hepatitis C – Missouri House of Representatives Newsroom

House committee approves bill to legalize syringe exchange programs for IV drug abusers

A House Committee has endorsed continued operation of programs that offer clean needles to drug abusers.

Representative Holly Rehder (Photo: Tim Bommel, Missouri House Communications)

Those programs aim to get drug users into treatment by introducing them to medical professionals who can consult with them while providing them clean needles. They also fight the spread of diseases like HIV and Hepatitis C, which are often transmitted through the use of dirty needles.

Representative Holly Rehder (R-Sikeston) is carrying the legislation for a third straight year. She said such programs operate in Missouri now, including one in St. Louis County and one that has been operating for decades in Kansas City, but they are technically in violation of state laws against distributing drug paraphernalia.

“The cities look the other way. It’s kind of a gray area because the cities want them there because they are helping so much with harm reduction,” said Rehder.

“We do not want to create a scenario of increasing drug use. In fact, syringe access programs have been found to cause a 13-percent reduction in use. They play a very large role in the referral for treatment. They’ve also been found to decrease needle sharing by 20-percent,” Rehder told the House Committee on Health and Mental Health Policy.

“[Drug abusers] are already using needles for their addiction. No one starts using the needle because they can get a free one,” said Rehder.

The top Democrat on the committee, Representative Doug Clemens (D-St. Ann), said he is enthusiastic about House Bill 1486, and the finding that users who take advantage of needle exchanges are five times more likely to enter a drug treatment program.

“I appreciate legislation like this which actually works to solve a problem instead of punishing people arbitrarily for a disease. Addiction is a disease and it’s something that we in Missouri are struggling with every day,” said Clemens.

Chad Sabora has testified to House committees on this proposal for several years. He runs a needle exchange program in Missouri. He is also a former Chicago prosecuting attorney who has been clean from a heroin addiction since 2011. He said the way society treats drug abusers now could be described as, “negligence and malpractice.”

“The message has been call me when you’re ready for help. The message has been when they get arrested they’ll get help, when they show up at a church basement for an AA meeting they’ll get help, when they make that phone call to treatment they’ll get help. One hundred thousand people died last year because that’s our philosophy. Our philosophy needs to change,” said Soborra.

Bill Kraemer of St. Genevieve testified in favor of the bill. He told of finding his daughter dead on a basement floor of an overdose. He managed to revive her and she recovered, and today is 2.5 years clean and just had a baby girl.

He said he learned through his experience with her that drug users will resort to dirty needles if they must.

“A person who needs to inject, sometimes they are so in need that they let their inhibitions down. They need to shoot up so they will use a dirty needle. My daughter was always meticulous in not using a dirty needle, always, but she found herself a couple times in need to inject and she used somebody else’s needle, and out of the three times that she used a dirty needle she got Hep C,” said Kraemer.

Kraemer and representatives on the Committee said they hope needle exchanges will spread to rural parts of the state, because it is needed there at least as much as in Missouri’s urban centers.

Rehder and other proponents of the programs say their ability to combat the spread of diseases is particularly important now. Missouri is on the verge of a crisis in the spread of HIV and Hepatitis-C, mostly among drug users who are sharing needles.

“Right now in Missouri we have 13 counties on the CDC’s top five percent watch list … across the U.S. of counties that are on the verge or at risk of Hep C and/or HIV outbreaks,” said Rehder.

The proposed change would cost Missouri nothing as these programs are privately funded. Rehder said the legislation could actually save the state some of the cost it has expended to treat drug abusers.

In each of the last two sessions the House has passed needle exchange legislation by sizable, bipartisan votes, but it has stalled in the Senate. HB 1486 has been approved by one House committee and is awaiting a hearing by a second.

House votes to clear needle exchange programs to fight IV drug use, disease

The Missouri House has passed a bill that would legalize programs already operating in the state that give drug abusers clean needles. Supporters say those fight the spread of intravenous diseases and expose drug users to treatment options.

Those running needle exchanges in Missouri now could be charged with violating the state’s drug paraphernalia law. They are protected only by handshake agreements with local law enforcement who recognize the benefit of the programs.

House Bill 168 would exempt from that law needle exchange programs that are registered with the Department of Health and Senior Services.

“Syringe access programs have been found to cause a 13-percent reduction in use. They play a very large role in referral for treatment, and they’ve also been found to decrease needle sharing by 20-percent,” said Sikeston Republican Holly Rehder, the bill’s sponsor.

She said the CDC has identified 13 counties in Missouri as ripe for an outbreak of Hepatitis C and HIV. She said preventing an outbreak would save lives and save the state money.

“In 2016 the cost to the state for Hep-C and HIV treatment was $70-million. In 2017 it was $63-million, and in 2018 it was $80-million,” said Rehder.

Missouri has plenty of examples in other states to look to, to see how needle exchange programs have run and what results they’ve had.

“We’ve had over 30 states enact legislation to allow these to take place,” said Columbia Democrat Martha Stevens.

Supporters say in places with needle exchange programs, drug users are five times more likely to enter treatment. That’s because when users go to get needles, they’re getting them from a health care professional who can tell them about treatment options.

“This could be the entryway into someone getting treatment. This could be the first healthcare professional that one of these IV drug users ever meets,” said Lee’s Summit Republican Jonathan Patterson.

“So often people who are using, once they get to using needles, they don’t have anyone in their life that knows how to get them help, that knows how to get them plugged in when they reach out for help,” said Rehder. “Having this person who meets them where they’re at, becomes their friend, and becomes that medical professional with the knowledge to get them plugged in, and that’s who they go to reach out to when they’re ready for help.”

The House’s 124-27 vote sends the bill to the Senate, where it stalled last year. Rehder has said she has assurances from members of that chamber that it will be supported this year.

Earlier stories:

House Committee considers legalizing needle exchange programs to fight disease, addiction

Missouri House asked again to revamp HIV infection laws, endorse needle exchange programs

Missouri House votes to support needle exchange programs to fight IV drug abuse, disease

House Committee considers legalizing needle exchange programs to fight disease, addiction

People who’ve benefited from needle exchange programs that are operating outside Missouri law are asking the state House to make them legal so they can be expanded.

Aaron Laxton with the Missouri Network for Opiate Reform and Recovery holds 1.5-month old Grayson, as he testifies in favor of a needle exchange program proposal before a House Committee, while Chad Sabora, Executive Director of the Missouri Network for Opiate Reform and Recovery listens. (photo; Mike Lear, Missouri House Communications)

Needle exchanges in the Kansas City and St. Louis regions allow abusers of intravenous drugs to get clean needles. Similar exchanges in other states have been shown to be successful in combating the spread of diseases like HIV and Hepatitis C, while getting more drug abusers into treatment programs.

In Missouri, however, those exchanges are in violation of the state’s drug paraphernalia laws. The ones in Kansas City and St. Louis are essentially operating through unofficial “handshake” agreements with local law enforcement, who allow them to keep running. House Bill 168 would exempt them from the state’s drug paraphernalia laws.

The bill is sponsored by Sikeston Republican Holly Rehder, who has strongly promoted and sponsored this and other bills aimed at fighting opioid abuse throughout her seven years in the House.

Chad Sabora runs one of those programs. He is also a former prosecutor who became a heroin user, and has been in recovery for almost eight years.

He said needle exchanges are successful because they promote human connections with abusers.

“At our current syringe access program we are putting about 100 people a month into treatment. That’s 100 people off the streets, off the needle, finally getting help, and they did that because they walked in one day to get a free, 9-cent needle. It’s not about that needle,” Sabora told the House Special Committee on Urban Issues. “We need to gain trust, we need to get somebody in front of us, and also we have tons of federal money right now for the opioid epidemic.

“Most active drug users do not know that within 24-hours my workers can get them into treatment. They have no idea, and we’re not going to be able to educate them until they walk into the office, and the best way to get them in there to get that clean needle.

“This is how this works. This is how we’re going to reduce drug use in St. Louis and Missouri,” said Sabora.

Aaron Laxton with the Missouri Network for Opiate Reform and Recovery, like Sabora, has testified in support of needle exchange legislation several times in past years. He told the committee that in past years he’s talked about loved ones he’s lost to opioid abuse, but in this hearing he offered an example of two lives saved by an exchange program.

