Determined to reduce the spiraling number of new HIV infections in South Florida, the Florida House sent a bill to the governor Wednesday that will create a pilot program in Miami-Dade County to allow drug addicts to exchange their dirty needles for free, clean needles and syringes.
For four years. Sen. Oscar Braynon, D-Miami Gardens, sponsored the bill but he could never get it through both the House and Senate. But this year — with blood-borne diseases among intravenous drug users rising in Florida — he and House sponsor, Rep. Katie Edwards, D-Plantation, were able to win bi-partisan support for the idea.
The state leads the nation for new cases of HIV/AIDS with the number of infections rising each year, even as it drops nationwide. The infections have risen as heroin use has exploded while the size of county health departments have been shrinking under Gov. Rick Scott and the state's top health officer, Dr. John Armstrong, who have made it a policy to cut programming and personnel at the Department of Health.
The HIV epidemic is most severe in Miami-Dade and Broward counties, which have the highest rates of new infections per 100,000 residents of any area in the country, according to state and federal data. A study done at Jackson Memorial found that the cost of treating patients with bacterial infections as a result of dirty needles is about $11.4 million a year.
The program will be run through the University of Miami, which will be allowed to circumvent the state's drug paraphernalia laws to use a mobile unit that attempts to reach addicts to encourage them to replace their dirty needles for clean ones. The university is responsible for securing funding through grants and donations so there is no cost to state taxpayers.
The program will also distribute information that directs people to drug treatment and counseling programs and makes educational materials available. The House voted 95-20 for SB 242, which had cleared the Senate 37-2.
Braynon said "it took a while for us to get people to understand what this program did." Opponents argued that the program could make it easier for addicts to get access to drugs but proponents said but the main goal of the program is to prevent the transmission of HIV, AIDS, viral hepatitis, or other blood-borne diseases by offering addicts clean needles, not to treat addiction.
Rep. Michael Bileca, R-Miami, was the only lawmaker to speak against the bill Wednesday. He said he had read many studies about effective needle exchange programs and objected to the provision that allows the needle exchange to occur through a mobile unit, and not at a fixed site where addicts could be encouraged to get counseling and treatment.
But Rep. Julio Gonzalez, a conservative Republican from Naples who is an orthopedic surgeon, countered that anyone who understands addicts realizes "their world is a very, very horrible place" and they are often unable to "leave that world to go someplace else to go get a needle to protect themselves."
He said he treated HIV patients at Jackson Memorial who "have a glazed look because of the effects of medications" and saw people who were so afflicted with their "GI tracts were so riddled with infection" they couldn't digest food. Their veins were so damaged by their intravenous drug use, medical personnel could not find a vein, forcing them to ask patients to insert their own IVs, he said.
"This is a very palpable, very real, very threatening disorder that threatens not only the lives of people that are affect but their families, their communities, our budget," he said.
Edwards noted that the bill does include a requirement that the program refer addicts to drug abuse treatment, counseling and prevention programs and gives the university the flexibility "to employ mobile units to locations where they know they will reach the highest population of addicts."
Dr. Hansel Tookes, a resident physician of internal medicine at Jackson Memorial Hospital, who treats HIV patients, first brought the idea of needle exchange to Braynon.
"This all came about because we were seeing more and more people entering the hospital with [bacteria-related infections] and they studied the cost of treating those patients at Jackson in a year and found it was $11.4 million in cost to the public health care system,'' he said. "If we can decrease any HIV cases in Miami, we've done the community a service."
He cited the experience of Scott County, Indiana, which saw an explosion of 140 HIV diagnoses tied to drug use in just a few months, prompting the governor to declare a state of emergency and launch a needle exchange program.
"There are well over 10 thousands of injection-drug users and that number is just going up,'' he said. "So before the perfect storm happens where we have a situation like Indiana, I'm really happy we're able to bring back this proven, evidence-based public health effort to prevent an epidemic of unknown proportions."
Several legislators from both parties indicated they would like to expand the pilot program in the future to go beyond Miami-Dade.
"The issue we have of addiction and AIDS is not only a Miami-Dade issue, it's a Florida issue,'' Braynon said. "This is just the beginning."