1-1 By: Luna S.B. No. 799 1-2 (In the Senate - Filed February 28, 1995; March 1, 1995, read 1-3 first time and referred to Committee on Health and Human Services; 1-4 April 5, 1995, reported adversely, with favorable Committee 1-5 Substitute by the following vote: Yeas 5, Nays 4; April 5, 1995, 1-6 sent to printer.) 1-7 COMMITTEE SUBSTITUTE FOR S.B. No. 799 By: Moncrief 1-8 A BILL TO BE ENTITLED 1-9 AN ACT 1-10 relating to harm reduction programs to reduce the risk of 1-11 transmission of human immunodeficiency virus infection and acquired 1-12 immune deficiency syndrome. 1-13 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-14 SECTION 1. Chapter 85, Health and Safety Code, is amended by 1-15 adding Subchapter H to read as follows: 1-16 SUBCHAPTER H. HARM REDUCTION PROGRAMS 1-17 Sec. 85.161. FINDINGS; PURPOSE. (a) The purpose of this 1-18 subchapter is to establish HIV infection and AIDS harm reduction 1-19 programs to combat the spread of infectious and communicable 1-20 diseases. 1-21 (b) The legislature finds that: 1-22 (1) there is a growing public health problem in the 1-23 state due to the rapid spread of HIV infection and AIDS and other 1-24 communicable diseases such as tuberculosis and hepatitis B, which 1-25 are generally associated with the chronic disease of addiction; 1-26 (2) 25 percent of new AIDS cases reported in this 1-27 state in 1993 were in the population that injects drugs; 1-28 (3) 55 percent of heterosexual men and women who have 1-29 AIDS were injecting drug users or had a sexual partner who was an 1-30 injecting drug user; 1-31 (4) nationally, 56 percent of children younger than 13 1-32 years of age with AIDS had a parent who was an injecting drug user; 1-33 (5) 13.3 per 100,000 persons in this state have 1-34 tuberculosis and 7.3 per 100,000 persons in this state have 1-35 hepatitis B; 1-36 (6) there are an estimated 59,759 medically indigent 1-37 injecting drug users in this state and 53,648 of those persons are 1-38 not receiving drug abuse treatment, which places them at high risk 1-39 for HIV infection; 1-40 (7) preventing HIV infection is a high priority since 1-41 every symptomatic case costs a minimum of $119,000 to treat, with 1-42 the future costs of treating just the estimated 73,000 Texans who 1-43 are currently HIV positive being $6,687,000,000; 1-44 (8) a harm reduction approach to HIV infection and 1-45 AIDS provides a continuum of strategies for those who are 1-46 chemically addicted, which also protects the health and well-being 1-47 of the community; 1-48 (9) research conducted by the United States General 1-49 Accounting Office and the United States Centers for Disease Control 1-50 and Prevention of the United States Public Health Service on 1-51 programs in other states and abroad that use needle exchange as a 1-52 harm reduction strategy demonstrates that needle exchange programs: 1-53 (A) do not increase drug use and do not attract 1-54 new users; 1-55 (B) reduce the transmission of HIV infection by 1-56 injecting drug users, such as a 33 percent reduction among clients 1-57 in the New Haven, Connecticut, Needle Exchange Harm Reduction 1-58 Program; 1-59 (C) provide a link to drug treatment and other 1-60 health services; 1-61 (D) decrease the number of needles and syringes 1-62 discarded in parks and neighborhood streets; and 1-63 (E) constitute effective outreach to hard-core, 1-64 normally inaccessible drug users; 1-65 (10) the following recommendations have been made by 1-66 organizations established to study HIV infection and AIDS and 1-67 related problems: 1-68 (A) the Texas Commission on Alcohol and Drug 2-1 Abuse's HIV Networking Group, in updating the Texas State Plan to 2-2 serve substance abusers at risk of HIV infection, recommends making 2-3 sterile needles available to injecting drug users and recommends 2-4 the removal of barriers to lifesaving strategies; 2-5 (B) the department, in managing the development 2-6 of Texas Year 2000 Health Objectives, recommends: 2-7 (i) increased drug treatment services; 2-8 (ii) intensive education and outreach 2-9 efforts to reduce HIV infection among substance abusers; and 2-10 (iii) the provision of a comprehensive 2-11 range of prevention, intervention, and treatment services for all 2-12 areas of the state; 2-13 (C) the HIV/AIDS Interagency Coordinating 2-14 Council, required by Section 85.017 to make recommendations to the 2-15 legislature concerning HIV infection prevention, has recommended 2-16 that the