Pamela Sardo, PharmD, BS


Pamela Sardo, PharmD, BS, is a freelance medical writer and is currently a licensed pharmacist in 3 states. She is the founder and principal at Sardo Solutions in Texas. Pam received her BS. from the University of Connecticut and her PharmD. from the University of Rhode Island. Pam’s career spans many years in retail, clinics, hospitals, long-term care, Veterans Affairs, and managed health care responsibilities across a broad range of therapeutic classes and disease states.


Topic Overview

Human trafficking is considered a form of modern slavery, and it is global in its reach and impact. Trafficking in persons affects all genders, ages, and ethnicities. Human trafficking can be found in various illegal and otherwise legal businesses, industries, and services, including many economic sectors in the United States. They include agriculture, food service, sales, domestic services, construction, and landscaping. Human trafficking adversely affects a victim’s mental and physical stability, security, and well-being. It adversely affects entire communities, commerce, countries, and geographical regions. Pharmacy personnel are among the most accessible healthcare professionals and may have more contact with trafficking victims than other healthcare providers in Florida and the United States. There is often little guidance available for pharmacists who identify and strive to support victims of Human Trafficking. To address this gap, this program provides education and guidance for pharmacy staff who wish to provide care and referral for victims of Human Trafficking under Florida law. When and how to report human trafficking and available resources to support victims who have been trafficked are also explained.


Accreditation Statement:

 image LLC is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education.


Universal Activity Number (UAN): The ACPE Universal Activity Number assigned to this activity is 

 Pharmacist  0669-0000-23-128-H99-P

Pharmacy Technician 0669-0000-23-129-H99-T

Credits: 1 hour of continuing education credit

Type of Activity: Knowledge


Media: Internet/Home study Fee Information: $4.99


Estimated time to complete activity: hours, including Course Test and course evaluation


Release Date: September 1, 2023 Expiration Date: September 1, 2024


Target Audience: This educational activity is for pharmacists.


How to Earn Credit: From September 1, 2023, through September 1, 2024, participants must:


Read the “learning objectives” and “author and planning team disclosures;”

Study the section entitled “educational activity;” and

Complete the Course Test and Evaluation form. The Course Test will be graded automatically. Following successful completion of the Course Test with a score of 70% or higher, a statement of participation will be made available immediately. (No partial credit will be given.)

Credit for this course will be uploaded to CPE Monitor®.


Learning Objectives: Upon completion of this educational activity, participants should be able to:


Identify individuals who may be victims of human trafficking

Categorize distinctions between sex trafficking and labor trafficking

Describe how to report suspected cases of human trafficking

Recall resources available to victims of human trafficking



The following individuals were involved in developing this activity: Sardo, PharmD, BS. Pamela Sardo was an employee of Rhythm Pharmaceuticals until March 2022 and has no conflicts of interest or relationships regarding the subject matter discussed. There are no financial relationships relevant to this activity to report or disclose by any of the individuals involved in the development of this activity.


© LLC 2023: All rights reserved. No reproduction of all or part of any content herein is allowed without the prior, written permission of LLC.



Human trafficking is considered a form of modern slavery, and it is global in its reach and impact. It is often associated with organized crime but human trafficking can be more localized and include perpetrators known within a local community. Human trafficking is also referred to as trafficking in persons (TIP). It often involves the sexual exploitation of persons and forced labor, but other forms of trafficking are also perpetrated. Human trafficking adversely affects a victim’s mental and physical stability, security, and well- being. It adversely affects entire communities, commerce, countries, and geographical regions. Pharmacy staff are uniquely situated to identify victims of human trafficking through patient contact. Trafficked persons may present to the pharmacy, and pharmacy teams need to know how to recognize them, when and how to report human trafficking under Florida law, and to be familiar with available resources to support victims who have been trafficked.


