Update on Syringe Exchange Outreach Programs in Texas

Dear friend,

When the 81st Texas Legislature convenes in January, legislators from both sides of the aisle will support bills to reduce the spread of hepatitis C and HIV/AIDS by allowing local health authorities to implement syringe exchange outreach programs.

Bills have been filed by Senator Bob Deuell of Rockwall (Senate Bill 188), Representative Ruth McClendon of San Antonio (House Bill 142), and Representative Solomon Ortiz, Jr. of Corpus Christi (House Bill 272).

Needle exchange isn’t only about saving lives. The programs can save millions of dollars. Preventing HIV and hepatitis C costs taxpayers less than treating sufferers of these debilitating diseases. Although the state’s first pilot syringe exchange program in Bexar County was authorized by the Legislature during the last session, implementation has been blocked since January. Bexar County District Attorney Susan Reed, based on her misguided interpretation of the law, threatens prosecution of health care providers who participate.

The thwarted pilot program was to serve as a model for the development of needle exchange programs in major cities around the state, a move strongly supported by the ACLU of Texas. (To learn more about needle exchange programs, visit www.TexasAccessProject.org)

Today in Texas more than 300,000 people are infected with hepatitis C, leading to chronic liver disease and death. More than 35 percent of those infected, including almost all infants with HIV, got sick because they or their parents shared dirty needles.

Local counties and hospital districts bear most of the treatment costs, which are difficult to quantify. Whatever the local expense, the state spends an additional $100 million annually to treat HIV/AIDS and hepatitis C.

During this time of fiscal crisis, a cost-effective syringe exchange program could save millions of tax dollars currently spent on expensive liver transplants, cancer- and HIV/AIDS-related treatments.

The ACLU Foundation of Texas has partnered with Capitol City Solutions to bring this issue to the attention of all concerned Texans.

We have launched a web site with the latest information on needle exchange advancements (www.TexasAccessProject.org).

Join with us. Let your state representative and senator know you support syringe exchange. Too many lives are at stake for us to be silent.

In liberty,

Terri Burke
Executive Director
ACLU Foundation of Texas

The Access Project is a project of the American Civil Liberties Union Foundation of Texas.

SB 308 half way home, but more obstacles

SB 308 passed the Senate Health and Human Services Committee April 12th with 7 to 1. You can see what I wrote about it here. All the witnesses for the committee did an amazing job of providing the committee members the information they needed to become convinced that needle exchange is necessary in the combat against HIV and hepatitis C, and a valuable tool in reducing drug use. There was not a single person registered to testify in opposition of the bill. The only member to vote against the bill in committee was Senator Dan Patrick (R-Houston) . Senator Jane Nelson voted in favor of the bill after several sessions of active opposition, and we commend her for listening to the evidence and making the right decision. The hearing could not have gone any better.

The bill then passed the Senate floor with a 23-8 vote, which generated a great story from KVUE. Senator Deuell has been a great champion of this improtant piece of legislation, and most members of the Senate really stepped up to support his efforts this session making a great statement in favor of needle exchange. We encourage all of you to join us in our thanks to Senator Deuell and his staff for the amazing work they have put into this bill.

The news is not all good though, SB 308 must now get a hearing in the House Public Health Committee. Representative Delisi (R-Temple), Chair of Public Health has yet to show interest in scheduling a hearing for SB 308, and if she does not schedule a hearing by this week, the needle will sink back into the haystack.

Representative Delisi has been awarded volumes of honors for being a great legislator in the field of health care and public health, however that has not rung true in regards to needle exchange. We can only hope that she will examine the vast amounts of evidence in favor of needle exchange programs and make her decision based on testimony, as the Senate did just weeks ago.

Legislators Get the Point!

by Chris Bernard

There is a bright and shiny light shining out from the Republican part of Texas. It must be the reflection of the syringe access bill that Senators Deuell (R-Greenville) and Van de Putte (D-San Antonio) joint-filed last week. SB 308 was accompanied by a stellar press release from Deuell's office which laid out their reasoning behind the bill:

Deuell Files Needle Exchange Bill
Doctor / Senator Says Program Will Save Lives and Money AUSTIN --
State Senator Bob Deuell (R-Greenville) today filed SenateBill 308, relating to disease control programs aimed at reducing the risk of communicable diseases. A key component of the bill would allow local health authorities to set up programs that permit anonymous exchange of used hypodermic needles. Deuell, a practicing family physician, stated the program will save lives, save money and could actually help get drug abusers into rehabilitation and treatment.

