Used syringes are viewed at a needle exchange clinic where users can pick up new syringes and other clean items for those dependent on heroin on February 6, 2014 in St. Johnsbury, Vermont .(Photo by Spencer Platt/Getty Images)

A bill that would decriminalize needle exchange programs that aim to reduce the spread of infectious diseases was voted out of the Senate General Laws Committee Tuesday.

Needle exchange programs allow drug users to swap out used syringes with clean, new ones in an effort to decrease the chances of contracting or spreading diseases like HIV or hepatitis C from using a contaminated syringe.

Needle exchange programs are operating in 43 states, and are permitted under a mix of state and local laws. As of 2021, they were still illegal in 11 states, including in Missouri, according to The Foundation for AIDS Research.

But that hasn’t stopped programs from being operated for decades in St. Louis and Kansas City, which are currently functioning in a “gray area” said Sen. Holly Thompson Rehder, R-Sikeston, the bill’s sponsor.

Under the bill, distributing or manufacturing hypodermic needles or syringes to operate an exchange program would be exempt from the offenses of unlawful distribution, sale or manufacturing of drug paraphernalia — which can result in a class A misdemeanor or class E felony if done for commercial purposes.

Entities would be required to be registered with the state health department. The bill would also limit programs from being within five hundred feet of a school, but allow those operating prior to a school’s construction — like Kansas City’s program — to remain in operation.

“These are individuals who are already using syringes for their addiction,” Thompson Rehder said. “No one starts using needles because they can get a free one.”

She noted that of the top 220 counties nationwide that were most at-risk or experiencing an HIV outbreak in 2018, 13 were in Missouri —  the fourth highest after Kentucky, Tennessee and West Virginia, according to the Centers for Disease Control and Prevention. 

All 13 counties were located in the southern half of the state.

“That is far more than our share,” said Jon Martin, director of prevention Services at Vivent Health in St. Louis, who testified in support of the bill. “And if we don’t act, it’s not a matter of if, but when, we see such an outbreak.”

Because of current law, Missouri is the only state out of the four served by Vivent Health, a nonprofit health care organization focused on HIV, that a syringe program isn’t operated in, Martin said.

Needle exchange programs have been found to reduce the transmission of infections, and program participants have also been found to be more likely to seek treatment for their addictions.

“By the time that you’re using syringes for your addiction, a lot of folks don’t have anyone then in their close orbit or community that knows how to get them plugged in to treatment,” Thompson Rehder said. “And so that’s where the relationship part of the syringe access programs really come into play.”

Despite their benefits, programs have faced fierce pushback and stigma across the country, and have been at the center of a renewed debate over harm reduction as the U.S. sees a rising number of drug overdose deaths.

In West Virginia, which has been hard hit by the opioid crisis, local needle exchange programs have helped reduce HIV cases. But after a 2021 state law imposing new restrictions on programs, some have had to shut down, Mountain State Spotlight reported.

Thompson Rehder’s own family has battled with opioid addiction, and she has filed a version of the bill since 2016. While it came close to passage last year, it eventually failed in the session’s final week after language was added to renew an essential tax on hospitals, nursing homes and pharmacies, known as the federal reimbursement allowance.

Over half a dozen health care organizations, like the Missouri Center of Public Health Excellence, Missouri State Medical Association and Missouri Family Health Council, Inc., voiced their support for the proposal Tuesday, with no one testifying in opposition. The bill now heads to the Senate floor for consideration.

The proposal is another effort by Thompson Rehder to prevent opioid abuse and support those battling addiction.

After nearly a decade of trying, last year lawmakers passed a new law to establish a prescription drug monitoring program that will allow physicians and pharmacists to track prescriptions.

While the proposal has previously faced concerns around privacy issues, the Centers for Disease Control and Prevention point to prescription drug monitoring programs as “among the most promising state-level interventions to improve opioid prescribing” and protect patients at risk.

The establishment of the program, like creating a centralized database and choosing a vendor to collect patient data, will be overseen by the Joint Oversight Task Force for Prescription Drug Monitoring. The committee is made up of six members of various state medical boards who are licensed healthcare professionals and has so far met once in mid-December.

The task force is in the process of hiring an executive director, Chris Moreland, a spokesman for the Office of Administration, said last month.

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