San Antonio May Be On the Cusp of Developing Texas’s Only Legitimate Needle Exchange

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Editor's Note: The following is Their Town, a column of opinion and analysis.

More than a decade ago, then-District Attorney Susan Reed put the kibosh on efforts to save the lives of intravenous drug users on the streets by giving them clean needles. She made clear that her office would prosecute anyone caught handing out new syringes to addicts.

As a result, three volunteers for a clean-needle program run by St. Mark’s Episcopal Church were picked up in January 2008 for distributing drug paraphernalia. Each would have faced a $2,000 fine and up to one year in prison if found guilty, though Reed didn’t follow through.

Their mission had been the same as that of any needle-exchange program – to trade dirty needles for cleans ones, to prevent addicts from getting blood-borne diseases such as HIV and hepatitis C.

“In this case, the county failed its citizens – specifically, the office of the district attorney,” said attorney Neel Lane, who represented the three St. Mark’s volunteers and is a longtime needle-exchange advocate.

These programs prevent the spread of diseases such as HIV and hepatitis, he said, and they spare the public huge health-care costs since local hospital district, VA hospitals, Medicaid and Medicare most often cover the treatment expenses.

William Martin, a drug policy expert at Rice University’s James Baker Institute of Public Policy, estimates the lifetime cost of treating someone with HIV or hepatitis C is more than $300,000.

Thanks to Reed, a syringe-exchange program approved by Bexar County commissioners in August 2007 was stillborn. After spending as much as $120,000 on planning, all county officials had to show for the effort was a bunch of kits with equipment to sterilize dirty needles and business cards for treatment programs, but no new syringes. T.J. Mayes, the chief of staff for County Judge Nelson Wolff, said officials donated the incomplete kits to Haven for Hope and other organizations helping drug addicts, many of them living on the streets.

But the bullshit is finally giving way, nearly four years after voters threw Reed out of office. All it took was an opioid crisis, a city health director with an activist streak and DA Nico LaHood’s willingness to drop cheap political theatrics – at least on the issues of drug addiction and disease prevention.

On May 23, the county, city, health-care and drug-treatment providers, law enforcement officials, religious leaders and nonprofits will meet to discuss the possibility of establishing a syringe-exchange program.

Wolff credited LaHood’s support – which is conditioned on providing information of treatment to addicts seeking clean syringes – and city MetroHealth Director Colleen Bridger with breaking the stalemate. Bridger, hired a little more than a year ago, co-chairs the county’s opioid task force. “She’s more of an activist, more collaborative,” Wolff said.

Bridger was traveling overseas last week and unavailable for an interview.

“There’s no question that [syringe-exchange programs] work,” Martin said. “The key players in San Antonio understand that this would be a good thing, and that they ought to do it. San Antonio ought to take on this.”

Several years ago, Martin took a tour of places around San Antonio where IV drug users routinely shot up. “There were needles on the ground and under the bridges, and where little kids could be playing,” he said. A successful needle exchange would mean fewer dirty syringes littering the ground.

If local officials succeed in launching a program, it would be the only legitimate, above-board effort of its kind operating in the state of Texas. Meanwhile, 228 such programs are running in 35 states, Indian nations, the District of Columbia and Puerto Rico, according to the North American Syringe Exchange Network.

An unknown number of organizations and individuals around the state currently supply drug addicts with clean needles, but they do it under the radar out of fear of prosecution.

That’s because Greg Abbott, when he was Texas attorney general, effectively gave Reed his blessing. He issued an opinion saying district attorneys had the discretion to prosecutor needle-exchange workers and volunteers under state law. That opinion still stands, which is a major reason why no Texas cities have officially recognized syringe programs.

“It’s absolutely crazy the way this is set up,” Wolff said. State lawmakers “need to legislate on this. It’s been left to the discretion of 254 district attorneys.”

The paths of various needle-exchange measures through the Texas Legislature have mostly hit dead-ends. A little legislative gamesmanship by the late state Rep. Ruth Jones McClendon, a San Antonio Democrat, is the only reason local officials are talking today about setting up an exchange program. In 2007, she slipped an amendment clearing the way for a pilot program in Bexar County into a major health-care funding bill.

That’s what riled Reed 11 years ago and prompted then-state Sen. Jeff Wentworth, a San Antonio Republican, to seek Abbott’s opinion on prosecutors’ authority in relation to clean-needle programs. It’s not hard to figure out the politics.

“We’ve had a century of propaganda about drugs, and it’s hard to get past that,” Martin said. “People say, ‘You want to give needles to dopeheads? That doesn’t make sense.’”

The most common misconception is that handing out new syringes will lead to more illicit drug use. People who believe this don’t get that drug addicts will just use contaminated needles if they have to inject their drug of choice. Not having a clean syringe won’t stop them from shooting up.

McClendon’s amendment dedicated $50,000 to the pilot program, according to Lane. But Wolff said the amount was too modest, adding, “We’ll all have to chip in some.”

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