Senator Leticia Van de Putte (D-San Antonio), a certified pharmacist, has signed on as a joint author. "I have seen extensive research that show programs like this reduce the spread of hepatitis and HIV, and do not encourage or increase the use of illegal drugs," Deuell said.
"On the fiscal side, the cost of treating a single HIV case run into the hundreds of thousands of dollars making this program cost-effective as well."

Deuell also said this initiative may have the added incentive of getting drug users into treatment. "The local health authorities who administer these programs may also provide drug counseling and treatment," Deuell said. "This might be the only time we can get to these people and give them the opportunity to rehabilitate themselves. One study showed more than 1,000 drug users found their way into treatment through a needle exchange program."

"As a physician and a member of the Senate Finance Committee, I am confident these programs make sense from a medical and a fiscal standpoint," Deuell said. "I firmly believe this represents good,conservative public policy."

We want to congratulate the senators on this groundbreaking effort in the fight against HIV and other blood borne diseases in Texas. We also want to encourage our readers to contact Senators Deuell and Van de Putte and express their support. In addition, please contact your own Senators and Representatives and tell them to support SB 308 and it's House companion, HB 856, filed by Ruth McClendon(D- San Antonio)

We have already seen a great response on the left and the right sides of the blogosphere. Particularly this entry from the Lone Star Times is right on the money. Syringe exchange is good conservative policy and the "christian " thing to do.

One invisible beauty of this bill is that it will not require any spending money from the state, making the fiscal note on the bill a big zilch. And as a bill that seeks to remove penalties rather than mandate programs, cities and counties don't have to create syringe exchange programs if they don't think they need one. Under SB 308/HB 856, public health workers, outreach workers, faith based organizations have the option to use the most effective and least expensive means necessary to prevent HIV and outreach to injection drug users. Reduced HIV means the money saved in state health care costs, and with no investment, syringe exchange will yield high returns.

Texas: Ahead of the Curve in HIV/AIDS Rates, Lagging Behind in Policy

By Chris Bernard

As a follow up to my previous post about New Jersey being the last state to provide syringe access, I decided to try to figure out exactly what states besides New Jersey are still preventing access to syringes for IDUs. Texas, Tennessee, South Carolina, South Dakota and Kansas are really the only states left without any kind of legal access to syringes for IDUs. Out of these five states Texas is the only state that is over represented in the annual HIV infections, we represent approximately 7.7% of the U.S. population and approximately 10.3% of the annual HIV infections. Texas is in fact in the top ten for AIDS cases (fourth actually) as well and we are the only state in that top ten without legal syringe access.

The question we should all be asking ourselves is why? Why is a state that is over represented in every category of HIV/AIDS refusing to act on the recommendations given by the CDC, IOM, AMA, WHO, Surgeon General Satcher, almost every state level medical organization, and many others in a list too long to lay out, to help stop the spread of HIV/AIDS? SEPs are and is shown to be cost effective, they even save money for the state! It is time we demand that our state legislators represent the interest of all Texans and allow SEPs to operate where health care providers deem them necessary to keep our fellow Texans alive until they are able to overcome their addictions.

Canadian Health Minister Deciding Fate of Vancouver Safe Injection Site

Our northern neighbors, those crazy Canadians, have instituted a semi-experimental program (semi only because they are prevalent throughout Europe and Australia) which allows injection drug users to "shoot up" their own drugs in a facility staffed by addiction counselors, nurses and persons in recovery. This program, called InSite, has actually been in operation since 2003 when the City of Vancouver, the Vancouver Police Department and various community groups asked the Canadian feds for an exemption to the controlled substances act. With the exemption granted, InSite opened it's doors and has since provided services to over 7000 people. The program has been examined intensely and has been showing that their services have reduced drug use, the harms associated with it, and cleaned up the streets. Here's an excerpt of some of the research results listed on their web site

Insite has been subject to rigorous, independent third party research and evaluation by the BC Centre for Excellence in HIV/AIDS, recognized as one of the world’s leading research organizations. The Centre’s research has been published in peer-reviewed journals including the New England Journal of Medicine, the British Medical Journal, the Canadian Medical Association Journal, and The Lancet.