He presented his one-and-a-half-month old adopted son Grayson, who was exposed to fentanyl, cocaine, and methadone before birth. He said the programs like those that HB 168 would support help people like Grayson’s mother get into treatment.

“We were able to keep her in care … she had the baby, and we were able to move in and do the adoption,” said Laxton. “And, in this system, we saved money from the criminal justice system, we saved money from the child welfare system; you can see that trickle-down effect that we’re having.”

Laxton told lawmakers that technically what he does is illegal, and he urged lawmakers to change that so that more programs like his can be started throughout the state.

“I can be pulled over by police, I can be arrested by police, even as a social worker, even doing this work in my own community. Now luckily, we operate with agreements from the city, but we shouldn’t have to operate on handshake agreements,” said Laxton. “We could probably have ten programs up and running within three months if this legislation moves forward.”

Rehder said opponents often raise the question of whether needle exchanges enable drug abusers.

“These are individuals who are already using syringes for their addiction. No one starts using a needle because they can get one free,” said Rehder. “Needles can be purchased now. They begin using them because it’s a progression in their addiction.”

Rehder said the CDC has identified 13 counties in Missouri that are primed for an outbreak of Hepatitis C. She said passing her bill would help keep those outbreaks from occurring, and could save the state tens of millions of dollars.

“In 2015 the cost of Hep C to the state was $20.9-million. In 2016 it was $42.7-million, and in 2017 it was $63 million,” said Rehder.

Last year a needle exchange program proposal passed out of the House with 135 votes in favor, but it stalled in the Senate. Rehder said she has assurances from senators that they will help propel her bill to the floor in that chamber if it clears the House this year.

The committee has not voted on HB 168.

Earlier stories:

Missouri House asked again to revamp HIV infection laws, endorse needle exchange programs

House asked to back needle exchanges to stem potential disease outbreaks

Missouri House votes to support needle exchange programs to fight IV drug abuse, disease

Missouri House asked again to revamp HIV infection laws, endorse needle exchange programs

Missouri lawmakers will again consider a bipartisan effort to reduce exposure to and the transmission of HIV in the session that begins in January.

Representative Holly Rehder will again in 2019 sponsor legislation that would change Missouri laws to allow needle exchange programs; and to encourage people to be tested for HIV. (photo; Tim Bommel, Missouri House Communications)

Representatives Holly Rehder (R-Sikeston) and Tracy McCreery (D-St. Louis) have filed legislation that would change Missouri laws that criminalize exposing individuals to HIV. Rehder will also file a bill that would let organizations give clean needles to users of illegal intravenous drugs. Both proposals were also filed last session.

Rehder’s House Bill 168 would relax state laws against delivery of drug paraphernalia. Programs that offer clean needles to users could register with the Department of Health and Senior Services and be allowed to continue operating.

Supporters say the offer of clean needles could reduce the spread among IV drug abusers of diseases like HIV and Hepatitis C. Representative Rehder said it also make s users 5-times more likely to enter drug treatment because the needle exchange programs put them in direct contact with medical professionals.

“You want that person who is using a syringe to go get a clean one so then they have that contact with someone who is medically educated, who has the information on how to get treatment, where to get help, for when that time comes that they do reach out for help,” said Rehder.

Rehder refutes opponents who have argued that needle exchange programs simply enable the abuse of IV drugs.

“A free syringe isn’t going to provoke a non-IV user to start using, nor will a free syringe cause an IV user to increase their use,” said Rehder.

Last session’s needle exchange legislation, House Bill 1620, was passed out of the House 135-13, but stalled in the Senate.

House Bills 166 and 167, filed by Reps. McCreery and Rehder, respectively, both aim to change Missouri laws that criminalize the act of knowingly exposing a person to HIV.

Representative Tracy McCreery is again sponsoring legislation meant to encourage people to get tested for HIV by easing Missouri’s law regarding knowingly exposing others to the disease. (photo; Tim Bommel, Missouri House Communications)

Both bills would expand those laws to criminalize knowingly exposing a person to any serious infectious or communicable diseases. Both would also specify that individuals who attempt to prevent transmission, including through the use of a condom or through medical treatment that reduces the risk of transmission, are not knowingly exposing others to a disease.

