Exchange of syringes should be legal in Texas
One of the first patients I ever lost in my work as a paramedic died from complications of hepatitis C, a virus that attacks the liver. Years of viral insult had withered his liver into a hard, shrunken version of itself, and this was causing blood to back up into his throat. We worked as hard as we could, as fast as we could, and yet we failed that day. His blood showered over me, down my scrubs and into my shoes until my socks squished. That day was horrifying, but perhaps the worst part of it is that it was entirely preventable.
In the United States, for the most part, there are two groups of people who get hepatitis C — baby boomers, who were exposed via blood transfusion before we discovered and began screening the blood supply for the hepatitis C virus, and people who inject drugs. In Texas, the syringes used to inject drugs are illegal to possess without a prescription under drug paraphernalia laws. This makes these tools scarce, encouraging people who inject drugs to share them with others.
Drug paraphernalia laws are ostensibly meant to discourage drug use, and as the daughter of a career prosecutor here in Texas, I understand this aim well. But what I’ve learned in my graduate study of public health is that drug use has remained flat over the past 50 years, while rates of hepatitis C have bounded upward in the past 15 years, neatly in lockstep with rising overdose deaths. Seeing these data in black and white has shaken me. If all we’ve been doing to push back against drugs hasn’t changed rates of use, then what should we do as we watch drug-related death rates climb steadily upward?
State Rep. Jasmine Crockett has introduced House Bill 1178 this legislative session, proposing that the possession of drug paraphernalia, including syringes, be decriminalized in Texas. Decriminalizing paraphernalia is a powerful and positive move for the public health of Texas. When syringes are shared, blood-borne diseases like hepatitis C and HIV spread like wildfire.
CDC data tell us that programs offering sterile syringes to people who inject drugs cut the local rates of new cases of HIV and hepatitis C in half, but as long as syringes are criminalized as paraphernalia, these programs cannot legally operate in Texas. We need to empower these programs.
Hepatitis C rates in the United States have risen by more than 350 percent since 2004 and continue climbing, with the most gains among people younger than 30. This issue looms menacingly over our future.
The same programs that supply clean syringes that stop the spread of hepatitis C and HIV also collect used syringes and have them incinerated as medical waste, so that syringes are less likely to end up discarded in public spaces. They connect people who use drugs to treatment, health care, housing and other support programs. CDC data show that people who use drugs and are able to access these programs are five times more likely to enter substance use treatment, and three times more likely to stop using substances altogether, versus people who cannot access these programs. Contrary to assumptions that bills such as HB 1178 worsen drug use and its consequences, years of excellent data tell us that the opposite is true.
Decades of our most aggressive law enforcement efforts have not hampered drug use rates. And yet, rates of infectious disease and overdose deaths have shot upward and continue to climb. The decriminalization of drug paraphernalia like syringes is a necessary move to improve the health of Texans. Contact your representatives in the Texas Legislature and urge them to support HB 1178.
Zagorski is completing graduate work in public health at the London School of Hygiene and Tropical Medicine. She has practiced clinically as a paramedic in multiple treatment settings, including as a member of the Austin Harm Reduction Coalition, providing care directly to people who use drugs and people experiencing homelessness.