TMA Written Testimony
House County Affairs Committee
House Bill 1722 by Rep. Garnet Coleman
April 4, 2019
Chair Coleman and members of the committee, the Texas Medical Association, representing nearly 53,000 physicians and medical students, is pleased to express our support for the disease control activities proposed in House Bill 1722 by Chair Coleman. This bill addresses the spread of serious communicable diseases – a great concern among our members, many of whom care for the thousands of Texas residents at risk for the communicable diseases associated with intravenous drug use.
House Bill 1722 will allow a county or municipality to address the transmission of dangerous bloodborne pathogens that occurs with illegal, nonsterile intravenous drug use. TMA strongly supports comprehensive, sterile syringe services programs. Our physician members do so out of confidence in the many studies that have found comprehensive syringe services programs to be effective in reducing the transmission of diseases and in helping get people into drug treatment programs and other support services.
We support the public health framework identified in HB 1722 because local officials and those with public health expertise will organize and manage the disease prevention/harm reduction activities. Each county or municipality should be able to develop and be responsible for its own program so the program fits its population. However, some of our members express concerns about the complexity of implementing the programs as currently laid out in HB 1722. Studies tell us that effective harm reduction programs not only must offer a range of services but also must have community acceptance and engagement. We urge you to ensure broad participation from residents and community-based organizations knowledgeable and experienced in harm reduction programs and well suited to support those who need services. We have been advised that in some locations registering organizations and charging fees could be a challenge and limit those who would be willing to participate.
Another concern about HB 1722 is its proposal for the one-for-one exchange of syringes. We have learned this is not a requirement in most programs in other states. The spread of infectious diseases occurs because of the routine sharing and reuse of syringes. This is the very nature of nonsterile syringe exchange, and the one-for-one exchange limitation may discourage local participation. Finally, HB 1722 directs a local drug rehabilitation treatment program to provide a long-acting, nonaddictive drug for opioid or alcohol dependence treatment. However, the U.S. Food and Drug Administration and the U.S. Substance Abuse and Mental Health Services Administration have authorized several drugs for medication-assisted treatment of addiction. Each medication provides different benefits and risks for the person entering into recovery. The provision and prescription of only one medication is a significant limitation for those seeking treatment. Physicians agree that it is critical that a harm reduction program allow access to all approved medication options based on the unique social and health needs of a person entering treatment and recovery.
We recognize that some view the exchange of used needles for sterile ones as contributing to a person’s addiction and the continued use of illegal, dangerous drugs. But almost every state allows for comprehensive syringe exchange because of the widely recognized evidence that such a program offers intravenous drug users a path to treatment in their community. For people not ready to go into treatment, the information physicians, public health personnel, and others share on the value of clean needles and syringes – and information about needle exchange – will enable them to better protect themselves and others from infectious diseases.
Physicians know opioid addiction is a chronic disease of the brain, and we can provide evidence-based treatment and therapy for people with this disease. But to get people into treatment, we also must adopt and allow for the full practice of public health/harm reduction measures that can stop the spread of communicable diseases. Many states have reduced the transmission of a bloodborne disease, and with some modifications, HB 1722 will enable Texas to join them in this evidence-based effort. And reducing the exposure of Texas’ intravenous drug users to these diseases also will reduce the risk of other Texans, such as health care personnel, peace officers, and family members with whom the drug users come into contact.
We hope you will move to quickly approve HB 1722, and we offer our assistance with your work. HIV, hepatitis B, and hepatitis C can be spread through injection drug use regardless of where you live. We must get this effort right to reduce the spread of diseases and to target more of those who use injection drugs so they can obtain the treatment and support needed to address their addiction.
86th Texas Legislature Letters and Testimonies
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