If personnel is policy, President Biden made a curious decision in nominating Rahul Gupta to be his drug czar.

It’s not that Gupta is unqualified. He is a respected health official who has substantial experience working to address addiction. But as head of the administration’s strategy on drugs, he will need to navigate a thorny issue at the front lines of the culture wars: needle exchanges.

This is an issue that haunts Gupta from his time as West Virginia’s health commissioner. If he is to effectively carry out the president’s agenda, he’ll have to do a much better job not just defending but also promoting these programs.

The Biden administration has signaled strong support for needle exchanges as a harm-reduction strategy. The idea behind such programs is simple: Those suffering from addiction will inject drugs one way or another, so the government has an interest in making sure they can do so safely. Studies have regularly found that programs providing sterile needles not only help prevent the spread of diseases such as HIV and hepatitis but also reduce risky behavior such as needle-sharing.

The question for Gupta is not whether he supports harm-reduction strategies; he has a long record of doing so. It’s whether, as health commissioner, he provided cover for opponents of needle exchanges, contributing to what is now the “most concerning” HIV spike in the country, according to an official at the Centers for Disease Control and Prevention.

In 2018, then-Charleston, W.Va., Mayor Danny Jones went on a crusade against the syringe service program operated by the Kanawha-Charleston Health Department, which he described as a “mini-mall for junkies.” He and the City Council suspended the program and asked the state to conduct an audit of it.

Gupta complied, issuing a 62-page document that recommended the program be suspended, even though the city had already done that. The audit criticized the program for sloppy record-keeping and for missing out on opportunities to refer participants to treatment. It also noted the program resulted in syringe litter that, while a legitimate concern, fed into a common negative narrative about needle services. (When operated correctly, such programs can actually reduce discarded needles.)

The program’s opponents seized on the document. The program remained closed, and the city implemented strict rules for other syringe services in the city. These include restricting the number of needles given to participants, establishing criminal charges for any organization that doesn’t follow the rules and requiring that needles be tracked and returned. That last is a massive hurdle to overcome, given that these programs work with a population that already greatly mistrusts the government. The state legislature also issued its own requirements (though they are not as onerous as the city’s and were recently blocked in federal court).

It is important to note that these policies took effect even though the addiction crisis was raging — and still is. Worse, they were motivated not by science but by misconceptions about addiction and — yes — contempt for people who use drugs. The lazy formulation posits that “some people say” needle exchanges enable drug use. This is often followed with claims that such programs attract crime (not true) or pose a moral hazard to communities. In reality, making drug use more difficult doesn’t make addiction go away. That only makes it more dangerous. The challenge is to balance drug enforcement policies with strategies to keep people with substance-use disorder safe while, if possible, steering them toward treatment.

While Gupta later said closing needle exchanges is “not in the best interest of the community,” he also said he stood by the audit and that it should serve as a lesson for other needle exchanges.

State health data make clear that intravenous drug use is the primary driver of the HIV outbreak. In response, CDC officials recommended expanding syringe services to address the problem, but because of Charleston’s rules, that’s nearly impossible.

This is a health policy failure. And it’s happening across the country. In Scott County, Ind., county commissioners last month ended syringe services that were widely credited with helping to contain an HIV outbreak. Similar battles have been raging in North Carolina, New Jersey, California and elsewhere.

Gupta needs to set the record straight during his confirmation hearings and explain what he thinks about needle exchange programs. That should include whether he supports the sort of restrictions on programs that Charleston and West Virginia have passed. The White House was unable to make him available for comment for this column.

More important, Gupta needs to demonstrate that he’s willing to lead on the issue. Yes, these programs are bound to produce local gripes. But there are ways to address concerns. The federal government should come up with strategies to better connect participants to treatment and to clean up discarded needles, such as by making needle drop boxes more accessible.

The Biden administration promised to put compassion at the core of its public health strategies. Gupta can help deliver on that promise by embracing and defending syringe services.

Read more: