'No politics, just keep people alive': Syringe services hope legality continues

The Indiana Recovery Alliance has come a long way since its founding about a decade ago.

Like other Indiana syringe service programs, the alliance does more than just provide sterile supplies and safely dispose of used needles. Staff say their work goes beyond basic addiction services; they're a human rights advocacy organization.

"Our biggest motto is we meet people where they're at and try not to leave them there," said Scott Pietrovich, syringe services program coordinator.

Six Indiana counties operate a syringe service program, often acting as a bridge to healthcare, overdose prevention education and addiction treatment. But the programs could end in July, when the law allowing them expires.

Kylee Kimbrough, Indiana Recovery Alliance board president, said that could destroy hundreds, potentially thousands, of lifelines.

"It would be devastating for this law to not be renewed," Kimbrough said.

A senate bill to extend syringe services for 10 more years is working its way through the Indiana General Assembly.

What happens at a syringe service or exchange?

The Indiana Recovery Alliance serves about 5,000 people a year, working with counties to provide healthcare and addiction-related services. By law, a physician, registered nurse or physician assistant must oversee syringe services.

It is illegal to possess drug paraphernalia in Indiana, but the law also states police can't stop, search or seize people solely because they participate in syringe exchanges.

While the number of syringes collected and distributed are reported to the health department, the Indiana Recovery Alliance's services are anonymous. They accept used syringes from anyone.

"Whether you're an IV drug user, or whether you're needing them for steroids, or you need them for insulin, we don't care," said Nick Voyales, executive director of the Indiana Recovery Project. "We don't need to know."

Along with sterile syringes, the Indiana Recovery Alliance offers hygiene supplies, group therapy and free HIV and Hepatitis C testing. Treatment referrals are another major part of their work.
 

Each year staff give out more than 30,000 doses of naloxone, also called Narcan. It can fully reverse opioid overdoses when used properly. The alliance teaches participants how to use naloxone and the proper way to perform rescue breathing.

"We believe that drug users should be treated with dignity and respect," Pietrovich said. "When folks come in here, it's a safe place for them. They are allowed to be themselves."

Why are syringe exchanges in jeopardy?

Syringe services have been legal since 2015.

That winter, more than 230 people became infected with H-I-V in Southern Indiana. The outbreak was linked to the opioid epidemic, as drug users often shared, reused, and resharpened dirty needles.

Four months after the first confirmed HIV case, former Gov. Mike Pence authorized a temporary sterile syringe exchange.

"I will tell you that I do not support needle exchange as an anti-drug policy, but this is a public health emergency," Pence said.  

Pence was hesitant after meeting with federal and state officials who urged him to authorize a syringe exchange. He famously said he prayed about the issue.

"I hated that he waited that extra day," Voyales said. "But I loved it, like, 'Oh, cool. So Jesus is down. Thank you. I always knew he was, but I just wanted to hear you say it.'"
 

Since 2015, eight counties have adopted a syringe exchange program.

Despite improvements in HIV, hepatitis C and overdose cases, the stigma around syringe exchanges persists today.

Indiana's first syringe exchange in Scott County ended in 2021after its county commissioners said they believed it enabled drug abuse.

"I know people that are alcoholics, and I don't buy him a bottle of whiskey," Commissioner Mike Jones said in 2021. 

Opponents have echoed that idea.

"You have a government acting and giving them everything but the heroin," Sen. Aaron Freeman (R-Freeman) told the Senate this week.

Harm reduction advocates such as Kimbrough agree that drug use is dangerous and unhealthy, but they have different perspectives on how to help people in active addiction.

"Harm reduction accepts that people use drugs," Kimbrough said. "They always have and they always will. This is a reality, no matter how much war on drugs we try to do."

She said people find recovery at their own pace, in a way that makes sense to them. For example, a clean syringe could be the first step to taking care of themselves, protecting their community and working toward recovery.

"Over time, I've seen so many people enter into recovery in a way that I don't think they would if it wasn't for coming here," Kimbrough said, "And if it wasn't for someone saying, 'You don't need complete abstinence for recovery.'

"At the end of the day, if you're dead, you can't engage in any recovery," Kimbrough continued.

What's happening with the bill to extend syringe exchanges?

As for Indiana's law, Sen. Michael Crider (R-Greenwood) has made progress in Indianapolis. Crider authored a bill to keep syringe services for another 10 years. That bill passed the Senate this week.

Crider told the Senate hepatitis C cases decreased by about 65 percent from 2017 to 2024. Exchange participants are six times more likely to safely dispose of the syringes they receive, and they are five times more likely to get treatment.

"Individuals that participate in the program have clearly recognized that their behavior is risky, and they're seeking out options," Crider said.

Preventing HIV and hepatitis C could also save the state money. A Medicaid patient with HIV costs the state about $300,000 a year.

"I think the data is all there," Crider said. "It suggests that this is something we should continue."
 

While the services help Hoosiers suffering from mental health and addiction issues, Crider said healthcare and law enforcement also benefit. The syringe service law was inspired by his past job leading security in an Indiana hospital.

"It's kind of easy to say, this is a program that enables addicts or does something else if you're never a person that got blood on your own hands, right?" Crider said.

Crider worries if Indiana allows these programs to end in July, the state would be unprepared for another epidemic. He said ideally, Indiana would legalize syringe services without an expiration date, but it's been tough to pass previous renewals.

That's something Voyales and others at Indiana Recovery Alliance hope for too.

"We have no politics," Voyales said. "We just want to keep people alive."