Defining the Scope of Human Trafficking


The state of Florida is ranked third nationally in human trafficking abuses.1 Recognizing that the crime of human trafficking is a gross violation of human rights, the Legislature has taken measures to raise awareness of the practices of human sex trafficking and labor trafficking of children and adults.2 Human trafficking is a crime and a violation of a person’s human rights.3,4 Human trafficking involves exploiting a person against the person’s will. The victim may be recruited, transported, harbored, transferred, or received for exploitation. This may be accomplished through force, abduction, fraud, or coercion. Exploitation can take the form of forced labor, sexual acts, military involvement, or the harvesting of organs.5 Florida human trafficking law, section 787.06, defines human trafficking in much the same way.6


Human trafficking is often considered in its narrow scope as a criminal justice matter, but it is also a serious healthcare issue.5 Victims may seek healthcare services to address the negative health effects associated with human trafficking. These effects may present as sexually transmitted infections, trauma wounds, bruising, and tattoos can be present. This means

that healthcare professionals may encounter victims of human trafficking while providing medical services.5


Trafficking in persons affects all genders, ages, and ethnicities. Women, including women forced into prostitution, children, and men are all victims of human trafficking. Human trafficking is not found only within illegal businesses. Human trafficking can be found in various otherwise legal businesses, industries, and services.5 Koegler, et al. (2019) described some of the economic sectors in the United States where trafficking occurs. They include agriculture, food service, sales, domestic services, construction and landscaping, commercial sex, and marriage.7


Human Trafficking in the U.S.


The United States responded to the problem of human trafficking through the Trafficking Victims Protection Act (TVPA), passed by the United States Congress in the year 2000.8 The most common forms of TIP appear to be sex trafficking, labor or forced labor trafficking, and child soldiering.9


Under the TVPA, sex, and labor trafficking are broadly defined to include a myriad of acts of fraud, force, or coercion. For example, sex trafficking includes “all the elements of the crime of forcible rape when it involves the involuntary participation of another person in sex acts by means of fraud, force, or coercion, [and it] also involves violations of other laws, including labor and immigration codes and laws against kidnapping, slavery, false imprisonment, assault, battery, pandering, fraud, and extortion.”10


Under the TVPA, sex trafficking is defined as “the recruitment, harboring, transportation, provision, obtaining, patronizing, or soliciting of a person for the purpose of a commercial sex act.”11 Sex trafficking is also described as a severe form of TIP. This involves “a commercial sex act” that is “induced by force, fraud, or coercion, or in which a person induced to perform such act has not attained 18 years of age….”12 The term “commercial sex act” means any sex act on account of which anything of value is given to or received by any person.13

Severe forms of TIP also include labor trafficking.14 This involves the “recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, using force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage (an employer compels a worker to pay off a debt with work), debt bondage, or slavery.”14


The TVPA defines debt bondage and involuntary servitude in the context of human trafficking. Debt bondage is described as a pledge of personal services by a debtor, or a person controlled by the debtor, as a security for a debt to another, where the “value of the debtor’s services as reasonably assessed is not applied toward the liquidation of the debt or the length and nature of those services are not respectively limited and defined.”15 Involuntary servitude is defined as servitude induced by “any scheme, plan, or pattern intended to cause a person to believe that, if the person did not enter into or continue in such condition, that person or another person would suffer serious harm or physical restraint [or by] abuse or threatened abuse of the legal process.”16


The TVPA also provides increased protections for trafficking victims by expanding services and health benefits to victims regardless of immigration status. It creates immigration protection for foreign national victims of human trafficking.


It is important to note that these definitions indicate that human trafficking does not necessarily mean moving or smuggling a person or holding a person in captivity. Human trafficking is the dealing or selling of humans as a commodity for profit. There is also an overlap between the concepts of sex and labor trafficking since a “sex employee” may be subjected to both.7


With the broad presence of TIP and the overlap of categories, many federal agencies are involved in the investigation and prosecution of TIP. According to the U.S. Department of State Trafficking in Person Report, 2023, the Department of Homeland Security, the Department of Justice, and the Department of Defense are each involved in investigating cases of human trafficking.3


Take home message: If you see something, say something


Risk Factors for Sex/Labor Trafficking in the U.S.


