By Mary Wisniewski and Steve Bittenbender

AUSTIN, Ind (Reuters) - Since Indiana opened its first state-run needle exchange last spring, Tara Burton, 25, has made weekly visits to turn over needles she used to shoot Opana, a prescription painkiller, up her track-marked arm.

The one-story clinic in rural Scott County, Indiana, marks a sea change in states where conservative lawmakers had staunchly opposed old needles-for-new exchanges.

An HIV epidemic in Indiana and a rise in hepatitis C cases in Kentucky helped push those states to pass laws allowing communities to open needle exchanges. A pilot exchange program is due to begin in West Virginia in September. And Southern Ohio has opened exchanges in two cities since 2012.

"Some of the most conservative members of the community are supporting this now because they understand it," said Scott Lockard, president of the Kentucky Health Departments Association. He added, however, that "lots of education" is still needed.

Opponents insist exchanges facilitate criminal behavior.

"Really, you're encouraging drug use," said Kentucky State Representative Stan Lee, a Republican, comparing distributing clean needles to giving out condoms at schools.

Needle exchanges, which exist in 34 states, are gaining wider acceptance as health officials nationwide have expressed alarm at the surge in opiate abuse, including heroin and prescription opiates delivered through needles that are often passed between addicts. Those needles also spread potentially deadly diseases such as HIV and hepatitis C.

Deaths from heroin overdoses jumped 286% nationwide from 2002 to 2013, according to the Centers for Disease Control.

Few communities have been as starkly confronted with the health risks as Indiana's Scott County, a rural pocket of 24,000 people anchored by the working class towns of Austin and Scottsburg. Since December, the county has recorded 175 new HIV cases, up from an annual average of five, all tied to injected drugs.


Faced with a public health emergency, Indiana Governor Mike Pence, a Republican who had opposed exchanges, approved the state's first exchange program in March. Soon after, the Scott County Health Department's needle exchange opened its doors, providing intravenous drug users with sterile needles when they turn in dirty ones.

Since then, the number of new HIV cases has dropped from more than 20 each week to one in the last two weeks. Madison County also plans an exchange.

"The Scott County outbreak scared everybody because it was easy to look over your shoulder and say we've got all the conditions here to be next," said Daniel Raymond, policy director of the New York-based Harm Reduction Coalition.

"What's driving greater acceptance of needle exchanges is we don't have time to fight over ideology. We need to do something now because we're losing too many people."

Forty miles south, health officials in Louisville, Kentucky, opened that state's first needle exchange in June. The city of Lexington and rural Pendleton County have since approved exchanges, and officials are considering opening them in at least half a dozen more places in the coming months.

Kentucky State Senator Wil Schroder, a former prosecutor, said he did a "180" on needle exchanges, going from opposing them to persuading fellow Republicans that they can inform users about addiction programs while getting dirty needles out of parks.

The exchanges could also cut treatment costs, he added.

Kentucky has the highest rate of hepatitis C in the United States, with more than 56,000 infected residents requiring possible lifetime insurance and Medicaid costs of $4.5 billion. Schroder said hepatitis C cost Kentucky $28 million in 2014.

"The more I researched the issue, my mind started to change," he said.

Wayne Crabtree, a Louisville health official, said he sees all kinds of people enter the clinic as drug abuse spreads to include more women and high income earners.

One of his jobs is to convince users that exchange workers are there to help, not punish or judge. In its first month, the exchange has gotten 12 people into rehabilitation.

Burton, the woman who drops off used needles weekly at the Scott County clinic, said the exchange keeps users safe.

"People didn't care whose needle was whose before; that's what started this," said Burton, who contracted HIV before it opened. "It's a lot better now."