CHARLESTON, W.Va. — To its critics here, the needle exchange was an unregulated, mismanaged nightmare — a “mini-mall for junkies and drug dealers” in the words of Danny Jones, the city’s mayor — drawing crime into the city and flooding the streets with syringes. To its supporters, it was a crucial response to an escalating crisis, and the last bulwark standing between the region and a potential outbreak of hepatitis and H.I.V.

When Charleston closed the program last month after a little more than two years of operation, it was the latest casualty of a conflict playing out in a growing number of American communities. At least seven other such exchanges have closed in the past two years, even as dozens of others have opened.

Needle exchanges dispense sterile syringes to drug users and give them somewhere to discard their used syringes safely. Often, as in Charleston’s case, an exchange will offer supporting services, too: on-site medical care, hepatitis/H.I.V. screening, counseling and connections to drug treatment.

They were once a largely urban phenomenon. But the opioid crisis is changing the landscape. After an H.I.V. outbreak among injection drug users in Scott County, Ind., in 2015, health officials opened many exchanges in suburbs, rural areas and small cities in more conservative parts of the country. Some of these communities have had second thoughts.

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