Recent data from the Centers for Disease Control and Prevention found another record broken for drug overdose deaths: 70,237 Americans died from overdose in 2017, more than those who died because of gun violence or motor-vehicle collisions. This staggering rise in mortality corresponds with increased access to powerful synthetic opioids such as fentanyl. Although fentanyl began trickling into the illicit drug supply a decade ago, many municipalities have found fentanyl-associated deaths now superseding those caused by oxycodone and heroin. National mortality due to fentanyl almost doubled from 2016 alone.
Young people are hardest hit by this rise in overdose mortality. The sudden disappearance of many of our otherwise healthiest and most productive members of society has resulted in yet another record broken: U.S. life expectancy has dropped three years in a row, a multiyear decrease that has not occurred since World War II. Despite extraordinary funding for drug enforcement, crackdowns on pill mills and legislated changes in prescribing habits, deaths continue to rise.
However, there are pockets of our country where overdose mortality is decreasing. Recent Florida Department of Law Enforcement data found that overdose deaths declined in Miami-Dade County last year, bucking a multiyear surge in local, state and national opioid mortality. Miami-Dade has a unique benefit as home to the state’s first and only needle exchange program. Established in December 2016, the IDEA Exchange has saturated the county with thousands of doses of naloxone, the overdose-reversal agent used in every ambulance and emergency department and recommended to be in every American’s first-aid kit by Surgeon General Jerome Adams.
Unfortunately, people at greatest overdose risk often cannot access medical care. What the IDEA Exchange does differently is put naloxone in the hands of people who use opioids, their friends and their family members, allowing those most likely to witness an overdose emergency to save a loved one’s life. Two thousand doses have been distributed, and workers at the IDEA Exchange in Miami have recorded more than 1,000 overdose reversals. Each reversal represents a life saved.
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The IDEA Exchange is the product of civic engagement led by Hansel Tookes, M.D., MPH, assistant professor at the University of Miami Miller School of Medicine, beginning when he was a medical student advocating in the Florida Legislature to legalize needle exchange, based on the strongest bedrock of public health science. While some areas of the country began programs in the early 1980s, access to clean needles and naloxone lagged for decades nationwide — until the opioid epidemic struck. Now, federal funding is authorized for needle exchange, and nearly every state has formally authorized it.
Although the CDC and the World Health Organization joined the past five U.S. surgeons general in strongly supporting needle exchange, Florida legislators were initially hesitant to pass the Infectious Disease Elimination Act allowing the practice here. On the fourth attempt, Gov. Rick Scott signed a limited bill in 2016 authorizing a pilot program to take off in Miami.
Two years into this pilot, we’re beginning to see IDEA’s protective effects, and they are miraculous. Overdose deaths in Miami-Dade County plateaued, and then reversed. IDEA Exchange physicians have halted HIV outbreaks through real-time recognition of new cases. Hundreds of patients struggling with addiction have been referred for rehabilitation and given a new lease on life with high-quality care for HIV and hepatitis infections. Each HIV case prevented saves taxpayers more than the annual cost of a needle exchange. Most important, it saves another family from untold anguish.
But needle exchange in just one Florida county is not enough. Orange, Palm Beach and Duval counties have the worst overdose mortality rates in history. Florida also sees the second greatest burden of new HIV cases nationwide. In 2017, Jacksonville climbed to seventh place in HIV incidence, while Orlando surged to second place behind Miami, which has had the highest rates for decades. While more work needs to be done, HIV incidence in Miami is at its lowest in over a decade, and overdose rates are declining. The rest of Florida deserves this effective intervention.
Once again, we have an opportunity to lead the way in public health: When the 2019 Florida legislative session begins, Representatives Shevrin Jones and Rene Plascencia will file a bipartisan bill to expand needle-exchange access. We need legislators in Tallahassee to do the right thing and make needle exchange available to people throughout the state. All of Florida deserves the IDEA Exchange miracle.
Kasha Bornstein and Austin Coye are members of the University of Miami Miller School of Medicine MD/MPH Class of 2021. Henri R. Ford, M.D., MHA, is dean and chief academic officer of the University of Miami Miller School of Medicine.