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TMA's Position on the Syringe Exchange Program

80th Texas Legislature
Senate Health and Human Services Committee
Testimony on Senate Bill 308
Austin, Texas

Janet P. Realini, MD, MPH
Texas Medical Association

April 12, 2007

On behalf of nearly 42,000 physician members of the Texas Medical Association, we strongly encourage the Senate Health and Human Services Committee to support SB 308. There is substantial evidence sterile syringe exchange programs are extremely effective in preventing human immunodeficiency virus (HIV) and other blood-borne infectious diseases among injection drug users and their families.[1]

In 2004, approximately one-third of all HIV and hepatitis C infections were directly or indirectly linked to injection drug use.[2] [3] Injection drug users become infected and transmit the viruses to others through sharing contaminated syringes and other drug injection equipment and through high-risk sexual behaviors. Women who become infected with HIV through sharing needles or having sex with an infected injection drug user also can transmit the virus to their babies before or during birth or through breastfeeding. In addition to HIV and hepatitis C infection, injection drug users are prone to many health risks, including other viral and bacterial infections, overdoses, violence, and suicide. Many injection drug users have complex medical, social, and psychiatric problems and face tremendous difficulties in accessing the appropriate services.  

Syringe exchange programs (SEPs) ensure that injection drug users who cannot or will not stop injecting drugs have access to sterile syringes and provide a means to safely dispose of used syringes. In addition, many SEPs provide a range of preventive health services to help injection drug users reduce their risks of acquiring and transmitting blood-borne diseases, tuberculosis, and other contagious diseases. SEPs also provide referrals to substance abuse treatment, needed medical care, and mental health services. Studies show that SEPs do not encourage drug abuse and that injection drug users will use sterile syringes if they are able to obtain them.[4] The National Institutes of Health Consensus Panel on HIV Prevention indicates that an impressive body of research has shown a reduction in risk behavior as high as 80 percent, with estimates of a 30-percent or greater reduction of HIV in injection drug users as a result of needle exchange programs.[5]

Through economic studies, syringe exchange programs have been shown to be cost-effective. At an average cost of 97 cents per syringe distributed, the cost per HIV infection prevented has been calculated at $4,000 to $12,000, which is considerably less than the estimated $190,000 medical cost of treating a person infected with HIV.[6]  One recent National Institute of Drug Abuse-funded study showed that in communities where an exchange program is in place, it appears that needle-exchange-based health care services can reduce emergency department use among high-risk intravenous drug users.  

SB 308 is consistent with TMA policy that communities should have the option to implement a sterile syringe exchange program if the community agrees that this type of program would help reduce the spread of infectious diseases, including HIV and hepatitis C.  We applaud the approach of making this a local option and not a statewide mandate.  We believe that many communities will establish syringe exchange programs once the benefits of such a program are fully understood.

TMA’s policy stresses that any harm reduction strategy should include a recommendation to cease drug use and the importance of effective treatment, which also is consistent with the bill language. If cessation cannot be achieved, education about the value of clean needles and syringes and information about needle exchange is useful. 

Many national organizations support the needle exchange programs, including the American Medical Association, American Bar Association, American Public Health Association, American Academy of Pediatrics, American Academy of Family Physicians, American Pharmaceutical Association, Association of State and Territorial Health Officials, National Alliance of State and Territorial AIDS Directors, and the National Association of Boards of Pharmacy.

We appreciate the opportunity to testify in favor of this important public health legislation and strongly encourage you to consider passage.

Last Published: 4/10/2007