There are specific risk factors for sex trafficking in the U.S. Individuals who are most at-risk include the following persons:17


female gender

children between the ages of 12 and 14

a person in an abusive relationship

a person suffering from drug addiction

a runaway or homeless person

a person who is a low educational achiever

a person who is in state foster care

a person who is in the juvenile correction system

a member of the LGTBQ community


Risk factors for labor trafficking are similar to sex trafficking, except that reports of labor trafficking indicate male gender is a greater risk factor.7 Other factors include “an international airport, interstate highway connections, sporting centers, multiple strip clubs, high poverty, violence, widespread substance use, a weak education system, high numbers of homeless and runaway children, and large immigrant populations.”7


Reid, et al. (2017) evaluated 913 juvenile justice cases in Florida.18 The purpose of the study was to see the role adverse childhood experiences played as a risk factor for victimization in human trafficking. Among the boys and girls in the study, the authors found that sexual abuse was the most damaging childhood adversity. This adverse event was linked to victimization in human trafficking, and it appeared to make boys and girls more susceptible to exploitation.18 The authors’ findings were consistent with other research on this issue, which found “that although cumulative trauma is more harmful than singular instances of trauma, sexual abuse may be a particularly strong form

of childhood trauma that functions as a ‘gateway’ trauma initiating increased exposure to other forms of victimization.”18


Children who are trafficked often have developmental delay, or the exploitation may have been promoted by a family member. Locations where human trafficking victims may be placed are diverse. Examples are shared in the following Table.


Table: Select Locations of Sex and Labor Trafficking


PornographyAgricultural trafficking
Forced ProstitutionDay labor
Massage parlorSweatshops/factories
Nail salonDomestic servitude/nanny
Online adsFood service
Modeling agenciesPeddling
Escort services 
Strip clubs 


Consequences of Human Trafficking


Trafficked individuals experience many adverse physical health issues.17,19 Negative impacts on a victim’s psychological and emotional state are also a consequence of human trafficking.17,19 The abuse may even lead to trauma bonding by the victim.3 Trauma bonding is discussed below.


Physical Consequences


Victims of human trafficking are often subjected to physical abuse by the perpetrator. The victim may be beaten, burned, or raped.17 A victim may be forced to take drugs, with the intent being that the victim will become dependent on the perpetrator.17 Some traffickers engage in what is called tattooing, which is a way to “brand” the victim.17

Injuries a victim may suffer from physical assaults include chronic pain and fatigue, poor nutrition, disability, and chronic and acute injuries to the body or organs.17 Sexual assaults may result in sexually transmitted diseases, pubic lice, human immunodeficiency virus, and AIDS.17 Women may experience urinary tract infections, changes in their menstrual cycle, acute or chronic pain during sex, vaginal injuries, anal injuries, unwanted pregnancies, cervical dysplasia, or cancer.17,19


Signs and symptoms that may be present in forced labor victims may include back, visual, or hearing problems from work in agriculture, construction, or manufacturing.20 Skin or respiratory problems can be caused by exposure to agricultural or other chemicals.20 Infectious diseases, such as tuberculosis and hepatitis, are spread in overcrowded, unsanitary environments with limited ventilation. Not all victims present with physical symptoms, though.


Psychological Consequences


The victim of human trafficking is often threatened and humiliated.17 These psychological traumas control and manipulate the victim.17 In many instances, these traumas are compounded by childhood experiences of the victim, such as abandonment, poverty, and physical and sexual abuse.17 These psychological traumas may lead to mental disorders, e.g., anxiety, depression, suicide, self-harm, and post-traumatic stress disorder.17,19


Human Trafficking and Trauma Bonding


A hostage, or a victim, of exploitation by a human trafficker, may develop a bond or affection for his or her captor or perpetrator.21-23 This paradoxical, psychological phenomenon is called trauma bonding.21-23 Although trauma bonding may be more likely when a victim is imprisoned for a meaningful period of time, it may arise in situations where a person’s physical freedom is limited but not fully taken away, such as with some victims of sexual exploitation.22,23

