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Syringe exchange programs open in some jurisdictions, close in others.

Overdose isn’t the only danger for people who inject drugs. As Tom Frieden of the Centers for Disease Control and Prevention has explained, sharing syringes is “a horrifyingly efficient route for spreading HIV, hepatitis and other infections.”CDC, “CDC Telebriefing: New Vital Signs Report - HIV & Injection Drug Use,” November 30, 2016. As of 2018, there were 320 syringe exchanges, also known as needle exchanges, in 39 states.amfAR, “Syringe Exchange Programs,” But this year saw uneven action among jurisdictions with exchanges.

In one highly publicized move, a judge in Orange County, California, issued a preliminary injunction shutting down the county’s only syringe exchange program after the county government—as well as the cities of Anaheim, Costa Mesa, Orange, and Santa Ana—objected to a proposal to operate mobile exchanges.County of Orange v. California Department of Public Health, No. 37-2018-00039176-CU-MC-CTL (Cal. Super. Ct., San Diego County, November 27, 2018) (statement of decision); and German Lopez, “Needle Exchanges Help Combat the Opioid Crisis. But Officials Keep Shutting Them Down,” Vox, November 29, 2018. Charleston, West Virginia—a city at the center of the opioid crisis—closed its program in March, and Grays Harbor County, Washington, closed its county-run exchange in June, although commissioners have said that private groups with their own funding would still be permitted to run exchanges.Josh Katz, “Why a City at the Center of the Opioid Crisis Gave Up a Tool to Fight It,” New York Times, April 27, 2018; and Louis Krauss, “Grays Harbor County Commissioners Vote to End Syringe Exchange,” Daily Chronicle, December 19, 2018. And a bipartisan bill to expand syringe exchanges throughout Florida after a pilot program at the University of Miami proved successful died in the legislature this year.Danielle Prieur, “It’s the 30th Anniversary of World AIDS Day on Saturday, and Some States Still Don’t Use Syringe Exchanges as Prevention,” WMFE, November 30, 2018.

But exchanges have opened in other places. In Indiana, Marion County is looking to launch a syringe exchange program mirroring the successful program in Fort Wayne, and Madison County, which had voted to end its program in 2017, relaunched the program this year by unanimous vote of the county commissioners.John Russell, “Public Health Officials Applaud Needle-Exchange Programs, But Critics Remain,” Indianapolis Business Journal, June 8, 2018. Kentucky, which has one of the highest rates of hepatitis C in the country, opened nine exchanges this year, bringing its total to 52 programs—the highest in the country.Lisa Gillespie, “Kentucky Will Soon Lead Nation in Syringe Exchanges, But Work Isn’t Done,” WFPL, April 11, 2018. Like many states, Kentucky has struggled to bring syringe exchanges to its rural counties, but this year two northern Kentucky exchanges opened, including one in Bourbon County, which had rejected two prior attempts.Mary Meehan, “How A Rural Kentucky County Overcame Fear To Adopt A Needle Exchange,” WFPL, April 2, 2018. A disproportionate number of people who come into contact with the criminal justice system have—or are at risk for—hepatitis C.Duncan Smith-Rohrberg Maru, Robert Douglas Bruce, Sanjay Basu, and Frederick L. Altice, "Clinical Outcomes of Hepatitis C Treatment in a Prison Setting: Feasibility and Effectiveness for Challenging Treatment Populations," Clinical Infectious Diseases, 47, no. 7 (2008), 952-61. Although the disease is curable, 97 percent of people in state prisons with hepatitis C are not receiving treatment for it, according to a July survey.Siraphob Thanthong-Knight, “State Prisons Fail to Offer Cure to 144,000 Inmates with Deadly Hepatitis C,” Washington Post, July 9, 2018. Some prison officials cite the high cost of the 8 to 12 week drug regimen—which can reach as much as $90,000—as the reason for withholding care.Siraphob Thanthong-Knight, “State Prisons Fail to Offer Cure to 144,000 Inmates with Deadly Hepatitis C,” Washington Post, July 9, 2018. But incarcerated people in North Carolina are suing, alleging that without a valid medical reason for denying access to care, the state is violating their Eighth Amendment rights.Buffkin v. Hooks, No. 1:18-cv-502 (M.D.N.C., filed June 15, 2018) (class action complaint). Among the reasons North Carolina lists for denying access to treatment for hepatitis C is “infractions related to alcohol or drugs in the last year.”Taylor Knopf, “Three N.C. Prisoners Sue the State for Hepatitis C Treatment,” North Carolina Health News, June 29, 2018.