Tireless advocacy, care and research by faculty and students at the University of Miami Miller School of Medicine helped spur the Florida Legislature to pass a bill that allows counties across the state to establish needle exchange programs like the one created by the Miller School to reduce the spread of HIV and hepatitis C and prevent opioid overdose deaths.
The bill, which passed both the House and Senate and was sent to the governor Thursday for his signature, will expand the Miami-Dade pilot program by allowing additional counties to take part, with approval by county commissions. Counties will contract with hospitals, health clinics or medical schools to operate the programs.
In 2016 the Legislature allowed the University of Miami to establish a pilot needle-exchange program by passing a law called the Florida Infectious Disease Elimination Act, or IDEA. The IDEA Exchange is the product of years of civic engagement led by Hansel Tookes, M.D., M.P.H., assistant professor at the Miller School, beginning when he was a medical student advocating in the Legislature.
“We established the program, we used our rigorous evaluation methods to show that there was an immediate impact on saving lives, and it became clear that now was the time to go back to the Legislature to make the program available in other counties,” Dr. Tookes said.
The students who helped push for that expansion couldn’t be more excited about their success. “It was amazing to be able to go up to Tallahassee and talk to senators and representatives and show them statistics that not only are we helping individuals but this is also helping Miami as a whole by preventing the spread of disease,” said first-year Miller School student Lauren Rosenfeld.
“Every day we see how patients benefit, and we’re really excited to see that benefit extended to the rest of Florida,” said Margaret Ginoza, also a first-year student and project manager for the IDEA Clinic, which offers free wound care and general services once a week through the Mitchell Wolfson Sr. Department of Community Service (DOCS) program. “This has been a long time coming, and a lot of people have put a lot of work into it.”
The IDEA Exchange has reduced deaths from drug overdose by distributing thousands of doses of naloxone, the overdose reversal agent. “We were the first people in the state who were giving naloxone to people,” Dr. Tookes said. “It really changed the way we viewed the opioid epidemic, and now the new legislation requires that naloxone be given out at needle exchanges.”
The Miami program also regularly tests homeless people for HIV, and discovered an outbreak that caregivers were able to cut off before it spread. “There was no pathway for people living under a bridge with HIV to get care,” Dr. Tookes said. “By the end of our investigation and intervention, people were getting on medications within the same day. In a situation where hundreds of people would have been infected in the next year, there were only seven, and we’re really proud of that.”
The Miami-Dade County Health Department and UM/Jackson Memorial Hospital worked closely with the exchange to get these patients into care. “It worked because we had everybody at the table,” Dr. Tookes said.
In April state Sen. Oscar Braynon, D-Miami Gardens, was able to get the needle exchange bill through the Senate with no opposition. And after the House Health and Human Services Committee approved the bill co-sponsored by Rep. Rene Plasencia, R-Orlando, and Rep. Shevrin Jones, D-West Park, Jones said, “Public health must be a top priority for our state, and we must stop the spread of blood-borne diseases. The momentum behind this critical legislation puts us one step closer to making that a reality and sends a message to the communities impacted by this crisis that the Legislature prioritizes their best interest. Anything less than that is a disservice to the people of Florida as a whole.
“In recent years, Florida cities including Miami and Orlando have led the nation in new HIV diagnoses,” Jones’ office noted. “Simultaneously, Miami’s needle exchange program has helped the county decrease new cases as other areas of the state remained ill-equipped to address the issue, reiterating the need for a statewide solution.”
The IDEA Exchange “is actually one of the reasons why the University of Miami is an ideal place to get a medical education,” Rosenfeld said. “The needle exchange serves a population of people who otherwise wouldn’t be treated. … Even though this is just our first year, I plan to be involved with the clinic and with this type of population throughout the rest of my career.”
Dr. Tookes said legislators have loved talking with the medical students who have written op-ed pieces about needle exchange for Florida newspapers and advocated in Tallahassee. “The UM students who run the free clinic are so passionate and they know the topic so well that I often sent them in my stead,” Dr. Tookes said.
“It has truly come full circle for me.”