Thursday, March 24, 2005

Needle exchange could fight Hep C epidemic

On Tuesday the Texas Senate Health and Human Services Committee passed SB 127 authorizing local governments to enact needle exchange programs on a 5-1 vote. The bill now needs 16 more senators' approval to reach the Senate floor. Tracey Hays testified for the bill on behalf of ACLU, highlighting especially the health and financial concerns that make the legislation so immediately pressing. She also focused on how needle exchange helps develp values of personal responsibility among addicts that can lead to them entering treatment. Since her testimony contained a lot of interesting stuff I didn't know, and I'll bet Grits readers didn't either, with her permission I post her testimony here. After introducing herself, Tracey launched into these prepared remarks:

Texas needs syringe exchange

Between 2000-2003, TDH tracked infection rates for Hepatitis C. During that time, 5,500 new cases were diagnosed in Denton and Tarrent counties. Harris and Jefferson county combined reported almost 14,000 cases of hep C in 3 years. In those same years, TDH reports over 113,000 new cases of hep C. So 113,000 people in Texas now know they have hep C, and TDH says that almost 300,000 have it but do not know.

Most new infections occur among young adults, and over 60% of these cases happen among those who share syringes, and their partners, spouses and children. HCV treatment is incredibly difficult to endure, costs about $100,000 per person, is complicated and doesn't always work. With an over extended health care system, the state of Texas is paying a lot of money to treat a large epidemic of easily preventable blood bourne disease. And I havn't even mentioned AIDS, which is equally communicable, and easily preventable .

In our prisons, 28% of men and 40% of women enter with hep C.

I haven't even mentioned HIV or AIDS yet, which is as communicable, and preventable, by many of the same methods that hep c spreads, or doesn't. Without a vaccine or a cure, prevention is the only tool we have to control the spread of HIV, and of hep C.

Current penalty for syringe possession harm public health.

While it is common knowledge that syringe sharing leads to the spread of blood-boune diseases, tough paraphernalia laws make it impossible for health care workers to get sterile syringes into the hands of injection drug users who need them. Possession of syringes is a Class C misdemeanor, however, distribution of syringes is a class A misdemeanor. Under paraphernalia laws, a health care provider exchanging sterile syringes for used ones could face jail time, while a person in possession would face a fine.

Syringe Exchange programs work

Syringe Exchange programs are an important component of a comprehensive set of programs designed to reduce the spread of HIV/AIDS and other blood-borne infections among injection drug users, their families and communities. They've been recommended by every major medical organization that has ever studied their effectiveness. In that list of organizations, we find the Institute of Medicine, who reported in 2000 that the consequesnce of prohibiting access to sterile syringes has resulted in
"missed opportunities to prevent new HIV infections, resulting in lost lives and wasted expenditures……The committee recommends: removing legal and policy barriers that limit access to sterile drug injection equipment."
Similar statements have been issued by the American Medical Association, the Texas Medical Association, the Texas Pharmaceutal Association, and the list goes on, and I included it on the back of the ACLU hand out that I provided earlier.

Last week, I was speaking with Glen Mayhall at UTMB, where I was overwhelmed with the supportive response I got from the staff when discussing SB 127. Glen Mayhall, the Director of the Infectious Disease Department told me that he couldn't imagine a physician who wouldn't support syringe exchange programs. They are, quite simply, the right thing to do, regardless of politics."

Provide access to hard-to-reach populations.

SB 127 is written so that local municipalities can design and operate programs that not only exchange syringes one-for-one, but that also provide literature to participants about hep C/HIV prevention, drug abuse treatment options, and safe and proper medical waste disposal. SB 127 allows these programs to offer some simple health care to addicts, which is usually provided them by emergency rooms only. Very basic yet important care can be provided by SEP staff, such as vein and abcess care, hep C/HIV testing, and hygienic supplies. Other services can include counseling and testing for HIV infection, distribution of condoms, and safe disposal of returned contaminated equipment.

Perhaps the most important services provided by Syringe Exchange programs are the relationships built between the health care workers and the clients of the program. Those relationships often act as bridges to addiction recovery services. Every needle exchange in the United States recruits drug users into treatment. In Tacoma, the needle exchange is the single largest source of treatment referrals in all of Pierce County. In the last two years, Seattle's needle exchange has helped more than 400 people get into treatment.

The effects of a successful syringe exchange program resonate out into the non-drug using population. Preventing blood bourn diseases in injection drug users also prevents them in the partners, new born children, and friends. Many women are at risk for blood-bourne diseases because of their own injection drug use or because they are sexual partners of injection drug users.

SEPs decrease blood borne diseases

A study done on Baltimore, Maryland revealed that where NEP's operate, the rate of HIV infection is down and crime has not gone up. The presence of drity needles is down, and 1,500 IDU's used NEP's as a bridge to treatment.

