|
Leon County
Board of County Commissioners Cover Sheet for Agenda #26 November 12, 2019 |
| To: | Honorable Chairman and Members of the Board |
| From: | Vincent S. Long, County Administrator |
| Title: | Consideration to Authorize the Establishment of a Syringe Exchange Program |
| Review and Approval: | Vincent S. Long, County Administrator |
|
Department/Division Review and Approval: |
Alan Rosenzweig, Deputy County Administrator Wanda Hunter, Assistant County Administrator |
|
Lead Staff/ Project Team: |
Heather Peeples, Special Projects Coordinator Erin Kenney, Management Intern |
This agenda item provides a report on the recent legislation permitting counties to establish syringe exchange programs and a draft ordinance for the Board’s consideration authorizing the establishment of a program (Attachment #1).
This item has no fiscal impact. Section 381.0038, Florida Statutes, states that “state, county, or municipal funds may not be used to operate an exchange program. Exchange programs shall be funded through grants and donations from private resources and funds.”
Option #1: Accept the report on the recent legislation regarding syringe exchange programs and schedule the first and only public hearing to consider an ordinance authorizing the establishment of a sterile needle and syringe exchange program (Attachment #1) for December 10, 2019 at 6:00 p.m.
Report and Discussion
At the June 18, 2019 meeting, the Board directed staff to prepare a report on recent legislation authorizing counties to establish a sterile needle and syringe exchange program (SEP). During the 2019 Legislative Session, the Legislature amended Florida Statutes to allow counties to establish local SEPs by adopting a local ordinance (Attachment #2) and implementing several other specific requirements.
The new state law outlines the specific requirements and as explained in detail in the analysis, a county commission must take the following steps to establish an SEP : (1) authorize an SEP by ordinance; (2) enter into a letter of agreement with the Florida Department of Health (FDOH);
(3) enlist the county health department to provide ongoing operational advice, consultation, and recommendations; and (4) contract with an eligible entitiy to act as the program operator. The Leon County Health Department’s Health Officer, Claudia Blackburn, strongly supports the Board adopting an ordinance to authorize an SEP. However, it should be noted that adopting an ordinance does not guarantee that a program will be established. Florida Statutes prohibits the use of state, county, or municipal funds, therefore the establishment of an SEP is contingent upon identifying a qualified organization with the resources to successfully operate and sustain a program. The Health Department indicates that several community partners have expressed initial interest in establishing a program.
Should the Board choose to adopt an ordinance, the County Health Department will work to identify a recommended program operator. A contract for services as well as a letter of agreement with FDOH would then be prepared for the Board’s consideration. FDOH is currently preparing a standard letter of agreement, which will require any exchange program authorized by the County to operate in accordance with Florida Statutes. Once established, the program would operate independently with the County and FDOH providing oversight. As stated in Florida Statutes, the program operator is required to submit an annual report to both the County and FDOH by August 1st each year.
Syringe Exchange Programs (SEP)
SEPs provide sterile needles, syringes, and other injection equipment and facilitate the disposal of used needles and syringes to reduce the transmission of human immunodeficiency virus (HIV) and other blood-borne infections associated with reuse of contaminated needles and syringes by injection-drug users (IDUs). According to the Centers for Disease Control and Prevention, these programs may also help to:
The North America Syringe Exchange Network reports that there are approximately 224 SEP sites operating in the U.S. Currently, the only SEP operating in Florida is the Miami-Dade Infectious Disease Elimination Act (IDEA) pilot program, which was authorized by the Florida Legislature in 2016. This program is operated by the University of Miami through grants from the MAC AIDS Fund, the Elton John AIDS Foundation, the Fishman Family Foundation, the Comer Family Foundation, and the Health Foundation of South Florida. As of December 31, 2018, the program has enrolled 1,002 participants, made 8,998 exchanges, and provided 247,220 unused syringes in exchange for 259,838 used syringes. Additionally, the program achieved the following results:
The following analysis includes a summary of the amendments to Section 381.0038, F.S. and an update on the Leon County Health Department’s efforts to identify a possible program operator. Additionally, this item includes a draft ordinance for the Board’s consideration to authorize the establishment of a sterile needle and syringe exchange program.
Section 381.0038, Florida Statutes
The amendments to Section 381.0038, Florida Statutes, permits any county commission to authorize a “sterile needle and syringe exchange program to operate within its county boundaries.” The program may operate at one or more fixed locations or through mobile health units where the goal of the program must be the prevention of disease transmission. The program must offer the free exchange of clean, unused needles and syringes for used needles and syringes as a means to prevent the transmission of HIV, AIDS, viral hepatitis, or other blood-borne diseases among intravenous drug users and their sexual partners and offspring. Additionally, SEPs are required to provide educational materials, onsite counselling or referrals for drug abuse prevention and treatment, and kits containing an emergency opioid antagonist (known commonly as Naloxone), used for the complete or partial reversal of an opioid overdose.
The amended Statute also outlines the process for establishing an SEP. First, a county commission must authorize the establishment of a program under the provisions of a county ordinance. Following the adoption of an ordinance, the county must enter into a letter of agreement with FDOH in which the county commission must agree that any authorized program will operate in accordance with State law. The local county health department must also be enlisted to provide ongoing advice, consultation, and recommendations for the operation of the program.
