Missouri health director supports needle exchange

COLUMBIA, Mo. -- Missouri's health department director Wednesday said he wants state lawmakers to pass legislation for needle-exchange programs in the state during the next legislative session that starts in January.

Health and Senior Services director Randall Williams said providing intravenous drug users with clean syringes could reduce needle-sharing that spreads hepatitis C and HIV. His comments came after he and other experts talked about ways to fight the deadly opioid crisis in Missouri during a conference in Columbia.

Missouri law now bans possessing drug paraphernalia, and efforts to create exemptions for needle exchanges have failed in recent years. Republican Rep. Keith Frederick, an orthopedic surgeon and former pharmacist who leads a House health committee, said he expects "significant opposition" to proposals over concerns it would support illegal drug use.

"We think the benefit of that will outweigh the risk," Williams said. "There's not evidence that this will enable drug use but that they have a great benefit in preventing other harm."

The programs have been shown to decrease needle sharing. The Centers for Disease Control and Prevention said in a report released last year only about 1 in 10 people who used exchanges shared syringes, compared with more than 40 percent who didn't use the programs. But it's difficult to link them directly to decreased rates of blood-borne illnesses because data aren't typically collected in controlled clinical trials.

Williams referenced support of the programs by U.S. Surgeon General Jerome Adams, who as Indiana's former health commissioner oversaw efforts to allow needle exchanges in the state in 2015 after an HIV outbreak hit a rural southern county in the state.

Since then, several counties have enacted needle exchanges, but southern Indiana's Lawrence County became the second in the state this year to end its needle exchange amid concerns the programs provide illegal paraphernalia to intravenous drug users.

Frederick said he shares similar concerns and wouldn't support Missouri legislation focused only on a needle exchange. But he said he was persuaded by arguments the programs can help direct users into treatment, and he's now working on legislation that pairs a needle exchange with more resources for medication-based treatment programs.

Williams said he also supports Missouri lawmakers requiring continuing education for prescribing opioids and managing chronic pain. He cited North Carolina, where he previously worked in the state's health department, as a helpful model. The state requires physicians and physician assistants to complete three hours of training every three years.