Scholars have defined trauma bonding and described the conditions that give rise to it, but because of the complexities of this psychological phenomenon. Trauma bonding is an “emotional attachment” between a victim and the trafficker or captor.22 This attachment or bond with the perpetrator is paradoxical since the perpetrator is abusive and controlling and usually creates an environment where the victim is wholly dependent on the offender.18 In response to this abuse, the victim develops “deep feelings of love, admiration, and gratitude” toward the abuser.22 These responses are similar to a theory known as Stockholm Syndrome.21 Stockholm syndrome is when hostages develop a psychological bond with their captors.21-23 It can result from power imbalances in hostage-taking, kidnapping, and abusive relationships. The “love” for their captor can be a defense or survival mechanism.23


Bonding is not always unilateral. There are cases where positive feelings are reciprocal between the captor and victim. This contrasts with the situation where the captor’s apparent affection is not genuine but is calculated to cultivate the victim for profit.22 According to the U.S. State Department, greater research is needed to understand trauma bonding and the role it may play in the lives of persons who are or have been trafficked.21


Identifying the Victims of Human Trafficking


According to studies, up to 88% of persons who are victims of human trafficking see a healthcare provider.5,24 This means that healthcare professionals, including pharmacists, are uniquely situated to identify and assist trafficked individuals and to report trafficking to the proper authorities.24,25 Pharmacists who receive training to help identify human trafficking are more likely to identify and report the crime.25 Pharmacists are particularly accessible to patients, and they can play an important role in identifying victims and guiding them to safety.26 Many victims of human trafficking may be citizens of the country or foreign nationals who are in the U.S., legally, or who are undocumented.7

Regardless of gender, age, or background, the victims of human trafficking are part of a vulnerable group within society.17 Factors that make a person vulnerable are seen in almost every risk factor associated with human trafficking. They include the following:7,17,27


Victims with a history of childhood sexual abuse

Runaways, juvenile delinquency, Child Protective Services involvement

Transgender individuals

Homeless youth (who can easily become coerced or forced into a human trafficking situation)

Foreign nationals (who are far away from home, may not speak the language, have no support systems, and may be in the country illegally)

People who come from politically unstable countries or countries in which there is war or widespread violence (who may be desperate to leave and can easily be exploited)

Anyone who is poor or comes from a country in which there is significant economic instability

People who have disabilities

Victims of domestic violence and/or sexual abuse


Patients with any of the above risk factors may be victims of human trafficking.


Screening Tools for Victims of Human Trafficking


Not enough is known about whether assessment tools to screen for victims of human trafficking are effective or sensitive to either sexual or labor exploitation. Not all the tools raised in the health and social welfare literature are discussed in full detail here; however, several tools show promise for identifying risk factors associated with human trafficking in various geographic regions.24-26,28,29 Some of these tools provide multilingual applications. Greenbaum (2016) developed questions to be used for screening victims of human trafficking in the emergency department setting.26 Greenbaum (2018) provides an evaluation tool to identify children who are victims of sex

trafficking.28 Chisolm-Straker, et al. (2019) recommend screening tools for human trafficking among homeless young adults.29 Tiller and Reynolds (2020) adapted Greenbaum’s questionnaire and other tools and produced a questionnaire focusing on sex and labor trafficking.24 This questionnaire is currently available for open access on PubMed.24 Unertl, et al. (2021) recommended that valid trafficking screening instruments should be made available by electronic tools that can be implemented and evaluated across healthcare.30


Chisolm-Straker, et al. (2019) found the Quick Youth Indicators for Trafficking (QYIT) screening tool to be effective.29 The QYIT is comprised of four questions, three of which are seen as a short screening tool for identifying adolescents who may be trafficking victims.29


Rosenthal (2019) provides pharmacist-specific questions to identify victims of trafficking: “Where do you store your medications? How do you keep track of your medications? Who is in charge of handling your medications? What are you taking this medication for? How did your provider tell you to take these medications?”25


The Adult Human Trafficking Screening Tool is a survivor-centered intervention tool developed by the National Human Trafficking Training and Technical Assistance Center.31 It includes 8 closed-ended screening questions that professionals can utilize, such as “Sometimes lies are used to trick people into accepting a job that doesn’t exist, and they get trapped in a job or situation they never wanted. Have you ever experienced this, or are you in a situation where you think this could happen?”31 Additionally, it is recommended that the interviewer, with respect to their own safety, create opportunities to be alone with suspected victims, away from the trafficker. Pharmacy setting options may include stating that the individual must be counseled on the item they are purchasing, or treatment they are receiving.