The Hawaii Dept of Health funds an NEP, and reports similar success rates. From 1993 to 1997, 74% of Hawaii's NEP clients reported they did not share needles. Additionally, only 18% of the AIDS cases reported in Hawaii during 1997 were related to drug injectors, as compared to one-third of reported new cases throughout the rest of the United States.

SEP's don't increase drug use or crime

This question has been examined until today there is little debate. In the last seven years, eight major studies funded by the federal government have concluded that clean-needle programs reduce Hive transmission and do not increase the use of injected drugs. The studies are listed on the back of the ACLU hand out that I gave you.

One of those studies was conducted in Cambridge, Massachussets, where another successful NEP operates legally. Cambridge Police Commissiner Ronnie Watson reported that the existence of NEPs had no impact on crime in Cambridge, no impact on his department's ability to make drug arrests, and no impact on their ability to police. NEP's actually decrease the likelihood that a police officer will get stuck with a dirty needle during a pat down, because program participants feel safer telling officers when they have a needle on their person.

SEPs promote personal responsibility

Ultimately, abstinence from drug use is the goal of all health care providers who work with drug addicts. However, syringe exchange promotes values of personal responsibility and self-preservation that can be the first steps toward recovery for some addicts. By recognizing that some people, whether we approve or not, are unwilling or unable to discontinue engaginging in risky behavior, the CDC recommends giving them the choice to follow guidelines for the preservation of a disease free body. Many of these people are long term addicts, and are not able to make the choice to just quit using drugs. They will continue to shoot drugs, and they will use dirty syringes, if that's all they've got.

Portland Oregon went from handling 10,000 needles a year in 1989 to 450,000 today. 20,000,000 syringes were exchanged in the US in the year 2000, through 107 syringe exchange programs. Today that number is closer to 200. We have a lot of people being given the choice to protect their health, and they are taking it.

So, do Texans want syringe exchange?

I'd like to share an excerpt from a letter that I'm sure all of you received in your email's yesterday. But just incase, I've included a print out that I've handed to you all. Jill Rips, MA, MPhil, Associate Director of San Antonio AIDS Foundation wrote
Several times a month we receive phone calls at SAAF from person who are addicted to intravenous drugs who have just moved to San Antonio from a city that had harm reduction programs and they are seeking a similar program in San Antonio, so that they do not put themselves or their drug sharing partners at risk of infection. Sadly, we have no where to send them. Additionally almost weekly we have clients who show up asking for help. They are ready to give up drugs, and are seeking a placement immediately in in-patient programs. Slots are never available upon demand. We are told by drug treatment programs to have the client call back in several weeks, in which case the client is lost. Most treatment programs are only for a few days, with clients dismissed back to the drug using neighborhood they came from. Drug addiction is a terrible illness and it needs to be treated as such. To be successful in sobriety, people have to come to the decision on their own. Until that happens they need to be afforded the as much support to not get sick, nor to spread disease to others through the sharing of dirty needles.
Texas needs to join with the American Bar Association, the American Medical Association, and the American Public Health Association, among others and pass this Senate Bill 127 for effective public health policy for now and for Texas' future.

I've included another letter from P Alice Bell, L.C.S.W. Coordinator of the Overdose Prevention Project, and Prevention Point Pittsburgh, who writes that "The program has been well received in Pittsburgh which is considered to be a fairly conservative community.

I hope you all noticed the editorial pieces in the Houston Chronicle today in support of SB 127.

We would be doing the state of Texas a huge disservice if we do not seriously consider the urgings of almost every major medical association in the county, and remove the barriers to syringe access. Each year that we wait, we undergo a serious loss of lives and dollars.


Amanda said...

Tracey's testimony was pretty fantastic. There's a mountain of science to back up the argument for NEPs and none, none that I am aware of (and I've been looking) that suggests it increases drug use or doesn't dramatically decrease disease rates. AND the state doesn't have to pay for the programs!

The only real concern expressed at the hearing was that good parents living in bad neighborhoods would have to explain what needle exchange programs are to their kids. My guess is that it's better to explain that than to explain to your kids that you can't let them play outside b/c you're afraid they might be stuck by a stray needle.

Anonymous said...

wow.. I will honestly say i am in not in my home town and I am was looking on the net for the laws because I use needles to inject street drugs into my vain. I am a junkie. I'm out of clean needles (which aren't only sanitary but see how bad things get when u try to use a dull needle), and away from home. I was starting to panic cause i don't know where i can get some or texas' laws. I came across this article and thought yes, even before i used the needle i felt they should be available. Bottem line is, new needle or not, if a user wants to shoot up, there gona.
please... we all know it should STOP but it's not going to, so let's facilatate them (me) in some way. thanks