Researchers’ Findings Support Syringe Exchange Programs for Injection Drug Users

The reuse and sharing of needles by users of injection drugs create high risk for transmission of HIV, hepatitis C and a host of bacterial infections. The researchers studied the records of 349 patients treated for bacterial infections at Jackson who were injection drug users, 92 percent of whom were either uninsured or had publicly funded insurance. The total cost of treatment for the 349 patients was $11.4 million in one year. In addition, 17 of the subjects died during their hospitalization.

The results were recently published in PLOS ONE, an online journal from the Public Library of Science. The authors state that a syringe exchange program will provide significant public health and monetary benefits to Miami-Dade County and the rest of the state. The authors have led a campaign to have the Florida Legislature pass a bill permitting a pilot program in Miami-Dade County. The bill is known as the Infectious Disease Elimination Act (IDEA).

“It is currently against the law in Florida for a medical professional to give a clean syringe to someone if you know it will be used for illegal drugs,” said Miller School alumnus Hansel Tookes, M.D. ’14, M.P.H. ’09, an internal medicine resident at Jackson who was co-first author of the journal article. “Heroin use has a direct relationship with infections because it is a drug that is often injected. We are now seeing many of these drug users as patients at our HIV clinic at Jackson. The problem, however, isn’t restricted to HIV. Many injection drug users have bacterial infections like endocarditis, sepsis and abscesses and need to be hospitalized for weeks or even months while being treated with antibiotics. I find it very frustrating, because so many of these infections would be prevented if addicts were provided with clean syringes.”

“Miami-Dade County has the highest rates of HIV transmission in the nation,” said José Szapocznik, Ph.D., Professor and Chair of the Department of Public Health Sciences. “What most do not realize is that the epidemic among injection drug users affects us all. When injection drug users have sex with others, the HIV virus spreads to the general population through unprotected sex. Less often discussed, but equally harmful, is the high rate of hepatitis C transmission that also occurs when dirty needles are shared. In fact, more injection drug users die of hepatitis C than from HIV infection.”

Tookes and co-first author Chanelle Diaz, a fourth-year M.D./M.P.H. student, are making their fourth attempt since 2013 to get a pilot syringe exchange program approved in Florida.

“We will continue making trips to Tallahassee to educate lawmakers,” said Diaz. “We actually have bipartisan support for the idea, but it has been held up by politics. This is not revolutionary; we’re just trying to bring evidence-based policy to Florida. HIV is spreading among injection drug users and their partners, so action is inevitable. The question is whether we will wait for things to get more difficult to control before reacting, like Indiana, which recently legalized syringe exchanges in an effort to contain an HIV outbreak.

“But this goes way beyond clean needles. A syringe exchange program creates points of access for an otherwise hard-to-reach population, opening up the possibilities for HIV and hepatitis C testing, immunizations, overdose prevention education and linkage to substance abuse treatment. Studies show that these programs do not lead to increased drug use. In fact, people who inject drugs and have been part of a syringe exchange are more likely to enter a drug treatment program.”

“Tookes and Diaz have been pioneers not only by conducting policy-relevant research to demonstrate the extent of the problem in our county, but also in demonstrating the cost to taxpayers when dirty needles are shared,” said Szapocznik. “What is remarkable about their work is that they have focused their research on the kind of information that should move the hearts and minds of our policy makers. They have now labored intensely for three years to get a Miami-Dade County syringe exchange pilot approved by the Florida Legislature. They have been tireless advocates and will continue to fight to get legislators to do what is right for our community, which is to vote for a program that will save lives and tens of millions of dollars in health care costs in Miami-Dade County.”

The senior author of the study, Susanne Doblecki-Lewis, M.D., assistant professor of clinical medicine, added, “While most analyses of costs associated with infections related to injection drug use have focused on viral infections such as HIV and hepatitis C, we have shown that there are also substantial costs associated with severe bacterial infections that are very common and costly in this population. At a public hospital, such as Jackson, this results in enormous costs that could be reduced with availability of clean needles. Tookes and Diaz have done an incredible job documenting and presenting this important information.”

“When working with legislators, the fiscal argument is the best one,” said Tookes, “because as the use of injection drugs grows, so will the public cost of caring for infected patients. The number of deaths will likely increase, too. A syringe exchange program is our chance to intervene — to catch and control a burgeoning epidemic. I understand as a physician, however, that some people think it’s morally wrong to help addicts. Still, I think it’s a greater moral wrong to withhold something that you know will help them stay healthy, reduce cost to taxpayers, reduce the spread of the disease to the general population and ultimately get them into drug treatment.”

Additional authors of the journal article are Hua Li, M.D., Ph.D., M.S., Assistant Scientist and Biostatistician in the Department of Public Health Sciences, and Rafi Khalid, of Jackson Health System’s Department of Research.

The study was supported by the Infectious Diseases Society of America Medical Scholars Program and the Jackson Memorial Hospital Department of Internal Medicine Resident Scholarly Activity Program.

Miller School Departments, Centers and Institutes