There is a significant social stigma for human trafficking victims who attempt to access health and social services. Healthcare providers need to be able to accurately identify victims to connect them safely and appropriately

with services focused on providing a haven and rehabilitation. Factors that can guide clinicians in using a proper psychosocial assessment tool include the following:25-29


An injury or illness that cannot be explained.

An explanation cannot logically or factually account for the injury/illness.

Medical care is sought long after it seems reasonable to have done so.

Some injuries suggest intentional harm, such as bruises on the face or around the neck, intentional burn marks, puncture wounds, or trauma to the genitals.

Someone who seeks medical attention is accompanied by a friend who insists on always being with that person, is very controlling, and answers for the individual who is injured or sick. The injured or sick party seems hesitant and fearful when the ‘friend’ is nearby.

The same person is seen multiple times for the same illnesses or injuries. Examination of their records may show no voluntary follow- up care for these problems and/or no compliance with recommended treatments – both of which require time and money, neither of which the victim possesses.

The patient is exceptionally fearful and nervous while being questioned and examined.

The complaints always involve injuries, issues surrounding drug use, or are related to sexual activity.

The patient’s complaint seems as if it was memorized or scripted.

The patient has no identification or cannot state their address


Providers should also screen patients suspected of being victims of human trafficking “for feelings of helplessness, shame, humiliation, distrust, self-hatred, disbelief, denial, suicidal thoughts, disorientation, confusion, and phobias.”19


If human trafficking is suspected, a focused private interview should be the next step. Build trust with the patient and communicate hope. Try to

gently guide them to a private pharmacy counseling area or immunization room of the department, or a hospital room, to separate them from a suspected trafficker (or guardian handler) accompanying the individual. If in a hospital or clinic, try to move to an x-ray room or procedure room. Minimize who you share your concern with, so other staff will not mistakenly stare, but you might ask the front desk to have the guardian complete a form while you interview the patient. Enlist an interpreter, if available. Use the same words the patient uses. Do not correct their terminology. Be open to unfamiliar narratives or stories.


Questions need to be asked before affirming a case of human trafficking. The questions should be nonjudgmental, open-ended, and framed in a way that encourages the patient to talk.24-27 Interviewers of human trafficking victims found that the victims were more likely to be open and candid if the healthcare professional appeared to be knowledgeable about trafficking, was respectful, and showed a nonjudgmental attitude.24-27 Questions should be very simple. Examples of questions are in the following Figure.32



What type of work do you do?


Do you have control of your documents?


Can you come and go as you please?


Do you owe money?


Where do you eat and sleep?


Are you being paid?


Figure: Select Questions to Encourage Patient to Talk


Interviewing children can be difficult but is very important. When patient presentation warrants concern regarding possible human trafficking, gentle questions to ask youth may include:


Do people give money to your parents when you stay with them?

Do you feel comfortable telling me about it?

Do you have to do things with grown-ups that you do not want to do?

Have you ever been hurt by grown-ups?

Do you travel a lot?

Do you feel safe at home?


Reporting Human Trafficking


The requirements for mandatory reporting of human trafficking itself vary from state to state.33 For example, some states have requirements for reporting sex trafficking, while others have laws for reporting labor trafficking.33 Certain consequences of human trafficking, like gunshot wounds, stab wounds, child abuse, intimate partner violence, sexual assault, or immediate threats to a patient, are covered by mandatory reporting laws, and these situations should be reported to the police.


Sometimes, healthcare providers are faced with uncertainty as to whether suspected cases of human trafficking can be reported without patient consent. In situations that clearly fall under mandatory reporting or are imminently dangerous, healthcare providers should not hesitate to report, with or without consent. In other situations, efforts should be made to secure patient consent to disclose information to authorities.