Results include:

• Insite is leading to increased uptake into detoxification programs and addiction treatment. (New England Journal of Medicine)
• Insite has not led to an increase in drug-related crime, rates of arrest for drug trafficking, assaults and robbery were similar after the facility’s opening, and rates of vehicle break-ins/theft declined significantly. (Substance Abuse Treatment, Prevention, and Policy)
• Insite has reduced the number of people injecting in public and the amount of injection-related litter in the downtown eastside. (Canadian Medical Association Journal)
• Insite is attracting the highest-risk users – those more likely to be vulnerable to HIV infection and overdose, and who were contributing to problems of public drug use and unsafe syringe disposal. (American Journal of Preventive Medicine)
• Insite has reduced overall rates of needle sharing in the community, and among those who used the supervised injection site for some, most or all of their injections, 70% were less likely to report syringe sharing. (The Lancet)
• Nearly one-third of Insite users received information relating to safer injecting practices. Those who received help injecting from fellow injection drug users on the streets were more than twice as likely to have received safer injecting education at Insite. (The International Journal of Drug Policy)
• Insite is not increasing rates of relapse among former drug users, nor is it a negative influence on those seeking to stop drug use. (British Medical Journal)

The security of the program has recently been threatened, since the newly elected more conservative government has taken over. In purely reactionary statements provided without research, Health Minister Tony Clement virtually vowed to ensure that the programs would not succeed. However, shortly after threatening closure, he had a change of heart and allowed them to continue operations until the conclusion of certain research activities, or December 2007, at which point he intends to reviews the science to determine whether safe injections sites help or hinder public health.

According to a Jan. 4 article in Canada.com, Clement paid a surprise visit to InSite this week, (his first visit to the facility in fact) in effort to actually learn about the clinic, its goals, achievements and day to day activities. A commendable move for a person ultimately in charge of Canada's health policies.

He defended the fact that he did not visit before making that ruling. 'It's important for me to accentuate that I am here now,'' he said

''I had a good chat with the staff there, understood some of their procedures, asked a lot of questions, got a lot of answers,''Clement said after his tour.

But he declined to say whether his views had changed.

''I think I am continuing to get a deeper understanding and this is all part of being the best health minister I can be for the country,''he said.

With safe injection sites, Vancouver health officials are meeting drug users where they are at, intervening in addiction before users hit rock bottom, and providing safe injection equipment so that recovery will be unimpeded by deadly diseases. I hope Minister Clement takes a good look at the research, and prioritizes good public health policy over continued anti-drug war rhetoric. Nobody wants to encourage addiction, and while this program may seem counter-intuitive, it works to usher addicts into treatment earlier than they would have gone on their own, and without the complication of HIV/AIDS and hepatitis.

Major Combat is Not Complete

by: Chris Bernard

While reading the many articles regarding New Jersey's newly passed syringe exchange bill my joy over the victory was mixed with frustration over a common misconception. One article read (Press of Atlantic City 12/20):

New Jersey became the last state in the nation to allow drug users access to clean needles without a prescription when Gov. Jon S. Corzine signed legislation Tuesday to allow pilot needle-exchange programs in as many as six cities.

I can tell you from my own work that Texas does not have, as of today, legal access to syringes for IDUs. This critical mistake is committed over and over again in the press. I am not accusing anyone of bad reporting, I think that this claim is simply based on a misinterpretation of a couple of well researched and peer reviewed published papers by the ABA and Temple University (see the explanation of legal analysis) regarding the legality of syringe access. This paper claims that there are legal technicality arguments for MD's to prescribe syringes to IDUs as preventative medicine, or some other possibly legal access. However the papers do not indicate what is practiced in given states or what would actually be accepted as legal in the courts.

The victory in New Jersey is not the final victory in the battle for syringe access. Texas does not yet have legal syringe exchange programs and purchasing needles in pharmacies is illegal if the pharmacist has any reason to believe her client will be injecting illicit substances. The legislative session will be starting in just a week, and with Senator Deuell filing a bill to allow for syringe access perhaps we will finally find the needle at the bottom of the haystack here in the heart of Texas.

