More states and cities are considering needle-exchange programs as a way to fight the spread of HIV and hepatitis C among intravenous drug users, according to The Wall Street Journal.

Kentucky Governor Steve Beshear signed a bill into law last week that will allow local health departments to set up needle exchanges after obtaining approval from local governments.

In Indiana, Governor Mike Pence declared a state of emergency in response to a growing number of HIV cases linked to intravenous use of the painkiller Opana. He authorized a short-term program in one county to allow people to exchange used needles for sterile ones, to reduce the risk of contaminated needles being shared.

There are about 200 needle-exchange programs in 33 states and the District of Columbia, according to the North American Syringe Exchange Network.

In recent years, Nevada has allowed needle-exchange programs. Two Ohio cities on the Kentucky border, Cincinnati and Portsmouth, have established programs. In Florida, legislators are considering a proposal that would allow a pilot needle-exchange program in Miami-Dade County.

Supporters of needle-exchange programs say they reduce disease transmission, and can connect intravenous drug users with treatment programs. Critics say the programs sanction drug use, and discourage people from seeking treatment.

Public health officials are especially concerned about the spread of hepatitis C among people who use intravenous drugs. Hepatitis C can survive outside the body for at least 16 hours, and potentially up to four days.