket to back and expand harm reduction, offering unlimited syringes or pipes. West Virginia, by contrast, has closed programs amid mounting opposition. Hawaii lands in the middle—no cap on clean needles. Policy, mood, and geography dictate who gets help.

Federal agencies note, accurately, that tests and naloxone remain covered by grants. Still, the loss of basic supplies has pushed the work underground. Staff now pack “mystery bags” from private donations, cobbled together after official duties end. The program survives as an open secret, threading a needle made ever thinner by law.

What’s at risk is painfully clear to locals. Scott County’s exchange, when open, nearly eradicated new HIV cases—from crisis to a handful per year. Now, with its closure, there’s only nervous optimism that the numbers won’t spike again. “One less tool,” Alan Witchey from Indianapolis’ Damien Center laments, “and we know exactly what that means for hepatitis, HIV, and all the other fallout.”

Inside Clark County’s waiting room, on any given day, a pile of knit hats sits by a note that reads, simply, “You’ve got this.” Director Dorothy Waterhouse and her team might spend the better part of an hour with anyone who arrives—offering much more than clean supplies. “We’re not dealing with strangers,” Dorothy says. “These are our brothers, our sisters, parents, children. Compassion isn’t just nice—it’s necessary if we want them to reach treatment.”

Each day, the tiny rituals repeat: returned syringes, shared stories, a hope that endures despite legal shadows. For those on the front lines, the future is as uncertain as it has ever been, and the question grows more urgent the longer boxes sit, unopened, along the wall.

Boxes clutter a back wall inside the Clark County Health Department, words stamped across them in bold: “DO NOT USE.” For now, these boxes act as makeshift boundaries—inside, there’s everything from cookers to sterile water, tourniquets to test kits. Only a year ago, these were the lifeblood of the county’s syringe exchange. Now, after a sweeping federal shift, they sit unused, trapped in bureaucratic limbo.It was a single signature, President Trump’s, that redrew the lines on what harm reduction programs could purchase with federal funds. The intention, at least as it was explained, seemed straightforward: money would not cover anything that might look like encouragement. Cookers, gone. Tourniquets, off the list. Syringes themselves had already been banned. “We don’t want to get into a situation where we’re promoting drug use,” said Curtis Hill, Indiana’s former attorney general, summing up the prevailing logic.Clark County’s staff didn’t wait for a savior. Instead, they scrambled. Supplies started arriving through private donations. Sometimes, an employee would piecemeal a kit together at home—after work, after hours, outside the reach of official oversight. Brown paper bags became code; a visitor asking for “No. 1” might walk away with bandages, or naloxone, or maybe just a chance to talk.Joshua Gay remembers when those bags were all he had left. For him, addiction didn't just chip away at his routine—it bulldozed it. “I mean, it made my mind so bad,” he said, “I wouldn’t even shower.” He credits a spare exchange kit with saving not only his friend’s life but also, unexpectedly, his own. “He led me to the needle exchange,” Josh recalls, voice unsteady. He’s sober now, spending his own days pulling others back from the edge.Indiana’s history with syringe exchanges could be described as turbulent, even twitchy. Years ago, it took a catastrophic HIV outbreak in Austin to jolt lawmakers into reluctantly allowing the programs. They were tagged “temporary” from the outset. Unsurprisingly, the number of local exchanges has since ebbed: six operating now, compared to nine a few years back. With the law’s sunset clause approaching, plenty of people, including the staff, know the ground might shift again at any moment.Some numbers carry their own weight. Clark County, for instance, manages to get back 92 percent of the syringes it hands out—statistics that compare favorably to most places. Since the program began, over 27,000 people statewide have found their way to treatment. Close to 25,000 overdoses have been reversed with naloxone distributed through exchanges. And the CDC reports: areas with exchanges see dramatic drops—half as many new HIV and hepatitis C cases, if not even better. “People will use, whether the syringes are clean or not,” Clark County’s health officer, Dr. Eric Yazel, says with quiet certainty. “All an exchange does is make it less likely someone shares, less likely a disease spreads. It’s simple math. It’s about protecting everyone.”But this is America—politics complicates even the obvious. California, for instance, pays out of its own pocket to back and expand harm reduction, offering unlimited syringes or pipes. West Virginia, by contrast, has closed programs amid mounting opposition. Hawaii lands in the middle—no cap on clean needles. Policy, mood, and geography dictate who gets help.Federal agencies note, accurately, that tests and naloxone remain covered by grants. Still, the loss of basic supplies has pushed the work underground. Staff now pack “mystery bags” from private donations, cobbled together after official duties end. The program survives as an open secret, threading a needle made ever thinner by law.What’s at risk is painfully clear to locals. Scott County’s exchange, when open, nearly eradicated new HIV cases—from crisis to a handful per year. Now, with its closure, there’s only nervous optimism that the numbers won’t spike again. “One less tool,” Alan Witchey from Indianapolis’ Damien Center laments, “and we know exactly what that means for hepatitis, HIV, and all the other fallout.”Inside Clark County’s waiting room, on any given day, a pile of knit hats sits by a note that reads, simply, “You’ve got this.” Director Dorothy Waterhouse and her team might spend the better part of an hour with anyone who arrives—offering much more than clean supplies. “We’re not dealing with strangers,” Dorothy says. “These are our brothers, our sisters, parents, children. Compassion isn’t just nice—it’s necessary if we want them to reach treatment.”Each day, the tiny rituals repeat: returned syringes, shared stories, a hope that endures despite legal shadows. For those on the front lines, the future is as uncertain as it has ever been, and the question grows more urgent the longer boxes sit, unopened, along the wall.