April 2, 2013

Needle exchange bill inching forward in the Florida Legislature

Florida legislators are considering a bill to allow needle exchanges as a way to curb HIV, hepatitis and other blood diseases among injection drug users. If approved, a five-year pilot program would be based in Miami-Dade.

For nearly a dozen years, George Gibson worked in the shadows of Miami, meeting intravenous drug users at bus stops, corners and alleys to exchange dirty needles for clean ones.

The exchanges, typically on a one-to-one ratio, served as the entrée into a conversation about the risks of spreading HIV, hepatitis and other blood-borne diseases through tainted needles and, in the best case scenario , the first step toward drug treatment.

He has since stopped his small, unofficial needle exchange program – which served a dozen or so users – but he now hopes Florida lawmakers will approve a bill for a five-year pilot program in Miami-Dade County to legalize syringe and needle exchange programs. Such exchanges operate in at least 35 states, but remain illegal in Florida. The bill is based on research conducted by University of Miami students.

“It’s not a pretty business, but if I can get one person a clean needle which helps to stop the spread of disease, then it’s worth it,’’ says Gibson, 46, a community activist who also distributed educational materials and condoms in Liberty City, Overtown and Brownsville. “I am hoping they finally make this legal because it saves lives.’’

Rep. Mark S. Pafford, a West Palm Beach Democrat, is trying to move HB 735 bill through the Judiciary Committee and the Health & Human Services Committee but time is running short in the legislative session. A similar bill in the Senate, sponsored by Miami Democratic Sen. Gwen Margolis, has stalled.

Still, Pafford is continuing to fight for the measure, hoping to attach it as an amendment to another bill.

“I really didn’t think this bill had a chance,’’ he said, adding that the efforts of the UM students helped raise its profile. “I’ve got to find a bill to amend it to and, with a little luck, it’ll get out of the House and to the Senate. If not this year, maybe next year.”

In taking on the issue, he said, “This is absolutely about public safety. We are talking about trying to lower the spread of diseases and limiting the exposure of used needles to first responders like firefighters.’’

The proposed legislation was inspired by a study published by a UM student showing that Miami had eight times the number of publicly discarded needles as San Francisco, where the estimated population of injection drug users is double that of Miami. Needle exchanges have operated for 25 years in San Francisco.

The bill calls for the exchange program to provide free, clean and unused needles and hypodermic syringes in exchange for used needles and syringes as a way to curb the transmission of diseases among injection drug users, as well as to protect emergency workers and members of the public who might inadvertently come into contact with contaminated injection supplies. Participants would also receive educational materials, HIV counseling and testing and referrals to drug treatment. The program would operate for five years and be funded through grants and donations.

Historically, needle exchange programs have met some resistance, with critics arguing that such programs facilitate and encourage drug use. In the late 1980s, Republican Sen. Jesse Helms led the effort to ban federal funding of the programs. In 2009, Congress, then controlled by Democrats, rescinded the ban only to have the ban reinstated three years later by a Republican Congress.

Even with the ban, state and local governments can sponsor the programs but in Florida, the issue of funding is irrelevant because drug paraphernalia is outlawed for use with illegal substances.

Pafford sponsored the bill after learning about the troubling results of the study, published by Hansel Tookes, a third-year student at UM’s Miller School of Medicine. The bill comes as legislators are also considering a measure that would prohibit the sales of certain drug paraphernalia such as bongs and pipes. A Senate version of that bill cleared a critical legislative panel this week.

In late 2010, Tookes and a team of students spent hundreds of hours scouring some of Miami’s most notorious spots for illegal drug use, interviewing 448 injection drug users who admitted to throwing away a total of 9,845 needles in the streets. Of those, they sold or shared 700 needles. In all, 95 percent of the used needles were discarded improperly, potentially exposing the users and others to blood disease. In comparison, 13 percent of used needles were tossed improperly in San Francisco. That city’s syringe access program, one of the largest in the nation, was launched in 1988. Last year, it distributed approximately 2.4 million clean syringes.

The risks are real: Injection drug users accounted for 8 percent of all new HIV infections in 2010 in the United States, according to the Centers for Disease Control and Prevention. But the needle exchange programs seem to be effective. A 2009 study in the Journal of Urban Health showed 12 percent of injection drug users in San Francisco were HIV positive. In Miami-Dade, the figure is almost double, with 23 percent of injection drug users estimated to be HIV positive.

In Baltimore, infection rates among injection drug users have fallen significantly since public health officials launched a needle exchange program 19 years ago. When they started, about 60 percent of all new HIV cases were among the injection drug population. Last year, that number was 15 percent, according the Baltimore City Health Department.

Between 2004 and 2012, the department issued 3,488,369 needles. It conducted 3,446 HIV tests and made 2,487 drug treatment referrals. The program is operated out of 35 Winnebagos,retrofitted with exam rooms, testing equipment and safe injection supplies.

“It took some time for the people to trust us,’’ said Chris Serio-Chapman, the department’s program director for community risk reduction services. “The idea is to go where they are at and to make them feel comfortable. In our conversations, we are asking our clients what can we do to help them and if they are ready for treatment.’’

In Florida, Tookes’ study -- published in the Drug and Alcohol Dependence medical journal in 2011-- presented the stark reality of illicit needle use in Miami, galvanizing the support of medical students and healthcare professionals across the state to bring needle exchanges to Florida. Among the supporters: the Florida Osteopathic Medical Association, the Florida Nurse Practitioner Network and the Florida Academy of Family Physicians.

“The Florida Medical Association supports this legislation, which addresses a serious public health issue and has the real potential to save taxpayer dollars,” said Timothy J. Stapleton, FMA executive vice president in a statement. “These medical students have done a tremendous job not only researching the issue and its impacts, but also promoting this non-partisan bill and garnering favorable support among community and medical stakeholders, lawmakers, and the public,”

Armed with the study results, Tookes and three other students – Marek Hirsch, Dyani Loo and Chanelle Diaz -- launched a grassroots campaign called The Florida Needle Exchange Initiative to lobby for legalization. Pafford and Margolis agreed to take it on.

Among the most powerful messages: The program saves lives and taxpayer money.

The cost of a needle is about 97 cents. The estimated lifetime cost healthcare for an HIV positive person runs about $400,000 to $600,000, according to amfAR, The Foundation for AIDS Research.

“The entire community is at risk when you are talking about discarded needles,’’ said Tookes. “There is overwhelming evidence that getting the needles off the streets reduces the transmission of diseases.’’

Miami Herald staff writer Mary Ellen Klas contributed to this report .

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