Ravaged by Opioid Deaths and HIV, Broward Approves Needle Exchange. Miami is the Model

In the text of the ordinance authorizing a needle exchange in Broward County, commissioners ticked off a list of alarming public health statistics: 1,642 opioid overdoses in 2017, more than 21,000 people living with HIV, 387 heroin- and fentanyl-related deaths in 2018.

Needle exchanges are designed to prevent the spread of infectious diseases among drug users by providing clean syringes and help reverse opioid overdoses by distributing naloxone directly to people who use drugs, as well as offering them access to other services like testing for hepatitis.

After a three-year test run, Miami’s exchange, the first in the state of Florida and run by the University of Miami’s Miller School of Medicine’s harm reduction research group, has become the gold standard.

“We have an epidemic in our community,” said Broward Commissioner Nan Rich, who spearheaded the legislation that passed with unanimous consent Tuesday. “This is a best practice now, as far as I can see from other experiences in other places.”

UM created the exchange under the leadership of Hansel Tookes, who had advocated for the program for years before getting the Florida Legislature on board with a pilot run by his research group in 2016. Earlier this year, state lawmakers authorized Florida counties to go ahead with more needle exchanges.

On Tuesday, the same day that Broward authorized a needle exchange of its own, Miami-Dade commissioners made that pilot program permanent, passing the ordinance unanimously with little discussion and all the commissioners joining in as co-sponsors.

“It’s huge,” said state Rep. Shevrin Jones, a Broward Democrat who co-sponsored the bill that became this year’s needle exchange law. “You’ve got the two largest counties in the state of Florida who have passed life-saving pieces of legislation.”

Last month, Tookes put the life-saving component of exchanges into context, highlighting new data showing a steep drop in opioid-related deaths in Miami-Dade County: down by nearly 100 to 213 in 2018, compared to 305 in 2017 and 321 in 2016, the years that the exchange came into operation.

Not only are the exchanges designed to combat the opioid crisis, but they could also be a boon to HIV prevention. South Florida has some of the highest rates of new HIV diagnoses in the country.

Heather Davidson, director of policy for the United Way of Broward County, said needle exchanges lead to reductions in HIV transmissions and hospital costs for indigent people who need care.

“Syringe change programs have been shown to create a bridge where someone can be in crisis from intravenous drug use, and they need to be able to access a clean syringe,” Davidson said. “That ends up being a bridge to have a warm handoff into treatment, and that may take some time.”

William Green, who is overseeing the logistics of the needle exchange for Broward County’s human services department, said the clinic will be modeled closely after Miami’s: It will distribute clean syringes and naloxone, also known under the brand name Narcan, which is administered via a nasal spray and can almost immediately reverse an overdose. The clinic will also test for Hepatitis A and B, Green said.

Green said the county is in the process of convening potential funders, as the law passed by the Florida Legislature prohibits state or county funds from being used to operate the exchanges.

Rich, the Broward commissioner, said it will likely be funded by grants and donations.

“We’re pretty good at that in Broward,” she said. “That will not be an issue.”

Tookes, the UM doctor who served as the architect for Florida’s needle exchanges, said the news out of Broward and Miami-Dade was welcome this week, “but it’s not over until we reach all of the affected communities in the state.”

“They have to act,” Tookes said of the other counties. “I don’t know how they can see the overdose numbers and the HIV numbers and even hesitate. It’s their move.”