As the costs of treating HIV and Hepatitis C infections are rising, and as these blood-borne diseases continue to be transmitted at discouraging rates, will 2015 be the year that the Texas Legislature finally approves a needle exchange program?
San Antonio state Rep. Ruth Jones McClendon, a Democrat who has represented the east and northeast parts of town for almost 20 years, has once again filed a bill to create pilot programs in seven major counties—Bexar, Harris, Dallas, El Paso, Travis, Nueces and Webb—that would legalize clean syringe distribution to intravenous drug users, in exchange for their used needles, and provide wound care supplies, outreach and public education on the transmission of communicable diseases and drug abuse counseling.
McClendon's bill made it to the floor of the Texas House of Representatives in 2013 with bipartisan support at the committee level before some of the more conservative Republicans in the House killed it, arguing that programs like these do nothing more than condone illicit drug use and simply make free needles available to addicts. While the issue is susceptible to demagoguery and often used to score cheap political points, needle exchange programs have been recommended by a wide range of national medical groups and public health organizations, like the Centers for Disease Control and Prevention and the American Medical Association, as effective ways to curb the transmission of blood-borne diseases and save the taxpayer dollars spent to treat them. Law enforcement agencies also support the public health measure because it keeps dirty, contaminated needles off the streets.
"... These programs encourage habits that offer hope for recovery and promote good health," McClendon wrote, in an email to the Current. "These efforts also provide a safe means of disposing of used needles by trading in the used needles instead of throwing them away in public places like parks and restrooms."
Nationwide, approximately one-third of AIDS cases are attributable to the use of intravenous drugs. In Texas, of the 4,291 diagnoses of HIV in 2013, 223 cases were caused by intravenous drug use, according to the Department of State Health Services. More than 300,000 Texans are chronically infected with Hepatitis C, costing the state millions.
"Right now, we are spending funds on treatment of Hepatitis C and HIV-AIDS, but virtually nothing on prevention," McClendon said.
Federal funds cannot be used to support needle exchange programs, though some states have appropriated state dollars to implement programs while other nonprofits and faith-based organizations are running them. Texas is the only state that hasn't legalized needle exchange.
The legislation has historically received broad, bipartisan support in the Lone Star State. Several Republican legislators have co-sponsored the bill with McClendon or filed their own, including outgoing Sen. Bob Deuell and state Rep. John Davis from Houston. On the local level, the Bexar County Commissioners Court has also favored needle exchange, and for good reason. In Bexar County, the rate of HIV diagnoses continues to increase while the numbers decrease both statewide and across the country. Between 2006 and 2013, up to 12 percent of new HIV diagnoses were the result of injection drug use, including drug use among men who have sex with men, the population at highest risk of HIV. Seth Mitchell, assistant to the county manager, who has testified in support of the program at the Texas Legislature, said treatment has cost the county up to $4 million in previous years.
"These harm reduction programs in other states have shown themselves to reduce the incidence of HIV and hepatitis; both of those diseases are unfortunately still prevalent in our community," Mitchell said.
According to the national Harm Reduction Coalition, providing clean syringes lowered the incidence of HIV infections by 80 percent among drug users. While treatment for infectious diseases like HIV and Hepatitis C can cost hundreds of thousands of dollars for a lifetime of care, syringes can cost as little as 97 cents per needle.
San Antonio, in fact, came close to implementing a program in 2007. As McClendon was working in Austin to pass a pilot program designated for Bexar County, the volunteer Bexar Area Harm Reduction Coalition, which included licensed medical professionals, was already out in the community exchanging used syringes for clean ones and distributing wound care supplies. Curt Harrell, a founding member and retired blood bank manager, who also worked for the state for many years, remembers finding dirty needles stashed under bridges and in creek beds and ditches.
"I hate to say it, but I think I'd see essentially the same thing now," he told the Current.
That year, the Legislature passed the Bexar County pilot program and Charlene Doria-Ortiz, program manager at the Bexar County Department of Community Resources Community Health Program, was tasked with studying existing programs across the country and buying supplies that included needles, disposal kits and first-aid materials. The county pilot program operated separately from BAHRC, but the plan was to work together.
That is until District Attorney Susan Reed stepped in, threatening to arrest BAHRC volunteers for violating Texas' drug paraphernalia law. After coalition members were issued Class C misdemeanors, their cases were escalated to Class A offenses. At the request of former Republican Sen. Jeff Wentworth, Attorney General Greg Abbott issued a legal opinion on the issue, essentially kicking it back to Reed. In a move that many remember as a naked political maneuver, Reed's opposition halted all needle exchange activity in San Antonio.
"These were mental- and physical-health professionals with licenses that Susan Reed was threatening," said Neel Lane, local attorney with Akin and Gump, who represented the coalition members. "It was one of her most visible irresponsible acts."
Harrell told the Current that since then the coalition has been distributing condoms and harm reduction literature in the community. Doria-Ortiz said the 11 months the 2007 pilot program was running provided the county an opportunity to do substantial planning and education. Should the Texas Legislature finally pass McClendon's bill, which now includes language protecting clean syringe distributors from prosecution, Doria-Ortiz said county public health officials will be ready.
"I think the coalition of folks that supported needle exchange in the past still exists," Doria-Ortiz said. "I think we've done a lot of education about how this is truly a public health issue, that it is a sound intervention and that we have advocates for this. I don't think we're starting from scratch."
Another plus? Reed is on her way out. District Attorney-elect Nico LaHood didn't respond to our requests for comment by press time, but advocates for needle exchange hope he will take a public-health-minded approach to the policy.