Public health officials have been trying for years to get dirty syringes and the diseases they spread off Texas streets with needle exchange programs that allow IV drug users to get clean ones — and always they've come up short. Given November's election results, they fear 2011 may be no different.

“Trying to get a bill through like this might be a little more difficult,” says Randall Ellis, senior director of government relations at Legacy Community Health Services in Houston. “We know the House has shifted to the right. This is traditionally something the far right has been opposed to.”

Indeed, in what is perhaps an acknowledgment of the tough battle ahead, state Sen. Bob Deuell, R-Greenville, a doctor who filed and passed a needle exchange bill in the Senate in 2009 only to see it die in the House's end-of-session "chubbing" frenzy, has said he will not introduce the measure again this year. He said the Senate would likely pass the House version. That assumes, of course, that there is a House version, which is no sure thing coming from a chamber with 101 Republicans, many of whom are hyperconservative.

Advocates argue that needle exchange programs would save the state money by reducing the number of contaminated needles on the street and the incidences of HIV/AIDS, hepatitis B and C. They’re supporting House Bill 117, filed by state Rep. Ruth Jones McClendon, D-San Antonio, which would allow counties with more than 300,000 people to operate needle exchange programs. Local governments or private organizations could run the programs in at-risk communities so that users could anonymously exchange dirty syringes for clean ones.

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But some opponents believe needle exchanges would only promote drug use. “I cannot in good conscience balance the public policy contradiction in waging a concerted effort against illegal drug use while providing the tools used in taking these illegal drugs,” says state Sen. Craig Estes, R-Wichita Falls.

Likewise, Gov. Rick Perry "remains opposed to a program that would create an incentive to continue illegal drug use," says his spokeswoman, Lucy Nashed.

Advocates insist that needle exchange programs are safe and cost-effective. The Access Project, an advocate for needle exchange programs in Texas, says millions of tax and private insurance dollars could be saved each year by reducing infectious diseases. Ellis estimates the operational cost of an exchange program through Legacy Community Health Services would run about $250,000 per year, which would be funded by local and private dollars rather than state funds. That’s relatively inexpensive, he notes, in comparison to treatment costs of infectious diseases: The average lifetime cost of medical care for a person with HIV/AIDS is $380,000, according to the Texas Department of State Health Services.

Health experts, meanwhile, say that needle exchanges benefit not only intravenous drug users but first responders like EMTs and police and other innocent victims who could come in contact with dirty needles.

“The state has a responsibility to protect the public as a whole,” says Dr. James Rohack, the director of the Scott & White Center for Healthcare Policy. “If you can get rid of the dirty needle and stop the sharing, you can decrease the risk of who may be exposed to a communicable disease."

A potential problem for needle exchange programs, however, is that distributing and possessing syringes would remain illegal under current drug paraphernalia laws. The new bill would create a defense that would allow an individual to argue in court that the syringe was obtained lawfully through the needle exchange program, but ultimately it would be up to a prosecutor to decide whether to press charges.

“Part of what is really important is working to educate law enforcement and anyone who is a stakeholder on why it’s safe and smart,” says Jenny Panzo, education coordinator for The Access Project. “You can’t have a successful program if the police are going to show up and arrest clients.”

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