Syringe Exchange Programs Could Save Florida Hospitals Millions Of Dollars, Study Suggests
When people reuse syringes to inject intravenous drugs like fentanyl, they are at higher risk of infectious diseases like HIV or hepatitis C. In 2016, Miami-Dade County established Florida's first legal needle exchange program in an effort to reduce problems that can come from sharing needles.
It took years of campaigning by Dr. Hansel Tookes to get Florida's Legislature to approve the Infectious Disease Elimination (IDEA) Act. At the time, Tookes was a student at the University of Miami's Miller School of Medicine, where he now works as a professor.
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Based on the success of that pilot program, lawmakers approved a measure that Gov. Ron DeSantis signed into law in 2019, which allows all of the state's counties to set up their own programs. They often include not only the possibility to swap a used syringe for a new one, but also mental health counseling and HIV or hepatitis C testing, among other services.
County lawmakers need to approve these exchanges in order to set them up, and they may use grants and private donations to fund them, for example, but not state, county or municipal dollars.
These programs are slowly expanding across the state. In February, Hillsborough County approved its own. And Palm Beach County commissioners will vote Sept. 1 to potentially approve a program in the county.
Two fourth-year students at the Miller School, and their faculty mentor, worked on a study — published in June — that suggests hospitals across the state save millions of dollars through these needle exchange programs because they avoid the spread of infectious diseases and because, usually, users are uninsured and need lengthy hospital stays to heal from severe infections.
WLRN spoke with lead author Austin Coye, author Kasha Bornstein and senior author Dr. Joan St. Onge about their findings and efforts to get more lawmakers to take interest in these programs.
WLRN: When you've spoken to lawmakers about considering a program like Miami-Dade’s in their counties, what do they bring up as the main concern and what do you want them to know?
AUSTIN COYE: It's really a knowledge gap. I mean when you say syringe exchange, at first it sounds really counterintuitive. But when we explain how much medical and public health data there is that shows that this saves lives, that this prevents hospitalizations, that this prevents disease and suffering. And not only does it prevent all these medical conditions, but it saves a lot of money. I think when we present all of that data together, politicians are really amenable to learning more about this and to helping us implement it.
KASHA BORNSTEIN: There are numerous private funders, public health foundations and other private citizens, particularly people who have been affected by the opioid epidemic directly, who've come out to support both financially, and with their time and energy, getting syringe access programs off the ground and support the work that they do in preventing infectious diseases amongst people who inject drugs.
Austin and I have worked really hard in the past three years and change to have the benefits of the program we have here in Miami-Dade expanded across the state, and what we've worked to show — and I think what Austin has really taken the lead in showing in this project that we've completed — is just how much there is to benefit both medically and in public health, but also in terms of of the fiscal benefits. We found that across the state in a single fiscal year, almost $380 million went to the care of preventable infections related to injection drug use, and we we know that these are preventable because we've seen the benefits locally.
What we want to make clear in terms of this project is to legislators across the state. What can you do with another $380 million in the state budget? And for just a small investment in a very effective public health program, we can recoup so much money while also saving lives and supporting the public good.
COYE: It is a huge sum. It really behooves hospital systems to take charge on these issues while it's legal. It will save them money, especially right now when hospitals are pretty strapped.
JOAN ST. ONGE: I wanted to make sure that while we're talking about funding, we clarify that there are other things that the state and municipalities and federal government will support in the needle exchange programs, not necessarily the syringes or the needles, but they will support the kind of "wraparound services."
So things such as mental health care, drug treatment, care for other chronic diseases, et cetera. So bringing a patient in to, let's say, just have a needle exchange occur, that is something that the state cannot fund, but at the same time, all of the other very important parts and components of care to make that person's life better can be supported through federal dollars.
What gives you optimism about other counties setting up similar programs?
