Tag: House Bill 168 (2019)

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.

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

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.

Representative Holly Rehder (photo; Tim Bommel, Missouri House Communications)

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.