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.
See photos from the unfolding health crisis in Indiana:
Drug needle exchanges gain ground after Indiana HIV outbreak
FILE - In this April 21, 2015 file photo, new needles which clients can get as part of the needle exchange program at the Austin Community Outreach Center are displayed in Austin, Ind. Indiana's health commissioner approved a one-year needle-exchange program Thursday, May 21, 2015, for a rural county at the center of the state's largest HIV outbreak, an epidemic that's being driven by needle-sharing among intravenous drug users. The southeastern Indiana county had been operating a temporary needle-exchange under an executive order signed by Gov. Mike Pence that will expire Sunday. (AP Photo/Darron Cummings)
FILE - In this April 21, 2015 file photo, signs are displayed for the needle exchange program at the Austin Community Outreach Center in Austin, Ind. Indiana's health commissioner approved a one-year needle-exchange program Thursday, May 21, 2015, for a rural county at the center of the state's largest HIV outbreak, an epidemic that's being driven by needle-sharing among intravenous drug users. The southeastern Indiana county had been operating a temporary needle-exchange under an executive order signed by Gov. Mike Pence that will expire Sunday. (AP Photo/Darron Cummings)
Stickers are given to clients after they get tested for HIV at the One-Stop Shop at the Austin Community Outreach Center, Tuesday, April 21, 2015, in Austin, Ind. Indiana health officials trying to contain an HIV outbreak tied to needle-sharing among drug users are getting helping from specialists from other states in tracking down about 130 additional people who also may be infected. (AP Photo/Darron Cummings)
Information brochures are on display inside of Austin Community Outreach Center, Tuesday, April 21, 2015, in Austin, Ind. The center offer One-Stop Shop HIV testing and a needle exchange program. (AP Photo/Darron Cummings)
Indiana's deputy state health Commissioner Jennifer Walthall speaks Wednesday, June 17, 2015, during a news conference with State Health Commissioner Dr. Jerome Adams on an HIV outbreak in southeastern Indiana. Adams and Walthall announced that a community outreach center in Austin, the Scott County city that's the outbreak's epicenter, will close next week and reopen at another location that will remain in operation for at least one year. Indiana's outbreak tied to needle-sharing among intravenous drug users has 169 confirmed HIV cases and one preliminary positive case. (AP Photo/Rick Callahan)
Signs are posted for the Austin Community Outreach Center, Tuesday, April 21, 2015, in Austin, Ind. Indiana health officials trying to contain an HIV outbreak tied to needle-sharing among drug users are getting helping from specialists from other states in tracking down about 130 additional people who also may be infected. (AP Photo/Darron Cummings)
Indiana Gov. Mike Pence responds to a question during a news conference Wednesday, March 25, 2015, in Scottsburg, Ind. Pence held a news conference after meeting with local officials in Scott County about an HIV outbreak. (AP Photo/Darron Cummings)
Indiana Gov. Mike Pence meets with local officials in Scott County to discuss an HIV outbreak in the area, Wednesday, March 25, 2015, in Scottsburg, Ind. Pence is preparing to declare a public health emergency in the southern Indiana county where 72 cases of HIV have been confirmed. (AP Photo/Darron Cummings)
FILE - In this Thursday, July 5, 2012 file photo, people visit the AIDS Memorial Quilt on display as part of the Smithsonian Folklife Festival on the National Mall in Washington. Comparisons between Ebola and AIDS have surfaced in mid-2014 as the Ebola outbreak escalated. But Ebola is not expected to ever be in the same league as AIDS in terms of infections and deaths, said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. (AP Photo/Jacquelyn Martin)
A man holds up a syringe, hand towel and citric acid sachet at a needle exchange facility, with nursing staff member Christina Antoniadi, in the background, in central Athens, on Monday, Nov. 25, 2013. Drug experts and policy makers from around Europe are gathering in Athens to urge their governments to exclude drug treatment from economic austerity programs, citing an alarming rise in HIV infections among drug users in Greece. The number of reported new infections among drug users in Greece shot up from 22 in 2010 to 245 in 2011, according to the European Centre for Disease Prevention and Control. Experts blame the rise on a number of factors, several related to Greece's major financial crisis. (AP Photo/Petros Giannakouris)
In this photograph taken on November 3, 2011 a heroin drug user prepares a syringe at a park in Medan city in Sumatra island. Cordia-Caritas Medan, a non-government organization, focus rehabilitation efforts on heroin drug users thru their needle exchange and recovery program in Medan as part of its anti-HIV/AIDS campaign in Indonesia where the highest rate of HIV/AIDS infection comes from injecting drug users. The latest National AIDS Commission report estimated that there were 227,700 people living with HIV/AIDS in Indonesia in 2007, a figure it said would double to 501,400 by 2014 making the AIDS epidemic in the country one of the fastest growing in Asia. AFP PHOTO / SUTANTA ADITYA (Photo credit should read SUTANTA ADITYA/AFP/Getty Images)
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"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.
"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 percent 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."
(Reporting by Mary Wisniewski and Steve Bittenbender in Austin, Indiana; Editing by Richard Chang)