COYE: I'm actually from Orlando, very close but also very far from Miami, and and a few months ago actually, syringe exchanges were not allowed there. And what this project allowed us to do is we took a subset of the data that looked at the costs specifically related to Orange County. I took that to a working group on the needle exchange. We presented that data to county leaders, public health leaders, and in a few months later, the syringe exchange was passed in Orange County. So this is a really good example of the direct impact that this research has already had.
BORNSTEIN: As medical and public health students, Austin and I are, we rotate through several hospitals and clinics in Broward and Palm Beach counties, both of which have worked very, very actively to start their own programs. I've worked closely with the county government of Palm Beach County, with lawmakers there and public health administrators there, to get a program established.
We've been very successful in getting funding towards that program, and hopefully very soon we'll be able to launch it. [Note: Palm Beach commissioners will vote on an item to authorize a needle exchange program at their Sept. 1 meeting.]
ST. ONGE: I think that this is something that highlights the value of students who are interested in public health, and while they're also studying the practice of medicine and becoming physicians, combining those two things together, you empower students like Austin and Kasha to look at a problem and look at it maybe very differently than somebody else without a public health background would.
Then say, "What can we do at a systems level to address this problem, not just what can we do for the individual patient, but how do we advocate on a county, a state or eventually a national level for these things to occur?"
Within all the different areas of medicine and research that you could focus on, why do you care so much about this one?
BORNSTEIN: I have been personally affected by the opioid epidemic in terms of people that I have personally loved who have been harmed and have passed as a result of opioid-related consequences. But also prior to medical school, I was a paramedic and I found that almost every night when I was working, I would be called for overdoses and quite often we were just too late.
And unfortunately, many times the patients that we were too late to get to were my age or even younger, and so when I was working in New Orleans as a paramedic, I got involved with a community organization that provided naloxone and other resources to people who inject drugs. And when I started distributing and providing education on the naloxone (known by brand names like Narcan), which is an opioid antagonist drug to people who are affected by by this issue, I started noticing that when I would get to these calls, people had already been able to receive naloxone. And rather than finding people who were too far gone, I found people who were awake, breathing and alive, which really affected me, and something I want to bring along to my career as a physician.
COYE: For me, it's kind of a continuation of that. Almost everyone knows someone that that has been affected by the opioid crisis, and I'm definitely included in that. When I came to Miami, I was just so blown away by how effective this very simple and very humanistic treatment could be of just giving people clean needles and giving them physical and emotional support for the struggles that they're going through.
And then when I went back home to Orlando, it was clear to me that that was not an option, that it was actually illegal to give people that service that was so readily available in Miami. And so that really encouraged me to work with Kasha to try to change that and to change people's minds about how much we could be helping.
JOAN ST. ONGE: I'm a general internist and I've been practicing for many years. And part of my practice is on an inpatient service, working with wonderful people like these students and residents, and to see the heartbreak of people who come in with really preventable infections and to have the personal toll that these patients endure, their families, their friends. You know, anything that we can do as physicians and also as people who are interested in improving public health, we should be doing. It really helps make the argument that this is a very good way of approaching a problem that is really still an epidemic.
How has the COVID pandemic made the problem of intravenous drug use worse?
BORNSTEIN: Unfortunately, the COVID pandemic requires that people socially isolate. And that has a lot of other negative outcomes, including decreasing the likelihood that somebody is going to get to them in time with naloxone.
COYE: There is accidental overdoses and people also die by suicide. And we clump these deaths together and call them deaths of despair. And I think in very emotionally trying times like this, where there's economic hardship, there's personal hardship, there's isolation. We see these deaths of despair increasing, and we've absolutely seen that with the increasing number of people dying of overdose.
BORNSTEIN: A lot of people’s healthcare is tied to their jobs, and when people don't have access to standard health care resources, a lot of times people improvise. And those improvisations, while they might make sense in the moment, can have negative outcomes.
ST. ONGE: The pandemic has exposed just so much of the vulnerabilities in our society and our system, and these patients are very vulnerable. So having a syringe exchange program and maintaining the connection to it for these patients is really a lifeline.
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