A Tale of Two Syringe Policies

What do Australia and Texas have in common? Quit a bit it seems, from the size of land to the size injection drug using populations. (est. 100,000) But one statistic they don't share is amount of persons living with HIV/AIDS . Australia has only 14,000 people living with HIV, while Texas rates are 4 times higher.

Why the difference? Because in Australia's effort to be intolerant of drugs never overshadowed the importance of public health and disease prevention. At the dawning of the HIV/AIDS epidemic, Australia implemented an extensive network of syringe exchange centers across the country as part of their "Tough on Drugs" campaign.

According to syringe exchange poopoonants, providing syringes to addicts would have resulted in elevated drug use, elevated crime, and a very confused population of children who would be 'lured into drug use' thorough the sheer existence of syringe exchange programs. But that is not what has happened. Australia has one of the lowest HIV/AIDS rates in the world, and while nothing to brag about, their IV drug using population is the same size as Texas', a state with out legal access to syringes.

So, what affect does syringe access have on the size of IDU populations? Apparently none.
What affect does a lack of syringe access have on IDU populations? Lots of AIDS and hep C.

Texas has the 4th highest HIV/AIDS rates in the country that boast having the highest HIV/AIDS rate out of all industrialized nations! And, over 400,000 Texans are infected with the deadly HCV virus. Hasn't anyone heard that our health care system is in crisis? These diseases are expensive and cost us around 100g's a pop. Last I heard, a syringe cost 7 cents.

For more information on Australia's successful SEP's, check out their 2002 report that details how many HIV and hepatitis C cases have been prevented, how much it cost the government, and how much money it saved them.

For information on Texas HIV/AIDS rates, check out the Department of State Health Services annual surveillance reports.

Be Aware

....is what my friend Scott Henson says in his blog about National Meth Awareness day, which apparently is today. Before you head out to celebrate, check out his blog, and the link he included to Drug War Rant, which provides some basic facts about meth in America today. It's the holidays, time to get up to 'speed' (sorry) on your trivia, and check it out.

A more local approach towards meth awareness can start with the 2006 Report on Substance Abuse Trends in Texas. The report covers pretty much all drugs used illegally, including legal drugs like riddalin, alcohol, and cough medicine. Of the prohibited substances, the author Jane Carlisle Maxwell tells you where the goods are coming from, what it's typically made from (incase you were looking for recipies) and what you should expect to pay for it depending on what city you happen to be visiting.

She's also got a great graph on page 13 that demonstrates how Texans are finally starting to wise up when it comes to injecting the stuff. In the late 80's, over 80% of folks here were shooting meth, while only 1% were smoking it. In 2005, we see that the number of meth users poking themselves to get off decreased to 40%, while over 50% have taken to smoking it.

While I wouldn't recommend ever touching the stuff, it's good to know that people have chosen a method of delivery that is 'safer' than injection drug use. But at the same time, given the statistics provided in the report, injection is the second most common route Texans use to take meth, and that makes for quite a lot of people out there who are in need of clean needles.

Glossary of Popular Syringe Access Terms

As with all specialized fields of study, drug policy discussions frequently include terminology not used in every day conversations. Here are some brief definitions of common terms used in syringe access dialogue.

Harm Reduction-Harm reduction is a set of practical strategies that reduce negative consequences of drug use, incorporating a spectrum of strategies from safer use, to managed use to abstinence.

Names for Syringe Access Programs
SEP- Syringe Exchange Program- A program that collects dirty syringes in exchange for sterile ones. SEP's often provide many other services such as disease testing, referrals to treatment and other risk reduction education. syn: NEP
NEP- Needle Exchange Program- syn: SEP, see above
Pharmaceutical Access- non-prescription sales of syringes in pharmacies

Names for Users of Drugs
IDU- Intravenous Drug User
Addict- A person who has developed a psychological or physical dependence on a substance.
User- A person who uses drugs but is not addicted.
Junkie- A person addicted to narcotic drugs, especially heroin

Diseases and Health Risks Related to Injection Drug Use
HIV- Human Immunodeficiency Virus
AIDS-Acquired Immune Difficiency Syndrom
HCV- Hepatitis C
HBV- Hepatitis B
HAV-Hepatits A
Addiction- The disease of psychological or physical dependence on a substance.
Cotton Fever- Cotton fever is believed to be caused by the Enterobacter agglomerans bacterium, which colonizes cotton plants. IDU's elevate their chances of contracting cotton fever when using short strand cotton (cigarette filters, cotton balls, etc) as opposed to long strand cotton.
OD- Overose. Overdose is the poisoning of a persons body that occurs when a drug is ingested in too large of a quantity, causing severe illness or death.