Visit the National Human Trafficking Hotline online at:


Reports of human trafficking may be made to the National Human Trafficking Resource Center (NHTRC).34 The NHTRC operates a National Human Trafficking Hotline that is available every day, 24 hours, at 1-888-373- 7888, and SMS: 233733 (Text “HELP” or “INFO”). The National Human Trafficking Hotline can provide information, guidance, and resources for healthcare professionals who have questions about human trafficking.34 The NHTRC also includes a National Human Trafficking Referral Directory. This online Referral Directory provides information for anti-trafficking organizations and programs that offer emergency, transitional, or long-term services to victims and survivors of human trafficking and those that provide resources and opportunities in the anti-trafficking field.34


Florida Mandates and Reporting Requirements


The State of Florida enacted a human trafficking law, Chapter 2019-152, that requires health professionals to be educated on human trafficking by completing a one-hour course.35 This education for health professionals must include content on the different types of human trafficking, sex trafficking, and labor trafficking, and it must describe ways to recognize people who are victims of human trafficking and how to report and direct victims to available resources.36


Florida law mandates that any person who knows or has reasonable cause to suspect child abuse, abandonment, or neglect must immediately report the child abuse, abandonment, or neglect to the appropriate authorities.37 Virtually all healthcare professionals, including pharmacists, are mandatory reporters.38 The report must be made to the Florida central abuse hotline.39 They are required to provide their names when reporting child abuse, abandonment, or neglect; however, this information is held confidential.40 The Florida central abuse hotline or resources to report child or vulnerable adult abuse are:41


Telephone: 1-800-96-ABUSE (1-800-962-2873)

Florida Relay 711 is a service provided to residents in the State of Florida who are Deaf, Hard of Hearing, Deaf/Blind, or Speech Disabled that

connects them to standard (voice) telephone users) or TTY: 1-800-955- 8771 (TYY is a teletypewriter for the deaf, hard-of-hearing, or individuals who have a severe speech impairment)

Report Online:

Victims can directly text HELP to 233733 (BEFREE) for help from human trafficking or to connect with local services


National government agencies are also creating programs to identify human trafficking. For example, if there is a belief that a child is involved in a trafficking situation, a tip can be submitted to the National Center for Missing and Exploited Children’s CyberTipline ( or call 1- 800-THE-LOST (1-800-843-5678)


In the event of a suspected or actual case, the healthcare provider administration and legal departments should be informed and consulted. In addition to following state and federal law, the provider’s policies and procedures should be followed to the extent they do not conflict with state and federal law.


In addition to the above, healthcare professionals licensed by a specified Florida Board are required to “post in their place of work in a conspicuous place accessible to employees a sign at least 11 inches by 15 inches in size, printed in a clear, legible font and in at least a 32-point type, which substantially states in English and Spanish:42


‘If you or someone you know is being forced to engage in an activity and cannot leave, whether it is prostitution, housework, farm work, factory work, retail work, restaurant work, or any other activity, call the National Human Trafficking Resource Center at 888-373-7888 or text INFO or HELP to 233-733 to access help and services. Victims of slavery and human trafficking are protected under United States and Florida law’”


The Department has also provided Mandarin translations of these signs for use in offices where those languages are spoken. The link, contains signs that meet the statutory requirements when printed at the listed size.


Reporting human trafficking to authorities, even in mandatory cases, can be dangerous for the victim. Adult victims who are not categorized as “vulnerable adults” may refuse help.24 Care must be taken to protect the victim and to direct the victim to available resources for help and recovery.25


Take home message: Human trafficking signs can be subtle.



A young woman you often see in the pharmacy comes in and buys multiple pregnancy tests and an emergency contraception product. You offer to connect her with an Ob-Gyn provider, but she states she is picking this up for her sister.


What signs of possible human trafficking are in this scenario and what are the next steps?



Interdisciplinary Health Team Role in Reporting and Referral


All members of the health team have a role to play in identifying and intervening to help victims of human trafficking. Human trafficking has become a significant public health burden. Various health sites, including pharmacies, may unknowingly treat victims of human trafficking who have suffered physical injuries and who have mental health illnesses.26,43,44 A greater percentage of victims of human trafficking are helped and provided resources when healthcare professionals receive proper education and training on screening and reporting.44 Pharmacists and other can provide education to the community to raise awareness about human trafficking. An additional resource is in the box below.


