Texas Medical Association Testimony to Senate Health and Human Services Committee
Senate Bill 188 by Sen. Robert Deuell, MD
March 3, 2009
Presented by: Janet P. Realini, MD, MPH
Good Morning. My name is Janet Realini, MD, MPH, and I am a family medicine physician from San Antonio. On behalf of the Texas Medical Association (TMA) and our nearly 44, 000 physicians and medical student members, I would like to take this opportunity to thank the Chairman and the Committee for the opportunity to testify in support of Senate Bill 188.
I want to start out by saying that TMA strongly encourages the Senate Health and Human Services Committee to approve SB188. There is substantial evidence that sterile syringe exchange programs are extremely effective in the prevention of human immunodeficiency virus (HIV) and other blood-borne infectious diseases among injection drug users (IDUs) and their families .  Leading organizations that encourage the establishment of needle exchange programs include:
- The American Medical Association (AMA),
- American Bar Association (ABA),
- American Public Health Association (APHA),
- American Academy of Pediatrics (AAP),
- American Academy of Family Physicians (AAFP),
- American Pharmaceutical Association (APhA),
- Association of State and Territorial Health Officials (ASTHO),
- National Alliance of State and Territorial AIDS Directors (NASTAD),
- National Association of Boards of Pharmacy (NABP), and
- Texas Medical Association (TMA).
Nationally, approximately one-third of all HIV and hepatitis C infections are directly or indirectly linked to injection drug use.  ,  This is because injection drug users become infected with harmful and deadly viruses, then transmit these viruses to others through sharing contaminated syringes and other drug injection equipment and through high-risk sexual behaviors.
Here are a few compelling statistics on the harmful effects of this behavior:
- About half of all the new hepatitis C infectious infections occur among persons that inject drugs.
- In Texas, the Department of State Health Services (DSHS) estimates that there are 368,000 cases of hepatitis C . 
- DSHS also estimates that injection drug use was the mode of exposure for 16 percent of the more than 62,000 persons in 2007 living with HIV/AIDS in Texas. 
Women who become infected with HIV through sharing needles or having sex with an infected IDU also can transmit the virus to their babies before or during birth or through breastfeeding. In addition to HIV and hepatitis C infection, IDUs are prone to many health risks, including other viral and bacterial infections, overdoses, violence, and suicide. Many IDUs have complex medical, social, and psychiatric problems and face tremendous difficulties in accessing the appropriate services.
There is a solution. Syringe exchange programs (SEPs) typically offer a comprehensive range of services including preventive health services to help injection drug users reduce their risks of acquiring and transmitting blood-borne diseases, tuberculosis, and other contagious diseases. The single use of sterile syringes is recognized as one of the most effective methods to limit transmission of HIV and hepatitis B and C. SEPs ensure that IDUs who cannot or will not stop injecting drugs have access to sterile syringes and provide a means to safely dispose of used syringes. SEPs also provide referrals to substance abuse treatment, needed medical care, and mental health services to address the often complex needs of IDUs. 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.  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. 
Through economic studies, SEPs have been shown to be cost-effective. At an average cost of $0.97 per syringe distributed, the cost per HIV infection prevented has been calculated at $4,000 to $12,000. This is quite a savings when you consider that the medical costs of treating a person infected with HIV is an estimated $190,000.  One recent National Institute of Drug Abuse-funded study showed that in communities with an exchange program, there is lower emergency department use among high-risk injection drug users.
TMA supports SB188 because it allows communities the option to implement a sterile syringe exchange program. 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 they realize the benefits.
TMA also believes that it is important to encourage people about the dangers of drug use and the importance of effective treatment, which is also 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.
We appreciate the opportunity to testify in favor of this important public health legislation and strongly encourage you to consider its passage.
 Shalala, DE. Needle Exchange Programs in America: Review of Published Studies and Ongoing Research . Report to the Committee on Appropriations for the Department of Labor. Health and Human Services, Education, and Related Agencies. February 18, 1997.
 Glynn M, Rhodes P. Estimated HIV prevalence in the United States at the end of 2003. 2005 National HIV Prevention Conference: June 12-15, 2005. Atlanta, GA. Abstract T1-B1101.
 Hepatitis C Plan, Report to the 81st Legislature, Texas Department of State Health Services, December 2008.
 HIV/STD Program, 2007 Annual Report, Texas Department of State Health Services.
 Des Jarlais DC, Friedman SR, Sotheran JL, Wenston J, Marmor M, Yancovitz SR, Frank B, Beatrice S, Mildvan D. Continuity and change with an HIV epidemic: injecting drug users in New York City, 1984-1992. JAMA 1994; 271: 121-127.
 National Institutes of Health. Consensus Development Statement. Interventions to prevent HIV risk behaviors, February 11-13, 1997: 7-8.
 Holtgrave DR, Pinkerton SD. Updates of cost of illness and quality of life estimates for use in economic evaluations of HIV prevention programs. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1997; 16: 54-62.