The roles of the county, the local health department, and FDOH are limited to providing authorization and oversight as Statute prohibits the use of state, county, or municipal funds to operate a program. Federal funding may be used to support syringe exchange programs, with the exception of purchasing needles or syringes, if the state or local government can demonstrate to the Centers for Disease Control and Prevention (CDC), that its jurisdiction is experiencing or at risk for significant increases in disease transmission due to injection drug use. As of the writing of this item, FDOH has requested a determination of need for Florida and is awaiting a final response from the CDC.
Once an ordinance has been adopted and the local health department has been enlisted, the county commission can select and contract with one of the following entities to operate the program:
The contract must include provisions for an oversight and accountability system that ensures compliance with statutory and contractual agreements, tracking and reporting of program goals and objectives, and consequences for noncompliance. The program operator is also required to collect data as outlined in Statute as well as any other data that may be required by the Department of Health. An annual report, including all collected data, must be submitted to the county commission and FDOH by August 1st annually. It should be noted that SEPs are prohibited from collecting participant’s personal identifying information for any purpose.
Program staff and participants of an SEP are exempt from prosecution under the Florida Comprehensive Drug Abuse Prevention and Control Act, or any other law for the possession, distribution, and exchange of needles or syringes. However, individuals acting outside the scope of the program are not immune from prosecution. To prevent abuse of the program by staff or participants, the program operator is required by Statute, to provide for maximum security at all sites and implement additional security measures including an accounting of all needles and syringes in use or storage and the safe disposal of returned needles.
While several Florida counties have begun discussions about establishing a sterile needle and syringe exchange program, only Palm Beach County has adopted an ordinance as of the writing of this item (Attachment #3). However, Palm Beach County has not yet selected a program operator.
To assist with establishing local programs, FDOH scheduled three regional, one-day trainings for county health departments and county government staff. The training in Tallahassee was held on October 8th and representatives from both the Leon County Health Department and Leon County Government attended. FDOH announced that the Department is currently drafting rules for the program; however, their rulemaking authority is limited by Statute to data collection and reporting. Additional tools and resources for SEPs are also being developed and will be made available on a newly-launched website: www.floridahealth.gov/programs-and-services/idea/
Leon County Health Department
Following the Board’s direction to provide a status report on the recent legislation, staff reached out to the Leon County Health Department. The Leon County Health Department’s Health Officer indicated that the Leon County Health Department strongly supports the establishment of an SEP in Leon County, and they have begun reaching out to eligible entities to determine their interest in contracting with the County to operate a program.
As noted previously, Florida Statute prohibits the use of state, county, or municipal funds to operate an exchange program, thus requiring the program operator to rely on private grants and donations. To assist in determining the cost of operating an SEP locally, the Health Department provided the CDC study, Estimated Cost of Comprehensive Syringe Service Program in the United States, which is included as Attachment #4. The study found that the first-year operating costs ranged from $1.9 million for a large urban program serving 2,500 clients to $0.4 million for a small rural program serving 250 clients. Although a final program budget will be dependent upon the selected operator, the Health Department anticipates that annual cost for a program in Leon County could be much lower.
According to FDOH, there is currently no available method to estimate the total number of intravenous drug users in Leon County who might utilize an SEP. However, the Leon County Health Department recommends reviewing several data sets summarized in Attachment #5 to better assess the prevalence of intravenous drug use and associated health issues. The summary includes drug treatment admission data as well as HIV transmissions, viral Hepatitis infections, and drug overdose deaths which SEPs aim to prevent by providing sterile injection equipment as well as counseling, condoms, vaccinations, and emergency opioid antagonists.
The data shows that the population that may benefit from an SEP in Leon County is relatively small when compared to the rest of the state. However, trend data presented in Attachment #5 may indicate an increasing need for this type of program:
Draft Ordinance Authorizing the Establishment of a Syringe Exchange Program
Should the Board wish to establish an SEP in Leon County, the Leon County Health Department recommends adopting an ordinance as soon as possible so that entities interested in operating the program may begin to develop proposals and identify possible funding. A draft ordinance is provided as Attachment #1 and, pending the Board’s approval, a public hearing to consider the Ordinance would be scheduled for the Board’s December 10, 2019 meeting.
Through their preliminary discussions with qualifying entities, the Leon County Health Department has already identified organizations with an interest in being the County’s program operator. These organizations have stressed that an ordinance is needed for them to move forward. However, adopting an ordinance does not guarantee that a program will be established. The establishment of an SEP in Leon County is contingent upon identifying a qualified organization with the resources to successfully operate and sustain a program.
Should the Board choose to adopt an ordinance, the County Health Department will work to identify a recommended program operator. A contract for services as well as a letter of agreement with FDOH would then be prepared for the Board’s consideration. FDOH is currently preparing a standard letter of agreement, which will require any exchange program authorized by the County to operate in accordance with Florida Statutes. Once established, the program would operate independently with the County and FDOH providing oversight. As stated in Florida Statues, the program operator is required to submit an annual report to both the County and FDOH by August 1st each year.
Option #1