Take home message: Learn more about human trafficking and raise community awareness through the Look Beneath the Surface campaign by the Office on Trafficking in Persons an Office of the Administration for Children & Families, U.S. Department of Human Services.


Link for Look Beneath the Surface:


Because individuals may not have access to a computer, but may have their telephone, some mobile apps are mentioned below. Parents should also pair their phone with their children’s phones. The Sarasota Florida Sherrif’s Department has also posted 15 mobile apps parents should know about. The Sheriff’s Department reported arrests of suspected predators and reported these apps were used to prey on children. The mobile apps include Meetme, Grindr, Skout, WhatsAp, TikTok, and others which are located on this link: 6?ref=embed_post


Resources for Victims of Human Trafficking


Pharmacists can direct human trafficking victims to available resources. Pharmacy practice settings may have a protocol in place to identify human trafficking. If not, the HEAL Trafficking and Hope for Justice’s Protocol Toolkit for Developing a Response to Victims of Human Trafficking in Health Care Settings is available for download by completing a form. The link is:


The National Human Trafficking Hotline and the Florida central abuse hotline may also provide a resource for victims of human trafficking. In the case of children, the county’s child protective services should be contacted.25


In addition, there are other resources for victims of human trafficking. Miami has the THRIVE (Trafficking, Healthcare, Resources, and

Interdisciplinary Victim Services and Education) Clinic.45 This clinic is located at the University of Miami, Miller School of Medicine. It provides a model of outpatient trauma-informed interdisciplinary healthcare for victims of human trafficking, referred primarily by law enforcement. Miami is not alone. The Greater Houston Area Pathways for Advocacy-based, Trauma-Informed Healthcare (PATH) Collaborative at Baylor College of Medicine, CommonSpirit Health, and San Jose Clinic in Houston. This is a collaborative city-wide victim services model with a focus on healthcare for trafficking victims.45


The Florida Coalition against Human Trafficking also provides resources to victims of human trafficking. Their website link is:; and Safe Horizon assists victims of trafficking and other crimes. The Safe Horizons phone number with multilingual staff is 1-800-621-HOPE (4673).




According to studies, up to 88% of persons who are victims of human trafficking see a healthcare provider. This means that healthcare professionals, including pharmacists, are uniquely situated to identify and provide assistance to trafficked individuals and to report trafficking to the proper authorities. Pharmacy staff are committed to improving and contributing to the health of individuals through optimizing medication therapy and providing education. Pharmacy teams are accessible, there is no fee to speak to a pharmacist and the individual can remain anonymous during an interaction with a pharmacist. If pharmacy staff suspect human trafficking, knowledge and application of approaches to suspected human trafficking can result in action plans and processes to safely create an opportunity to speak with these patients.


Florida law mandates that any person who knows or has reasonable cause to suspect child abuse, abandonment, or neglect must immediately report the child abuse, abandonment, or neglect to the appropriate authorities. The same rules apply to vulnerable adults who are abused or are reasonably suspected of abuse, neglect, or exploitation.

Course Test


Human trafficking is best described as a crime in which a victim is


specifically moved or smuggled from one country to another.

working in an illegal business or industry.

forced, defrauded, or coerced to engage in sex, forced labor, military involvement, or organ harvesting.

under the age of 18.


If a debtor pledges personal services to another, and the value of the services is not reasonably applied toward the liquidation of the debt, this person may fall within the definition of


debt bondage.

involuntary servitude.

trauma bonding.

Stockholm syndrome.


According to Reid, et al. (2017), a history of           in a child’s past was the adverse childhood event that created the highest risk for a child to become a victim of human trafficking.


corporal punishment


substance use

sexual abuse


                is an “emotional attachment” between a victim and a trafficker or captor that is seen as similar to Stockholm Syndrome.


Trauma bonding

Posttraumatic stress syndrome (PTSD)

Emotional dysregulation


All of the following are more indicative of labor trafficking than sex trafficking EXCEPT:


involuntary servitude.



sweatshop work.


