Gary Stein: Needle exchange is the one-buck no-brainer

Florida is not an early adapter. Most of the time, our state takes a “wait-and-see” attitude regarding nearly any health policy, social program or economic strategy that has been attempted by another state’s legislature. In some cases, no amount of positive data on a successful program is enough to convince our leadership to move in the path of innovation, regardless of the possibility of lives or money saved.

One such innovative program has saved at least hundreds of thousands of lives, millions of dollars and is older than CDs, cellphones, home computers, Katy Perry and Flo Rida, but you won’t see a statewide needle-exchange program in Florida.

It’s not for lack of trying. Bills proposing needle-exchange programs (NEPs) have been attempted for the past three years, but never got to the governor’s desk. In 2013, HB 735 (Pafford) died in the Judiciary Committee and SB 808 (Margolis) got to the Senate floor, but died on the calendar awaiting a vote.

After that session, Democrat Rep. Mark Pafford of West Palm Beach filed again, but HB 491 died in Messages at the Senate after passing the House Floor and SB 408 (Braynon) died along with it. In 2015, HB 475 (Edwards) died in Government Operations Subcommittee while SB 1040 (Braynon) died on the Senate floor calendar while the House called a premature end of session.

The real question, though, is how many Floridians have died since needle exchange programs first came to the U.S. in the 1980s?

The bills floundered, but it was not for lack of bipartisan support. After the 2013 session, Republican Health Policy Chair Aaron Bean of Fernandina Beach told the media, “We had it, we researched it. It doesn’t sound like a conservative idea — at first, but it is backed by the Florida Medical Association and would be 100 percent funded with private money, and that combination sold me.”

It may not have appeared conservative to Sen. Bean at first glance, but the concept has had conservative support from the beginning. The very first national needle-exchange program was championed by the highly conservative U.K. Prime Minister Margaret Thatcher. She looked at the data and decided the program was necessary to prevent an HIV epidemic among British addicts. In England, only 1 percent of addicts contracted HIV since the program started. Addicts in the U.S. have fared much, much worse.

Especially in Florida.

Today, there are more than 90,000 needle-drugs users, 19 percent with HIV and at least 23,000 with Hepatitis-C. Considering the lifetime healthcare cost of more than $600,000 for HIV patients and $300,000 for those with Hep-C, the burden on the state is tremendous, since street addicts rarely have health insurance and often seek treatment in emergency rooms or in Medicaid-based clinics.

Add the problem of reduced Low Income Pool funding this year and additional reductions on the horizon, and it’s not too hard to see a crisis coming to the state budget and to hospitals caring for indigent addicts.

Florida, because of its inaction, has 30 years of data and success rates across  the country and around the world to verify that needle-exchange programs work as legislators take yet another year to make a decision to start one. There are 35 states with NEPs, and they exist in one form or another in almost every country in Europe, Australia and New Zealand. They know that avoiding hundreds of thousands of dollars in health-care costs by offering a $1 syringe is a no-brainer.

Almost any question or concern can be answered by the data. For those who think that offering clean needles facilitates heroin use, there is no data that an addict ever stopped using drugs because of dirty syringes. The choice of whether or not to use while tempting HIV or Hep-C infection doesn’t seem to come up to addicts. According to a 2012 report by the Florida Department of Health’s Bureau of HIV/AIDS, 29 percent said they reuse the needles from their last injection, and 64 percent reported they had used a needle previously used by someone else.

There are even statistics about unexpected consequences. A report from the American Journal of Public Health in 2000 took notice that some states with NEP’s saw a reduction in crime.

This week, TIME magazine, a long-time conservative publication, published an article called, “Needle-Exchange Programs Could Prevent HIV Outbreaks, Experts Say.”

In 1990, I was working alongside HRS in South Florida trying to control the HIV epidemic. The idea of a needle-exchange program was batted about and then forgotten, while some activist groups actually went so far as to distribute the syringes in communities in Miami-Dade and risk arrest to save fellow Floridians. Maybe 2016 will be the year that Florida’s Legislature wakes up and smells the rationale behind the compassion of a needle-exchange program and the ability to save lives and health-care money before another year of suffering and death occurs.

It’s an idea whose time came many years ago, but it’s never too late to save lives.

Gary Stein MPH, a native Detroiter, worked for the Centers for Disease Control, landed in the Tampa Bay area to work for the State Tobacco program and is now a policy consultant, a health advocate and activist and blogger for Huffington Post. He has also been the executive director for Health Equity and Accountable Care and the Policy Director for FAAST, Inc. Column courtesy of Context Florida.

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