The Indiana legislature is close to passing a bill that would expand needle-exchange programs following an HIV outbreak along the state’s southeastern border. Two hurdles remain: the end of the state’s legislative session and a potential veto from Gov. Mike Pence.

The measure would allow Indiana counties with the highest transmissions of hepatitis C, an infectious disease commonly spread through intravenous drug use, to run their own needle exchange programs, which are currently only allowed by an emergency decree of the governor. Supporters call needle exchanges a critical, if limited, tool to head off future public health emergencies because hepatitis C is far more easily spread and can presage an HIV outbreak. 

Pence authorized a 30-day exchange last month for the center of the HIV surge, Scott County, where more than 130 cases linked to intravenous opioid use occured in the past two months. The governor extended the exchange for another 30 days earlier this week. But Pence said he opposes a broad needle-exchange program, arguing it would encourage drug use.

More than 30 states already have needle-exchange programs, which allow drug users to obtain sterile syringes from health authorities. Public health experts say such programs actually help connect more people to treatment while reducing the risk of blood-born infectious disease from used and shared needles. They say needle-exchange programs also don't lead to increased drug use.

The needle-exchange proposal in Indiana was tacked onto a state Senate health bill as it advanced through the House. After the House adopted the bill, the Senate would not immediately agree to the additions, so now the two sides are hashing out their differences in a conference committee. They have until next Wednesday, the end of the state’s legislative session, to do so.

“We’re under a tremendous time crunch,” said Rep. Ed Clere, a Republican who chairs the House Public Health Committee and is the measure’s chief backer. 

As written, the exchange program would still be limited to counties in the top quartile of hepatitis C transmissions, though counties in the second-highest group could also start exchange programs after getting support from a local county commission. Programs would still be limited to a year, and legislation will likely expire after two or three years -- a sunset provision that Clere says may be necessary to win Senate support. 

“I think for now, this is where we are, this is where the politics are,” Clere said. “But the crisis in Scott County has provided an opportunity to talk about needle exchange as an essential part of a comprehensive public health response.”

Information brochures on display at an outreach center in Austin, Ind., that offers HIV testing and a needle-exchange program. (AP/Darron Cummings)

The HIV outbreak has spread to at least one additional county, according to local reports. Bill Piper, the director of national affairs for the Drug Policy Alliance, applauded Clere’s efforts, but argued a statewide policy that isn’t under time constraints is the most effective way to contain the latest problem and future outbreaks. “They’re just going to go back and forth where counties worst hit will have a program, but then as soon as they reduce the rates, they’re no longer allowed to use the exchange and their rates will go back up,” he said.

But it makes a lot more sense than Pence’s policymaking so far, Piper said.

“One program in one county for 30 or 60 days is not going to stop an epidemic,” he said. “People travel, they go across county lines, they go across state lines, so it makes no sense to limit this to just one county and it certainly doesn’t make sense to limit it to one or two months.”

Clere said he’s been keeping Pence’s administration informed in hopes of securing the governor’s approval, but he acknowledges that’s far from certain. His office won’t say whether the governor would sign the bill. “The governor has set the guardrails in opposing a broad-based needle-exchange program, but has allowed for it in the case of a public health emergency like the one we’re facing in Scott County,” said Bridget Cleveland, a spokeswoman. “We are going to reserve further comment on the issue while the legislature works on it.”