'Heroin is the devil': addiction, religion, and needle exchange in the rural United States

Like many rural and suburban counties in the Midwestern United States, George County, Indiana is facing increased rates of heroin use, drug-related overdose, and hepatitis C. Following an outbreak of HIV in 2015 in a nearby county, the George County department of health launched an effort to open a needle exchange despite considerable opposition from the community, including ambivalent stances among current and former users of opiates. This article examines these conflicted perspectives noting their grounding in a moral approach to addiction and seeks to explain opposition to the needle exchange program by examining locals' depictions of the religious and moral landscape of the county. This analysis is based on 29 qualitative interviews conducted with 20 people who have experience using heroin or prescription opioid painkillers and 13 other community members involved in local efforts to address addiction. Ethnographic observation of public events was undertaken. Examining the contours of the local moral economy and its links to religious spirituality and practice reveals that the moral model of addiction both mitigates and produces social exclusion and begets conflicted stances towards the presence of an initiative to open a modest needle exchange program. Interviewees expressed a variety of stances towards the initiative feeling that it might decrease the spread of disease, but may not be used effectively. Though it is situated on morally contested terrain, it may be a step towards social inclusion and empowerment for addicted individuals who stake their right to health and a place in the community.