McCreery and other supporters said those laws have actually discouraged people from getting tested and, if necessary, treated for HIV.

“Because of the way Missouri laws are written there is no motivation for people to know, and in fact not only is there no motivation but you can actually be charged with a more severe crime if you do know your HIV status,” said McCreery.

LaTrischa Miles, treatment adherence supervisor with KC Care Health Center, said in the time since Missouri’s and other states’ HIV exposure laws were written treatments have advanced so that people who might be in violation of those laws aren’t actually exposing anyone to a risk of HIV infection.

LaTrischa Miles with KC Care Health Center, which says Missouri’s HIV transmission laws are outdated and actually discourage people from getting tested and treated for HIV. (photo; Tim Bommel, Missouri House Communications)

“Most do not account for prevention measures that reduce HIV transmission risk such as condom use; antiretroviral therapy; preexposure, which is prep; or the fact that if the virus is maximally suppressed to undetectable levels, the person living with HIV has a zero risk of transmission,” said Miles.

“If people are doing things that pose no risk of transmission then that act should not be criminalized,” said McCreery. “Right now there are things in our laws that say if somebody commits a certain action, even if they absolutely pose no risk of transmission, they can still be charged with a crime.”

Rehder agreed with McCreery in saying that it’s time for Missouri to update its laws regarding HIV exposure and transmission, which were written in the 1990s.

“It’s important for our statutes to be updated as we become better educated and as technology and medicine advance. Bottom line is we want people to get tested, know their status, and get treatment,” said Rehder. “The Department of Justice along with many other national health organizations called for states to reform their HIV-specific laws many years ago because they run counter to many public health best practices.”

Last session’s versions of the HIV transmission laws legislation, House Bills 2675 (McCreery) and 2674 (Rehder) were subject to a hearing by the House Committee on Health and Mental Health Services. The hearing was in the final days of the session so the bills did not advance, but the committee encouraged McCreery and Rehder to reintroduce the bills for 2019.

These three bills were among dozens filed by lawmakers on Monday, the first day legislation could be prefiled for the session that begins in January.

Missouri House votes to support needle exchange programs to fight IV drug abuse, disease

The Missouri House has proposed easing state law to allow organizations to give clean needles to users of illegal intravenous drugs. Backers say the bill will help combat a potential outbreak in diseases like HIV and Hepatitis C caused by the sharing of used needles, and will get more people into drug treatment, but not all lawmakers are convinced.

Needle exchange or syringe access programs already exist in the St. Louis and Kansas City areas. Representative Holly Rehder (R-Sikeston) said those programs are operating in violation of state law regarding drug paraphernalia, but local jurisdictions allow them to operate because of the impact they have.

Legislation sponsored by Rehder, House Bill 1620, would relax state law to allow those programs to operate and to expand to other regions in the state.

Rehder said people who use those programs to get needles are 5-times more likely to get into drug treatment because the programs put them in contact with medical professionals.

“That becomes the medical professional in their life, so they go and they get a ten-cent needle but they get so much more than that,” said Rehder. “They get educational material explaining the harm of what they’re doing. They get a person who’s greeting them where they’re at in life who’s explaining there are options for you. We have places for you to go that we can get you into to help get you past this addiction, and so that becomes a relationship.”

Lake St. Louis Republican Justin Hill said as a former police officer and drug task force detective he supports the legislation. He said law enforcement officers are always conscious, when dealing with individuals abusing intravenous drugs, to look out for needles.

“Use extreme caution because you don’t want to be pricked by what? A dirty needle. We want clean needles on the street because of the instances where if an officer gets pricked they don’t want to have to take tests for the next two years of their lives every month – go get tested for HIV, go get tested for AIDS, go get tested for Hep C,” said Hill.

Some Republicans who are former law enforcement officers oppose Rehder’s bill. Cedar Hill representative Shane Roden, a reserve deputy sheriff, called the idea “stupid.”