Risk Reduction Drugs and Practices
Buprenorphine- An opioid drug used primarily in the relief of pain associated with drug addiction withdrawl and treatment.
Naloxone- A drug that instantly reverses the respiratory depression associated with opiate overdose, often used to save lives of those who OD on opiates. Does not work for non-opiate OD's.
Methadone- A simple synthetic opioid often used in the detoxification and treatment of people with addiciton to narcotics. Also used in treatment of chronic pain.
Safe Injection- Eliminating as many risks as possible to make injection drug use survivable. Example: never use alone, one sterile needle per person, used one time only, rotate injeciton site on body to save veins, ect.

7.7 BILLION DOLLAR VICTORY

Last week, St. Vincents Hospital in Darlinghurst Australia celebrated 20 years of providing sterile syringes to injection drug users, and they have a lot to celebrate. In 1986, one young and daring doctor, Dr. Alex Wodak, acted according to his medical ethics and against Australian drug policies, and began distributing sterile syringes to injection drug users using money collected in a hat that was passed among clinic staff. Alex challanged law enforcement with medical redommendations, and "It was a gamble that paid off" according to the Sydney Morning Herald (Nov 13),

By 2000, needle and syringe programs around Australia had prevented an estimated 25,000 HIV infections and 21,000 hepatitis C infections and saved the country as much as $7.7 billion in health costs.

Since the late 80's, the Australian government has incorporated harm reduction principles into their "Tough on Drugs" campaign and designated 860 locations where needle and syringe programs provide syringes and drug treatment services to addicts. By acting upon the recommendations of doctors rather than anti-drug laws, Australia prioritized disease prevention and they succeeded.

By contrast, the US authorities deciede it would be best to use HIV/AIDS as a deterrent to drug users. The result?

..the US has the highest AIDS incidence in the industrialised world, and 36 per cent of new HIV cases are injecting drug users, compared with less than 5 per cent in Australia.

Good for you Australia. And for my native country, shame, shame, shame.....

RIM JOB

The New Jersey Senate comittee finally passed a bill allowing for the legal operation of syringe exchange programs in the state. Great progress, now it just has to get voted off off the Senate floor to become a reality.

While most New Jersey residents understand the science supporting the programs, the Family Policy Council still persists with invalid and uniformed protests, reported the Cherry Hill Courier Post ("Needle exchange bill moves forward," Oct. 20).

Won Kyu Rim of the New Jersey Family Policy Council said that although he and the supporters of the bill shared the goal of stopping the spread of the disease, their solutions differed.

"We should be going with the programs that are proven to work, not a pilot program where the results are ambiguous," said Rim. "The best way to use the state's money is to allocate it toward established treatment programs, not to mush them all together."

The most interesting thing about Rim's comments is that NEP's are proven to work, with results that are easy to interpret: reduced blood born disease, reduced needle litter on the street and no increase in drug use. They also tend to pull addicts into treatment pretty regularly. In fact, the only reason NEP's are even being proposed in the form of pilot programs is to combat the irrational fear of increased drug use that folks like the Family Council have created.

New Jersey has the fifth highest HIV rate in the nation, and nearly 50 percent of those infections were caused from used of infected needles. Seventy percent of newborns infected with HIV get it because their parents had used shared needles. Sounds to me like pilot program or not, New Jersey needs clean needles.

Welcome to the Haystack

Welcome to the Haystack- thanks for checking it out. This blog is under construction, but hope to have it up and running by Novemeber 1. Please check back in with us then.

Until then, if you have pressing questions about syringe access, contact Tracey Hayes at thayes@aclutx.org, and I'll be happy to answer any questions you may have about the topic.