The specter of a ruinous budget shortfall has darkened the mood of the current Texas Legislature. In a climate with a mandate to slash spending, bills that seek new or increased funding — no matter how valid the need — seem doomed from the start.
Paradoxically, one of the earliest bills filed for the 140-day biennial session, a public-health outreach program that would include distribution of sterile syringes to injecting drug users, may benefit from the tight economic environment. While this is a controversial issue, and many people believe that needle exchange programs simply facilitate or condone illegal drug use, there is a powerful conservative argument for why it is nonetheless good public policy.
House Bill 117, authored by Rep. Ruth Jones McClendon, D-San Antonio, seeks no state money. It would simply allow local health authorities or nongovernmental organizations to use either private or public funds to establish disease-control programs that offer blood testing, education about the transmission and prevention of communicable diseases, and exchange of used syringes for new ones. Vitally important, these programs would also help participants gain access to effective treatment for their addiction.
Obviously, injecting illegal drugs — particularly in the corrupted state in which they typically reach the retail market — is risky business. This inherent risk is substantially increased when users share needles contaminated by blood-borne diseases, most notably HIV/AIDS and hepatitis. The actual result is stunning. According to the Centers for Disease Control and Prevention, nearly 30 percent of new cases of HIV/AIDS and 60 percent of hepatitis C can be traced to injecting drug use. Small wonder that politicians at all levels have long sought to deny drug users easy access to needles and to punish them whenever they are found with one.
While understandable at a superficial level, this policy rests on a demonstrably false premise. Addicts deprived of clean needles do not give up their drugs; they inject them with contaminated needles, and they contract deadly diseases.
One may regard such outcomes as a matter of just deserts, but even the most punitive of politicians pause in the face of the economic drain these diseases create. The average lifetime cost of treating a person with HIV/AIDS is currently estimated to be $380,000. Lifetime costs of treatment for hepatitis C can exceed $300,000. Texas has the fourth-highest rate of HIV/AIDS in the nation, with an estimated 63,000 Texans currently living with HIV, and at least 300,000 with hepatitis C.
Many people infected with these diseases receive little or no medical treatment, but of those who do, public funds bear a high proportion of the cost. From 2002 to 2007, state Medicaid costs for HIV/AIDS services totaled more than $476 million; the cost of treating hepatitis C reached nearly $160 million. That did not include outlays by private payers, insurance companies, local hospital districts or federal programs like Medicare and Veterans Affairs.
Well-run syringe exchanges can dramatically reduce the spread of these diseases. A Johns Hopkins study of the Baltimore City Needle Exchange found that, after six years in operation, the incidence of HIV in Baltimore decreased by 35 percent overall and 70 percent among the approximately 10,000 participants in the program. Even more striking, epidemiologist Don Des Jarlais, director of research at New York’s Beth Israel Medical Center and a leading expert on syringe exchange, reports that the incidence of new HIV infections among injecting drug users in New York City has dropped to less than 1 percent per year. "We appear," he said, "to be very close to eliminating injecting-related transmission in a city with over 100,000 injecting drug users."
At least 10 major studies, conducted by such organizations as the National Academy of Science, the Centers for Disease Control and the American Medical Association, have unanimously concluded that access to clean needles reduces the incidence of blood-borne diseases and neither encourages people to start injecting drugs nor increases drug use by those who are already users. Syringe exchange is an accepted part of public health programs in almost all countries of Western and Eastern Europe, Central Asia, and Australia and New Zealand. Even the hyper-conservative ruling mullahs in Iran have approved of syringe exchange as a way to fight an HIV/AIDS epidemic spread mainly by drug users.
Texas is the only state in the union that still flatly prohibits the purchase or possession of syringes for the purpose of injecting illegal drugs. Some religious and social conservatives have opposed exchange programs, contending that they abet addiction and facilitate sin, but legislators themselves have increasingly accepted the counterintuitive scientific evidence.
Sen. Bob Deuell, a conservative Republican and a practicing doctor, sponsored similar bills in both 2007 and 2009. "At one time," he recalled, "I was opposed, but I looked at the data. When people have disagreed with my vote, I've shown them the data and asked them, 'How could I argue with that?'" A fiscal conservative, Deuell also noted that syringe exchange makes good economic sense: "It costs us a fortune to treat HIV and hepatitis C. It's breaking the budget."
Deuell's support of needle exchange does not rest on science and economics alone. "I look at it from the Christian viewpoint," he said. "What would Jesus do? We need to show compassion and try to help. [Addicts] are God's children, too. When they need new needles, this puts them in touch with someone who might reach them. The very act of handing them clean needles says, 'Your life has value to me. I want you to know that we care about you. When you want to get off, we're here to help you.' If they're in a back alley, using a dirty needle, there's no chance of that."
This argument resonates on both sides of the aisle in the Capitol congregation. In 2009, it was Republicans on the House Public Health committee who organized a special session to hear pro-syringe testimony from religious leaders and others engaged in faith-based outreach to drug users. That panel challenged the morality of applauding churches that minister to AIDS victims but prohibiting a proven means of preventing the disease itself.
In 2007, Deuell's bill, essentially identical to McClendon's current version, passed the Senate by a 23-8 vote (12 from Republicans) but was blocked in the House by the chair of the Public Health Committee, who refused to allow a committee vote. In 2009, a similar bill sailed through the Senate again with an equally bipartisan 23-6 tally, and the House committee sent the bill forward with a 7-3 vote. Observers expected the full House to pass it easily, but the legislative clock ran down on the 140th day, leaving needle exchange and other worthwhile bills orphaned for lack of a vote. In the current session, the Senate will wait to see what the House does, but with only two new senators taking office, one from each party, continued solid support seems assured.
Some supporters of syringe exchange fear that new Republicans in the House might have a knee-jerk negative response to McClendon's bill, imagining it to be just one more Democrat effort to undermine morality and religion in the Lone Star State. The more optimistic expect that the newcomers will quickly see that syringe exchange has wide bipartisan support (Rep. Susan King, R-Abilene, a registered nurse on the Public Health Committee, has signed on as a co-author, as has Rep. John Zerwas, R-Simonton, another physician), is grounded in sound science, is supported by devout religious colleagues and will actually save the state millions of dollars.
Passing a syringe-exchange bill won't balance the state's budget, but it may be one of few opportunities Texas legislators will have this year to improve public health, show compassion for the afflicted and save money in the bargain.
William Martin is the senior fellow for drug policy at the James A. Baker III Institute for Public Policy at Rice University.
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