Friday, November 21, 2014

Might Texas revisit needle exchange pilots with Susan Reed gone, disease prevention in the news?

Grits wonders if - owing to recent events surrounding the Ebola scare and the outlandish costs of Hepatitis C treatment under new drug protocols - 2015 might be a year in which the Texas Legislature favorably revisits Rep. Ruth Jones-McLendon's legislation allowing local health authorities to create pilot needle-exchange programs? This session, her bill allowing such pilots in Bexar, Dallas, El Paso, Harris, Nueces, Travis, and Webb counties is HB 65.

Legislation authorizing a pilot needle-exchange program passed once before back in 2007. Rep. McLendon carried the bill in the House and Dr. Bob Deuell (who lost his primary in the spring and will not return next year) championed it in the Senate. The designated pilot location was McLendon's home county in Bexar; Governor Perry approved it and local officials looked forward to implementing it. But Bexar County District Attorney Susan Reed, who herself was ousted earlier this month in the general election, threatened to prosecute volunteers who participated in the pilot, effectively rescinding the Legislature's permission under authority of the executive branch. (See Grits coverage here, here, here, here, here, and here.)

Senator Deuell seemed to lose heart in the fight after 2009, when the bill passed the Senate but died sitting on the House calendar while Democrats chubbed over voter ID. The good doctor threw up his hands on the issue after that - there are plenty of other topics, after all, on which an East Texas Republican can expend his political capital - and the bill hasn't moved much since.

However, the political landscape surrounding the issue arguably has changed since then, for starters thanks to a renewed concern for preventive public-health strategies in light of the Ebola scare. A recent Texas Tribune headline, one of their last in the New York Times before that partnership ends, read, "Ebola scare behind it, Texas is bracing for the next viral crisis."

There are many possible methods of disease transmission and, just in recent decades, IV drug use has been a significant factor in the spread of both HIV and Hepatitis C. As the state considers comprehensive disease-prevention strategies (a Perry-appointed task force will release its Ebola-centered recommendations after the holiday), reviving the idea of pilot needle-exchange programs only makes sense. HIV/AIDS killed many thousands before treatments were found. And Hep C may end up costing the state untold sums thanks to a new drug called "Sovaldi," which cures the disease but costs in the neighborhood of $80,000 per patient. At those rates, it would run around $2 billion (with a "b") to treat every TDCJ prisoner with Hepatitis C if, say, courts ever ruled the state is obligated to provide the treatment as part of its basic standard of care for the disease. (When the state chooses to incarcerate someone, it assumes responsibility for their healthcare, federal courts have consistently found.)

All that to say, increasingly there are pragmatic public health and budgetary reasons, and perhaps even a bit of political momentum thanks to the Ebola scare, for the Lege to take a more expansive view toward the merits of preventive public-health strategies. Susan Reed is gone, or is about to be, and McLendon's permissive, local-control approach would let needle-exchange pilots happen in a way that would insulate legislators from on-the-ground decisions by local officials.

Texas Republicans should support local, pilot needle-exchange programs for the same reason Margaret Thatcher did: The public interest in disease prevention outweighs whatever principled disdain for addicts one might harbor. The election is over. It's time to govern.


jdgalt said...

Does this even require legislation? In California, the mayors of San Francisco and several other cities used their emergency powers to allow needle exchange programs "for the duration of the HIV crisis."

Gritsforbreakfast said...

I'm afraid it does, JDG. Possession of paraphernalia is a Class C misdemeanor otherwise.

Anonymous said...

As I recall, DA Reed wanted to prosecute people running the pilot program for "delivery of drug paraphernalia," which for a first conviction is a Class A misdemeanor.

Gritsforbreakfast said...

She could also do what they do in Harris County, 6:59 - send it to the crime lab and prosecute for felony possession based on traces left on a used syringe, etc.. There are lots of potential, creative charging options if one wants to ignore the express will of the Legislature and just be an obstructionist jerk about it.

Chris H said...

"Paying for someone's drug habit" will remain legitimate Republican primary campaign fodder so long as you're specifying the health authority (government) to pay for it.

If it were instead a permitting process of non profits and those funds were raised privately, you would be down to four Republican legislators that would object.

Fund it through state grants at a later point when you have proven programs in place and the campaign fodder goes the other way "costing billions in health care costs of felons".

Samuel G said...

Any idea on who are the swing voters on the issue?