“We’re not fixing the problem. We’re just creating Band-Aids. We’re not actually coming down with any solutions,” said Roden.

Representative Shane Roden (photo; Tim Bommel, Missouri House Communications)

Roden argued that with HB 1620, “We’re literally going to put the needle in their arm.”

Still the proposal has broad support including from Democrats. St. Louis City representative Peter Merideth followed-up Rowden’s statements by asking Rehder, “Do you expect this to cure the problem of opioid addiction in Missouri?”

“No, and no one other than that gentlemen has even insinuated that this is a fix for the problem. We all, that have stood up, have said it’s a tool in our toolbox,” Rehder replied.

Backers also say the bill will save the state money in costs to Medicaid of treating people who contract conditions like HIV and Hepatitis C by sharing needles.

The House voted 135-13 to send the legislation to the Senate. In previous years one similar proposal was voted out of one House committee but moved no further through the process.

House asked to back needle exchanges to stem potential disease outbreaks

Members of a House Committee have been told a bill to exempt needle exchange programs from drug paraphernalia laws could help combat a potential outbreak in intravenous diseases like HIV and Hepatitis C.

Representative Holly Rehder (R-Sikeston) told the Special Committee on Urban Issues that abusers who take advantage of needle exchange programs are five times more likely to enter treatment programs.

The committee also heard that the Centers for Disease Control have identified 10 counties in Missouri where conditions could lead to an outbreak like that in Scott County, Indiana. In that county of more than 24,000 people, 227 became infected with HIV in 2015 and 2016 due largely to sharing needles used to abuse intravenous drugs.

“This bill is to, honestly, sanction existing programs that we have running in the state,” Rehder told the committee about her bill, House Bill 1620 . “Right now we have syringe access, or needle exchange which it is also called, running in the St. Louis area and the Kansas City area. These have been ongoing for some time but the problem is that they’re running in a somewhat grey area because Missouri’s law has a paraphernalia charge that could be charged. The local jurisdictions have not pressed that because they see the good in these programs.”

Chad Sabora is a former prosecutor who became a heroin user, and is now an activist in fighting heroin addiction. He runs one of the needle exchange programs operating in Missouri, which he said won’t stop an outbreak but is a “crucial piece of the puzzle.”

“80-percent of the people that use my syringe access program I put into treatment within three months, because as Holly stated it’s early engagement,” said Sabora. “They walk into my office seeking clean needles and nothing else, and what they get is something different. They get conversation, they get compassion, they get treatment resources that they did not know exist, and once they find out that all these options are available for them most of them reach out for help, and I never would have told them about those options if they didn’t walk into my office just to get that clean needle that day.”

The committee heard needle exchange programs could also save the state money. Rehder told the committee the cost to treat HIV patients on Medicaid is expected to increase this year because of changes to the Medicaid program.

Sabora told the committee that a rule change by the Department of Social Services means that anyone with Medicaid can receive treatment for Hepatitis C.

“Before that passed, when it was only the very limited few that got Medicaid treatment, the state still spent upwards of $80-million in 2014. We can reduce these infections, we can reduce future cost of treatment, and lower the cost to the state,” said Sabora.

Rehder has led legislative efforts in recent years to pass a statewide drug monitoring program to help fight opioid abuse, and has shared how opioid addiction struck her family; her daughter became addicted to opioid painkillers after being treated for a cut she suffered at work. Rehder said she sees this as another tool to fight opioid addiction.

“We’ve got to be sure that we move emotion to the side and actually look at the numbers, look at the statistics – what’s working?” said Rehder. “When people first hear about needle exchange one of the first things they say is that’s enabling a user, but you have to look past that. You have to look beyond the stigma of addiction and you have to see, ok but what helps? What works? What gets better outcomes?”

Rehder said if her bill passes to remove the “gray area,” she believes needle exchange programs will spread to other parts of the state including the counties flagged by the CDC.

“There are some federal dollars that we’re passing up right now because we don’t have in statute that these are clear of any gray area, so once we get this passed these individual health departments or individual needle exchanges can reach out to get some of that help in some of these more underserved areas,” said Rehder.

The committee voted unanimously to pass HB 1620. It next goes to the House Committee on Rules.