law be changed to allow for the establishment of needle 2-17 exchange programs; and 2-18 (D) the National Commission on AIDS recommends 2-19 that "legal barriers to the purchase and possession of injection 2-20 equipment should be removed. Legal barriers do not reduce illicit 2-21 drug injection. They do, however, limit the availability of new, 2-22 clean, injection equipment, thereby encouraging the sharing of 2-23 injection equipment, and the increase in HIV transmission"; 2-24 (11) the relatively low rate of HIV infection among 2-25 injecting drug users in this state as compared to 50 to 60 percent 2-26 in some east coast cities makes this an ideal time to establish 2-27 harm reduction programs in Texas; 2-28 (12) providing treatment to reduce injecting drug use 2-29 and providing means for safer injection are complementary rather 2-30 than contradictory forms of both AIDS prevention and drug abuse 2-31 prevention, and harm reduction programs should be regarded as just 2-32 one weapon in the fight against HIV infection and AIDS in a 2-33 population that is both at very high risk and traditionally hard to 2-34 reach; 2-35 (13) the key educational message of a harm reduction 2-36 program is that sharing injection equipment carries with it the 2-37 likelihood of contracting HIV infection and of infecting one's 2-38 partner or child with the deadly virus; and 2-39 (14) behaviors related to injecting drug use account 2-40 for one of the fastest-growing rates of exposure to HIV infection 2-41 in this state. 2-42 Sec. 85.162. LEGISLATIVE DECLARATION. The legislature 2-43 declares that it is in the public interest to break the deadly 2-44 connection between HIV infection and AIDS and injecting drug use by 2-45 allowing legal access to clean needles and syringes in a 2-46 comprehensive effort to reduce the spread of HIV infection and 2-47 AIDS. 2-48 Sec. 85.163. HARM REDUCTION PROGRAMS. (a) A local health 2-49 agency, with approval of the local governing entity, may establish 2-50 a harm reduction program. 2-51 (b) A program authorized by this subchapter shall: 2-52 (1) be incorporated into existing AIDS prevention and 2-53 outreach projects; 2-54 (2) provide for free and anonymous exchange of needles 2-55 and syringes and provide that program participants receive an equal 2-56 number of needles and syringes for those returned; 2-57 (3) offer education on the transmission and prevention 2-58 of HIV infection; 2-59 (4) assist program participants in obtaining drug 2-60 treatment services; and 2-61 (5) provide materials such as bleach or sterile cotton 2-62 to promote safe health practices. 2-63 (c) A program authorized by this subchapter may offer 2-64 referrals or services for other health-related issues such as 2-65 sexually transmitted diseases, tuberculosis testing, and general 2-66 health care. 2-67 Sec. 85.164. REPORT. A local health agency or a person 2-68 conducting a harm reduction program shall submit a report 2-69 evaluating the effectiveness of the program to the department. 2-70 Sec. 85.165. EFFECT OF OTHER LAW. Sections 481.125(a) and 3-1 (b) do not apply to: 3-2 (1) a person or organization conducting a harm 3-3 reduction program authorized by this subchapter; or 3-4 (2) a person receiving needles or syringes from a harm 3-5 reduction program authorized by this subchapter. 3-6 Sec. 85.166. DISTRIBUTION OF NEEDLES AND SYRINGES TO 3-7 PROGRAM. A person licensed as a wholesale drug distributor under 3-8 Chapter 431 may distribute needles and syringes to a harm 3-9 reduction program authorized by this subchapter. 3-10 Sec. 85.167. HANDLING OF NEEDLES AND SYRINGES. (a) A harm 3-11 reduction program authorized by this subchapter shall store needles 3-12 and syringes in a manner so as to be available only to authorized 3-13 personnel and not to be openly available to program clients. 3-14 (b) Used needles and syringes awaiting destruction shall be 3-15 securely safeguarded until they are destroyed. 3-16 (c) Used needles and syringes shall be destroyed in a manner 3-17 that makes those needles and syringes unrecoverable. 3-18 SECTION 2. This Act takes effect September 1, 1995. 3-19 SECTION 3. The importance of this legislation and the 3-20 crowded condition of the calendars in both houses create an 3-21 emergency and an imperative public necessity that the 3-22 constitutional rule requiring bills to be read on three several 3-23 days in each house be suspended, and this rule is hereby suspended. 3-24 * * * * *