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Miami-Dade opioid deaths drop by nearly 100. Needle exchange may be the reason

Miami Herald - 11/19/2019

Nov. 19--Since 2016, public health advocates in Miami-Dade County have led the state in confronting Florida's opioid epidemic by starting a needle exchange that also widely distributed naloxone, a drug that counters overdoses, and getting it onto the streets.

With the latest data, experts believe those efforts have saved nearly 100 lives in 2018 alone.

Opioid-related deaths in the county fell significantly last year, totaling 213. That's down from 305 in 2017 and 321 in 2016, according to an analysis of the latest data collected by the Florida Department of Law Enforcement.

Hansel Tookes, assistant professor at the University of Miami'sMiller School of Medicine and principle director of its harm reduction research group, said he thinks the drop-off can be attributed to the IDEA Exchange, the needle exchange run by the research group. The harm reduction research group analyzed the FDLE data and grouped it to focus on deaths caused by all opioids.

Since it began distributing naloxone for free in March 2017, the IDEA Exchange has handed out 2,871 boxes of the drug, Tookes said. He added that those who have taken naloxone from the clinic to carry with them have reported 1,529 overdose reversals in that time.

"The people who use drugs are truly the first responders," Tookes said on Monday. "Nobody is saying the number of overdoses has gone down, but the number of people who have died preventable deaths has certainly responded to the availability of naloxone."

The exchange opened in late 2016 at 1636 NW Seventh Ave. in the heart of the UM health district and at the edge of Overtown, which has been ravaged by the opioid epidemic.

Tookes struggled for years to get the needle exchange launched in Miami, and won legislative approval for a pilot project in 2016. The IDEA Exchange became the only legal needle exchange in the state, where those who use intravenous drugs could turn in used syringes for clean ones to avoid sharing blood-borne diseases, get tested for those diseases and even get their wounds treated, among other social services.

The exchange's success prompted Florida lawmakers to expand the pilot program statewide earlier this year, allowing county governments to green-light needle exchanges of their own in other parts of the state.

While the prevention of opioid-related deaths can start at needle exchanges, the mindset goes well beyond the clinical setting.

Naloxone, also known under the brand name Narcan, is administered via a nasal spray and can almost immediately reverse an overdose. The prescription medication only works on people who have opioids in their system, and has no adverse effect if someone doesn't but is given the spray anyway.

Tookes said the drop in opioid-related deaths provides more evidence that everyone should carry naloxone at all times. He said he was caught without it just last week at the Whole Foods downtown, where he had stopped after a yoga class.

At the hot food bar, Tookes said he noticed someone under the influence of opioids. Within minutes, Tookes said the man was on the ground, breathing slowly and shallowly. But since Tookes had left his naloxone at home, he had to administer a sternum rub -- a method used to revive patients by applying painful pressure with a knuckle to the chest -- until Miami-Dade Fire Rescue arrived.

"I cannot believe that I, of all people, did not have naloxone on me," Tookes said.

The next day, Tookes said he returned to the Whole Foods and dropped off several boxes of naloxone for the store to keep on hand in the event of another overdose.

Sheila Vakharia, the deputy director of the department of research and academic engagement for the nonprofit Drug Policy Alliance, which supported the efforts to establish the Miami needle exchange, said the statistics showing the drop in opioid-related deaths in Miami-Dade County was a testament to long-understood research.

"It just reiterates what decades of research have suggested to us, that syringe access programs are not only a point of contact for individuals to get access to sterile equipment, but also a point of contact for life-saving support in a variety of other domains," Vakharia said. "Naloxone in the hands of community members, particularly those who use drugs, is one of the most effective ways to address the opioid crisis."

The success of the program was gratifying to people like Sally Heyman, a Miami-Dade County commissioner who backed the idea of a needle exchange.

"That's been the intent all along, to reduce the deaths and the hardships related with opioid addiction, through fatalities directly, and indirectly, for the families and people who care about them," Heyman said.

The Miami-Dade commission will vote early next month on an ordinance that would make the needle exchange permanent and allow it to expand, Heyman added. The exchange currently remains authorized as a pilot program.

Beyond public health advocates and local lawmakers, law enforcement and first responders have also contributed to the drop in opioid-related deaths.

Eldys Diaz, an executive officer at the Miami Police Department who was a member of the Miami-Dade County Opioid Task Force before it expired this year, said the deaths have been reduced due to both the needle exchange and the quick deployment of Miami-Dade Fire Rescue, whose members carry naloxone. The Opioid Task Force has since been folded into the county's Addiction Services Board.

Diaz also highlighted a $1.6 million grant from the U.S. Department of Justice that went to the city's Addiction Recovery Program as aiding struggling opioid users.

"It allows for pre-arrest diversion," Diaz said. "Now we can take someone right to the hospital instead of to jail."

Tookes took pride in Miami-Dade's progress, emphasizing that other metro areas around the state have seen increases in opioid-related deaths.

"We decided to work with compassion and understanding and meeting people where they are, as opposed to these other cities," Tookes said. "We should be proud of the changes we've made in Miami."

Miami Herald reporter Charles Rabin contributed to this report.

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