Students Launch Campaign to Allow Needle and Syringe Exchange Programs in Florida

Four Miller School students have launched a grassroots campaign aimed at convincing state lawmakers to allow the transfer of clean needles and syringes to people who inject illegal drugs, an infection-control practice authorized in 35 other states but illegal in Florida.

The Florida Needle Exchange Initiative was inspired by a study Hansel Tookes, now a third-year Miller School student, published in 2011 that found eight times the number of publicly discarded needles on the streets of Miami as on the streets of San Francisco, a city with twice the estimated number of injection drug users.

Unlike Miami, San Francisco provides injection drug users the opportunity to exchange their used syringes for sterile ones. Tookes and his initiative co-founders have presented such compelling evidence that needle exchange programs reduce the risk of acquiring or transmitting HIV, hepatitis B and C, and other blood-borne infections that two lawmakers have introduced bills to legalize them in Florida.

Now, under the guidance of José Szapocznik, Ph.D., professor and chair of epidemiology, Tookes and his initiative co-founders, fourth-year students Marek Hirsch and Dyani Loo, and Chanelle Diaz, a second-year M.D./M.P.H. student, are going public with their campaign to pass House Bill 735, sponsored by state Rep. Mark S. Pafford of West Palm Beach, or Senate Bill 808, sponsored by Senator Gwen Margolis of Miami.

Joined by the Miller School’s chapter of the Student National Medical Association (SNMA), they are encouraging supporters to follow the progress of both measures on The Florida Needle Exchange Initiative website and call and write their legislators, and the chairs of the subcommittees to which the bills are assigned, to urge passage. Templates for two letters, one for members of the House and the other for members of the Senate, offer another compelling reason fiscally conscious lawmakers should embrace syringe exchanges: Such programs not only save lives, they save taxpayer money.

“The estimated lifetime cost of treating an HIV positive person is over $600,000—with Medicaid/Ryan White footing the bill for those that cannot afford it,” the letters state. “The cost of treating hepatitis C is even greater: hepatitis C is responsible for one third of all liver transplants that cost $280,000 for just one year alone. A clean syringe can cost as little as 97 cents.”

But even that negligible cost, the letters note, would unlikely be borne by the state because syringe exchange programs “are commonly funded by non-profit organizations, private donations and local municipalities.”

In urging SNMA members to join the battle, Jennifer McLeod, the SNMA chapter’s Vice President and Community Service Chair, also notes that injection drug users and their sexual partners are not the only people at increased risk of infection from dirty or discarded syringes. Anyone who comes upon one is, and in many of Miami’s poorest neighborhoods, that could mean many children.

“In his study, Hansel found needles in many public areas, including parks, streets and sidewalks,” McLeod said. “So this is a very important public health concern and our chapter has a unique opportunity to influence public policy and safeguard many unwitting Floridians.”

Published in the journal Drug and Alcohol Dependence in December 2011, Tookes’ study, “A comparison of syringe disposal practices among injection drug users in a city with versus a city without needle and syringe programs,” already has galvanized widespread support for changing Florida’s paraphernalia law, which specifically prohibits the exchange of syringes, from a diverse group of public health and medical organizations.

In their biggest coup, Tookes and Hirsch convinced the Florida Medical Association (FMA) last year to seek the legislation legalizing syringe exchange programs. Initially, members of the FMA’s Board of Governors were reticent, but thanks to reports presented by Diaz, UM’s FMA medical student delegate, the FMA’s House of Delegates adopted a resolution supporting the amendment to Florida law.

Since then, more science-backed lobbying by the students under the auspices of the Florida Needle Exchange Initiative has produced a groundswell of support from other organizations, including the Florida Osteopathic Medical Association, the medical societies in Miami-Dade, Palm Beach, Lee, and Hillsborough counties, the Florida Nurse Practitioner Network, the Florida Chapter of the American Academy of Pediatrics, and the Florida Academy of Family Physicians.

Tookes, who undertook the syringe study as an M.P.H. student, is heartened by the support, and the prospects for change.

“I hope that the Legislature will allow Florida to join 35 other states in this evidence-based practice and take meaningful steps in the fight against HIV in our state,” he said. “As a medical student, I have seen first-hand the consequences of our lack of syringe exchange programs in Florida and I’m hopeful our research and legislation translate into new health policy that leads to improved health outcomes for people in Miami living at the center of both an infectious disease and drug abuse epidemic.”

For his study, Tookes replicated the methods of a 2008 study conducted in San Francisco by enlisting fellow students and epidemiology and public health staff to visually inspect the top quartile of Miami neighborhoods with the highest concentration of drug use, as designated by city data. Walking those neighborhoods, they found over 300 dirty syringes, more than eight times as many as on the streets of San Francisco.

The study—the first to compare a city with a needle exchange program to one without—also revealed that 95 percent of syringes used by injection drug users in Miami were disposed of improperly, versus only 13 percent in San Francisco. That translated to nearly 10,000 needles and syringes per month cast aside in trash cans, sewers, parks and other public places.

For more information on the campaign to change the law, visit The Florida Needle Exchange Initiative’s website, or its Facebook page.

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