Testimony from:

Josiah Neeley, Texas Director, R Street Institute

In SUPPORT of allowing disease control pilot programs in Texas (TX HB 1403)

March 15, 2023

House County Affairs Committee

Chair Neave Criado and honorable members of the committee,

My name is Josiah Neeley. I am the Texas director at the R Street Institute, a center-right, free market think tank that supports limited effective government in many areas, including integrated harm reduction. Harm reduction is an evidence-based, cost-effective and pragmatic approach that mitigates the risks associated with a wide range of behaviors, including drug use. As such, we support TX HB 1403, which would allow Texas communities to apply this approach to help keep individuals and communities safer and healthier.

In 2020, nearly 100,000 Texans were living with human immunodeficiency virus (HIV), and 3,548 people in the state were newly diagnosed.[1] Roughly seven percent of newly infected men and more than 13 percent of newly infected women reported injection drug use.[2] Texas is also home to more than half a million people who are living with chronic hepatitis C virus (HCV), a condition that is most commonly transmitted through shared needles and injection equipment.[3]

Though it would be ideal from a public health perspective if people simply abstained from all injection drug use, history tells us that cessation-oriented policies do not work at the population level and that even the best prevention programs leave many people behind. TX HB 1403 would permit pilot disease control programs that could provide syringe access, testing services and more. Such programs, commonly referred to as syringe service programs (SSPs), have been operating in the United States and all over the world for more than three decades.[4] In that time, we have learned much about what they do and do not do.

First and foremost, SSPs reduce the incidence of HIV and HCV by as much as 50 percent, as well as help clients avoid skin infections, hepatitis B infection and a range of other health issues.[5] By preventing these expensive-to-treat infectious diseases, SSPs save taxpayers money. For example, the lifetime cost to treat one person with HIV is nearly $400,000, and many of these costs are born by state Medicaid programs.[6] SSPs are at their most effective—and their most cost-effective—when they offer multiple evidence-based services, such as need-based (rather than one-for-one) syringe distribution, and when they are tailored to meet specific community needs.[7]

Furthermore, in addition to benefitting the individuals they serve, SSPs do no harm and can even improve health and safety outcomes for the community at large. By collecting used injection equipment and providing the people they serve with resources for safe disposal, SSPs lead to fewer needles in parks, playgrounds and other public spaces.[8] The programs have also been shown to improve relations with law enforcement and reduce occupational needlestick risks for first responders.[9] Research also shows that the programs do not lead to increases in local neighborhood crime or encourage drug use.[10] In fact, when adequate treatment resources are available, SSP clients are up to five times more likely than their counterparts who do not use an SSP to enter treatment and sustain recovery.[11] Finally, SSPs are on the front line of the ongoing overdose crisis, providing overdose prevention education and distributing life-saving resources, such as the overdose reversal medication naloxone.[12]

Decades of evidence tell us that by creating a pilot disease control program that would permit SSPs, TX HB 1403 would save lives, improve health and benefit communities. As such, R Street urges your favorable report.

Respectfully submitted,

Josiah Neeley
Texas Director
R Street Institute
[email protected] 

[1] “Local Data: Texas,” AIDSVu, last accessed March 14, 2023. https://aidsvu.org/local-data/united-states/south/texas.

[2] Ibid.

[3] Emma Freer, “Texas Medicaid to Loosen Access to Hepatitis C Treatment,” Texas Medical Association,Aug. 21, 2022. https://www.texmed.org/Template.aspx?id=60252#:~:text=More%20than%20half%20a%20million,Plan%20for%20treating%20the%20disease.

[4] Don C. Des Jarlais, “Harm reduction in the USA: the research perspective and an archive to David Purchase,” Harm Reduction Journal 14:51 (July 26, 2017). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5530540.

[5] “Syringe Services Programs (SSPs) Fact Sheet,” Centers for Disease Control and Prevention, May 23, 2019. https://www.cdc.gov/ssp/syringe-services-programs-factsheet.html#:~:text=SSPs%20are%20associated%20with%20an,in%20HIV%20and%20HCV%20incidence.&text=When%20combined%20with%20medications%20that,reduced%20by%20over%20two%2Dthirds; Cameron Bushling et al., “Syringe services programs in the Bluegrass: Evidence of population health benefits using Kentucky Medicaid data,” The Journal of Rural Health 38:3 (Sept. 19, 2021), pp. 620-629. https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.12623.

[6] “HIV Cost-effectiveness,” Centers for Disease Control and Prevention, March 16, 2022. https://www.cdc.gov/hiv/programresources/guidance/costeffectiveness/index.html; “Medicaid and HIV,” Kaiser Family Foundation, October 1, 2019. https://www.kff.org/hivaids/fact-sheet/medicaid-and-hiv.

[7] “Syringe Services Programs (SSPs) Fact Sheet.” https://www.cdc.gov/ssp/syringe-services-programs-factsheet.html#:~:text=SSPs%20are%20associated%20with%20an,in%20HIV%20and%20HCV%20incidence.&text=When%20combined%20with%20medications%20that,reduced%20by%20over%20two%2Dthirds; Bushling et al. https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.12623; Emanuel Krebs et al., “The impact of localized implementation: determining the cost-effectiveness of HIV prevention and care interventions across six U.S. cities,” AIDS 34:3 (March 1, 2020), pp. 447-458. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7046093.

[8] Harry Levine et al., “Syringe disposal among people who inject drugs before and after the implementation of a syringe services program,” Drug and Alcohol Dependence 202 (Sept. 1, 2019), pp. 13-17. https://www.sciencedirect.com/science/article/abs/pii/S0376871619301978.

[9] Carol Y. Franco et al., “’We’re actually more of a likely ally than an unlikely ally’: relationships between syringe services programs and law enforcement,” Harm Reduction Journal 18:81 (Aug. 4, 2021). https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-021-00515-2; Samuel L. Groseclose et al., “Impact of Increased Legal Access to Needles and Syringes on Practices of Injecting-Drug Users and Police Officers—Connecticut, 1992–1993,” Journal of Acquired Immune Deficiency Syndrome 10:1 (September 1995), pp. 82-89. https://journals.lww.com/jaids/abstract/1995/09000/impact_of_increased_legal_access_to_needles_and.12.aspx

[10] M.A. Marx et al., “Trends in crime and the introduction of a needle exchange program,” American Journal of Public Health 90:12 (December 2000), pp. 1933-1936. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1446444; “Summary of Information on The Safety and Effectiveness of Syringe Services Programs,” Centers for Disease Control and Prevention, Jan. 11, 2023. https://www.cdc.gov/ssp/syringe-services-programs-summary.html.

[11] “Syringe Services Programs (SSPs) FAQs,” Centers for Disease Control and Prevention, May 23, 2019. https://www.cdc.gov/ssp/syringe-services-programs-faq.html.

[12] “Syringe Services Programs,” National Association of Counties, Jan. 23, 2023. https://www.naco.org/resources/opioid-solutions/approved-strategies/ssps.