As the U.S. opioid epidemic continues to affect communities across the country, many towns and cities have opened syringe exchanges to help mitigate some of the risks of injection drug use, including the spread of diseases like HIV and hepatitis C virus (HCV) and life-threatening overdoses. But in Charleston, West Virginia, health officials appear to be taking the opposite approach and have shut down at least eight exchanges across the city over the past two years. A recent investigation by The New York Times sought to understand why.

Needle exchanges distribute sterile syringes to injection drug users, often in exchange for their used syringes. Such harm reduction facilities also often offer supportive services, including on-site medical care, HIV and HCV screening, counseling and referrals to drug treatment. Research shows that syringe exchanges help reduce outbreaks of blood-borne illnesses, do not lead to an increase in drug use and can help reduce overdose deaths and the number of needles discarded in public places. But opponents maintain that the facilities also enable drug use.

The first such site opened in the health department’s building in Charleston in 2015, with wide support from local government, law enforcement and the community. At its busiest, 483 people passed through the facility in just one day. But as the facility’s traffic grew, so did the number of complaints from law enforcement about discarded needles. 

This year, in response to mounting criticism from the community, Charleston’s mayor, Danny Jones, began using his daily radio show to drum up opposition to the facilities in an effort to get health officials to shut them down. Last month, local police imposed new rules requiring those using the facility to present a photo ID proving that they lived in the county, making HIV and hepatitis C testing mandatory and requiring needles to be dispensed only in one-for-one trades. Shortly after, the health department suspended the syringe exchange rather than comply with the city’s new regulations.

Now, drug users in West Virginia say unused needles are becoming scarce again. Some say people are resorting to robbing to get clean syringes. And advocates say they fear the city could be at risk for an HIV or hepatitis C outbreak if new solutions aren’t implemented. 

Critics have long claimed that the state’s first attempt at needle exchanges was an “unregulated, mismanaged nightmare.” To its supporters, the sites were a crucial response to a growing crisis in America’s opioid addiction capital. Now, only time will tell whether the city has any other solutions.