A group of students at the University of Miami Miller School of Medicine is behind an effort to get Florida to implement a syringe-exchange program in the state. A bill under consideration in the Florida Legislature would establish a pilot program in Miami-Dade allowing intravenous drug users to turn in dirty needles and syringes in exchange for clean ones.
Hansel Tookes came up with the idea while pursuing a master's degree in public health at UM in 2009.
"I've been interested in HIV prevention for a long time, and my mentor suggested that I replicate a study that had been conducted in San Francisco," said Tookes, now a third-year medical student at UM.
The study looked at how IV drug users dispose of their needles and syringes. Tookes interviewed drug users in Miami and walked through parts of the city with the highest drug arrests, looking for discarded needles. He found eight times the number of needles on the streets of Miami, compared with San Francisco. And Miami's drug users were more likely to dispose of their needles in public. San Francisco's four needle-exchange programs distribute more than 2.4 million syringes a year.
"That translated to over 300 syringes that I found on the streets of Miami on sidewalks, in parks, everywhere throughout the city," said Tookes.
The use of dirty needles poses significant public health risks.
"There's HIV that lives in syringes, and hepatitis B and hepatitis C live even longer within the needle," said Tookes.
Fourth-year UM medical student Dyani Loo added, "This bill will do more than just protect IV drug users from transmission of things like HIV and hepatitis. It will also protect their partners from potentially getting these diseases."
Loo says that's because people in relationships with IV drug users may may not even know about their partners' drug use.
Some critics of such programs are concerned that they promote drug use.
"It's actually quite the opposite," said Marek Hirsch, another fourth-year medical student at UM. "Studies have shown that these people are 40 percent more likely to be employed six months after enrolling in one of these programs. They're five times more likely to be involved in a drug rehab program."
Health Establishment and Law Enforcement Reaction
Several Florida health organizations, including the Florida Medical Association, support the bill. And Tookes says the Law Enforcement Planning Council of Palm Beach County is also backing the initiative. The group, which represents more than 50 law enforcement agencies in the county, has issued a letter in support of the bill. He says he plans to reach out to a similar group in Miami-Dade soon.
Last week, the students testified in front of the state House Health Quality subcommittee about the bill. The bipartisan panel voted unanimously in favor of an amended bill that would establish a pilot needle-exchange program in Miami-Dade County.
"The pilot program was definitely a concession, but Miami has over 10,000 injection drug users," said Tookes. "Miami also has the highest rate of HIV with the largest number of new infections per population living here."
The pilot program, he says, would consist of a mobile unit that would go to parts of the county with high rates of drug use. If that proves effective, the program could expand to include other parts of the state.
So how much is this going to cost?
Hirsch says the average cost of similar programs around the country is $160,000. He adds that treating an HIV patient costs $400,000 to $600,000, and a liver transplant associated with hepatitis C can cost as much as $250,000.
IV drug users are often reliant on public funds for their healthcare.
"So preventing these infections from occurring is vitally important to saving our healthcare dollars in the state," said Hirsch.
The bill is now under consideration in the state House Judiciary Committee, but it's stalled in the Senate. Senator Aaron Bean is the chairman of the Health Policy Committee, and he has not put this item on the agenda.
"What we're asking is that he at least give it the chance to be heard publicly," said Hirsch.