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Every Wednesday, people carrying plastic bags, pencil boxes and other containers filled with used syringes line up outside a street outreach site on San Antonio’s West Side.
For two hours, the Corazon Ministries outreach team operates an anonymous, one-for-one syringe exchange.
Clients turn in used needles and receive new sterile ones. They are also offered naloxone, the overdose-reversal medication commonly known as Narcan, along with condoms, bandages, cold bottles of water and a sandwich.
By the end of the exchange, a bright orange medical-waste container is filled with discarded syringes that might otherwise have been reused, shared or left in public places.
Texas has some of the country’s most restrictive policies governing syringe-service programs. Bexar County has long been the exception, operating the state’s only program authorized by the Legislature.
Mark Rodriguez, a Corazon outreach worker, recovery coach and peer-support specialist, asks each client what kind of syringe they want. Some prefer shorter or thinner needles.
“A lot of people see the '29s' (29-gauage needles). They love them because they’re easier on their veins,” Rodriguez said.
Rodriguez said he sees many of the same people each week. A participant may use 30 or more syringes over seven days.
“Some people use three needles or more a day,” he said. “It doesn’t last that long.”
Without access to sterile syringes, Rodriguez said, people who are not ready or able to stop injecting drugs are likely to reuse needles or share them with others. Repeated use also damages the needle.
“Every time you reuse a needle, it bends at the tip,” Rodriguez said. “So, it’s harder on the vein.”
Diana Cavazos, who leads a street nursing team with UT Health San Antonio, said the exchange also benefits the surrounding community. Every syringe collected is one that cannot be discarded in a park, encampment or neighborhood street.
“I have noticed when we go out on the street or when we go to encampments, I no longer have to be over-vigilant to see where I step,” Cavazos said. “There were needles everywhere.”
People using the exchange said receiving sterile equipment makes injecting less dangerous.
“You turn in your old needles and get new needles,” one participant said. “It’s convenient. It’s a lot better. It’s healthier.”
Public-health research supports many of those claims. The Centers for Disease Control and Prevention says comprehensive syringe-service programs are associated with an approximately 50% reduction in HIV and hepatitis C infections.
The CDC also reports that people who use the programs are more likely to enter substance-use treatment and stop injecting drugs than those who do not participate. Programs that distribute naloxone can also prevent fatal overdoses.
After 30 years of gathering data, the agency has concluded that syringe-service programs are safe, effective and cost-saving and do not increase illegal drug use or crime.
During the 2025 legislative session, Democratic state Rep. Toni Rose of Dallas authored House Bill 3174, which would have allowed similar programs in Dallas, El Paso, Harris, Nueces, Travis and Webb counties.
“This program does not encourage new drug use or increase drug use among existing users,” Rose told lawmakers.
Michelle Espinoza testified in favor of the bill. She said she injected drugs for more than 20 years and regularly reused syringes, sometimes under extremely dangerous circumstances.
“I once found a syringe on the railroad tracks and used it,” Espinoza said.
She said workers at a syringe exchange continued speaking with her and eventually helped her agree to enter treatment.
“It started with a sterile syringe that became a path to recovery,” Espinoza said. “It starts with a sterile syringe program, but it doesn’t end there.”
The proposal faced opposition from lawmakers including Republican state Rep. David Lowe, who questioned whether distributing syringes undermines laws prohibiting drug possession and use.
“Are we sending mixed messages by saying drug use is illegal, and then we’re providing the tools to do it?” Lowe asked.
Rose answered “No, what you are doing is providing safety. If you know somebody is going to use the drugs, don’t you want it to be safe?”
The Texas House passed the bill by a vote of 77-65. The vote included support from most House Democrats and a limited number of Republicans.
The Senate, which is led by Republican Lt. Gov. Dan Patrick, received the bill on May 14, but it was not referred to a committee or heard on the Senate floor. The bill died when the regular session adjourned on June 2.
Rose’s office said she intends to pursue the proposal again when the Legislature returns in 2027.
