WASHINGTON — In 1988, arch-conservative Senator Jesse Helms successfully pushed Congress to prohibit federal dollars from being used to distribute sterile syringes to intravenous drug users, equating an effort meant to slow the spread of AIDS and other diseases to federal endorsement ofdrug abuse.
Mr. Helms, a North Carolina Republican, fretted that the ban would not last since it could be lifted if the surgeon general certified that needle exchanges were effective. He need not have worried. Despite ample health research showing that such programs can reduce the spread of disease, the ban on federal funding of needle exchanges has remained intact except for some easing when Democrats controlled the budget process for 2010 and 2011.
Now, with a severe outbreak of H.I.V. and hepatitis due to a surge in heroin use in states including Indiana, Kentucky and West Virginia, the question of whether to let federal money support needle exchanges is back. Still, in contrast to a new willingness by state politicians to accept needle exchanges, Congress appears unlikely to overturn the moratorium even with drug problems hitting hard in states represented by those responsible for the spending bills that impose the ban.
Representative Harold Rogers, the Republican who is chairman of the House Appropriations Committee, has seen drug addiction spread in his rural district in southeastern Kentucky, leading him to direct money home for both treatment and law enforcement. But a spokeswoman says he remains opposed to needle exchanges, which he considers a matter of local discretion.
“While he will continue to monitor the implementation of these programs and their impact, he continues to support the ban on the use of federal funds for needle exchange programs,” said the spokeswoman, Jennifer Hing. She added that Mr. Rogers intended “to focus federal resources on education and treatment programs that support communities in their drive to end the cycle of dependency.”
The federal ban began as a tough-on-drugs measure with political appeal to both parties. Mr. Helms, who also won a ban on the federal government’s supplying bleach to clean needles, said needle exchanges amounted to declaring, “It’s not only all right to use drugs, but we’ll give you the needles.”
Though evidence has mounted that needle exchanges are effective — the Centers for Disease Control and Prevention and the World Health Organization, among others, have recommended them — they have remained anathema to many politicians, particularly Republicans who have long framed opposition as an essential element of their antidrug image.
“As Republicans, we don’t want to look like we are facilitating drug use,” said Representative Tom Cole, the Oklahoma Republican who is chairman of the appropriations subcommittee that distributes health funding. “We want to get you help, but we want to do other things.”
While expressing reservations, Mr. Cole acknowledged that public funding of needle exchanges could be more cost effective than the potential public expense of treating increasing numbers of AIDS and hepatitis cases. He said he expected the issue to come up as Congress put its health spending bill together and, like Mr. Rogers, said he was open to exploring the issue.
“If the evidence is such that it really makes a difference, it is something to look at,” Mr. Cole said.
To some Democrats, there is no question that the ban should be eliminated and that Republicans are stuck in the past when it comes to both drug and health policy.
“We should lift the ban,” said Representative Rosa DeLauro of Connecticut, a senior Democrat on the appropriations subcommittee. “Health, and not ideology, should be the determining factor.”
In Indiana, an epidemic of H.I.V. related to intravenous drug use in one southeastern county led Gov. Mike Pence, a former Republican House member and longtime supporter of the ban, to back away from his opposition. In March, he signed an executive order allowing a temporary needle exchange in Scott County. This month, he signedlegislation allowing counties around the state to begin exchanges if officials can demonstrate that they would be an appropriate public health response. The Kentucky Legislature, on a bipartisan basis, also passed legislation allowing needle exchange programs.
In the past, the ban was a touchy issue for both parties. President Bill Clinton continued the Reagan-era prohibition, partly at the urging of his drug czar’s office, even after his health secretary determined in 1998 that the criteria had been met for lifting it.
The Republican-led House that year rejected a Democratic attempt to overturn the ban.
“When the government says, ‘Drop by for some free needles,’ we are clearly saying something,” Speaker Newt Gingrich said on the House floor in April 1998 as he fought off the Democratic effort.
The ban stayed intact during the administration of George W. Bush, though the surgeon general found in 2000 that needle exchanges could play a critical role in preventing AIDS and that the programs could induce addicts to enter treatment programs.
President Obama said he would lift the ban, but he moved slowly. The Democratic-led Congress eventually allowed exchanges to be federally funded unless local public health and law enforcement agencies judged them to be inappropriate. The Department of Health and Human Services also began using the less politically charged term of “syringe services program.”
But the ban was quickly reinstated when Republicans took back House control in 2011.
Led by Mr. Rogers, the powerful appropriations chairman, Republicans again favor retaining the ban as spending bills begin moving through the House and Senate. But with their states overwhelmed by heroin abuse and a cascading public health crisis, some acknowledge it might merit rethinking.
“I’m certainly willing to look at it as an option,” said Senator Shelley Moore Capito, a West Virginia Republican who joined the Senate this year after seven terms in the House and now sits on the Appropriations Committee. “Our state is really suffering from this. It’s very worrisome.”
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