A Florida pharmacist or technician who suspects human trafficking or abuse of a child or vulnerable adult should call


the Florida Coalition against Human Trafficking and Shoplifters Anonymous

911 and the American Association of Poison Control Center

Al-Anon for Families and Girls and Boys Town

the National Human Trafficking Hotline and the Florida central abuse hotline


Factors that make a person vulnerable to human trafficking include


victims of childhood sexual abuse.


transgender individuals.

All of the above


Florida law mandates that all individuals report child labor or sex trafficking incidents


only if they are certain of the charge.

only if they have first-hand knowledge of the abuse.

if they have reasonable cause to believe the child is or was trafficked.

only if the patient consents to the report.


All of these are ways to report suspected human trafficking EXCEPT:


NHTRC at 1-888-373-7888

SMS: 233733 (BEFREE), Text HELP or INFO

1-800-THE-LOST (1-800-843-5678)

(800) FOR-AIDS

If a victim of human trafficking in Florida is hearing impaired, the state provides             for this population.


the Florida Relay and TTY

a referral to the CDC

a KNFB Reader

None of the above



Human Trafficking Awareness. Florida Department of Health, Office of Communications. 2018. trafficking-awareness.html. Accessed August 14, 2023.

State of Florida. Committee Substitute x3 for House Bill No. 851. Chapter 2019-152. June 26, 2019. 0laws%20-%20regular%20session/chapters%202019-151%20-

%202019-170/2019-152.htm?fn=document- frame.htm$f=templates$3.0Accessed August 13, 2023.

U.S. Department of State. Trafficking In Person Report. June 2023. Persons-Report-2023.pdf. Accessed August 8, 2023.


Lee H, Geynisman-Tan J, Hofer S, Anderson E, Caravan S, Titchen K. The Impact of Human Trafficking Training on Healthcare Professionals' Knowledge and Attitudes. J Med Educ Curric Dev. 2021;8:23821205211016523. Published 2021 May 17. doi:10.1177/23821205211016523

Florida Statutes, §787.06

Koegler E, Mohl A, Preble K, Teti M. Reports and Victims of Sex and Labor Trafficking in a Major Midwest Metropolitan Area, 2008-2017. Public Health Rep. 2019;134(4):432-440. doi:10.1177/0033354919854479

22 USC §§ 7101, et seq.

Department of Defense. Combating Trafficking in Persons Program. Trafficking in Persons 101. heet_2020.pdf?ver=2020-08-20-143340-510. Accessed August 8, 2023.

22 U.S.C. §§ 7101 (9) and (10)

22 U.S.C. § 7102 (12)

22 U.S.C. § 7102 (11)(A)

22 U.S.C. § 7102 (4)

22 U.S.C. § 7102 (11)(B)

22 U.S.C. § 7102 (7)

22 U.S.C. § 7102 (8)(A)

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Reid JA, Baglivio MT, Piquero AR, Greenwald MA, Epps N. Human Trafficking of Minors and Childhood Adversity in Florida. Am J Public Health. 2017;107(2):306-311. doi:10.2105/AJPH.2016.303564

Deshpande NA, Nour NM. Sex trafficking of women and girls. Rev Obstet Gynecol. 2013;6(1):e22-e27.

Identifying victims of human trafficking fact sheet. Department of Health and Human Services. 2023. dentifying_victims_of_human_trafficking.pdf . Accessed August 14, 2023.

OFFICE TO MONITOR AND COMBAT TRAFFICKING IN PERSONS. TRAUMA BONDING IN HUMAN TRAFFICKING. June 2020. Trauma-Bonding-in-Human-Trafficking-508.pdf. Accessed August 22, 2022.

Casassa K, Knight L, Mengo C. Trauma Bonding Perspectives From Service Providers and Survivors of Sex Trafficking: A Scoping Review. Trauma Violence Abuse. 2022;23(3):969-984. doi:10.1177/1524838020985542

Karan A, Hansen N. Does the Stockholm Syndrome affect female sex workers? The case for a "Sonagachi Syndrome." BMC Int Health Hum Rights. 2018;18(1):10. Published 2018 Feb 6. doi:10.1186/s12914-


Tiller J, Reynolds S. Human Trafficking in the Emergency Department: Improving Our Response to a Vulnerable Population. West J Emerg Med. 2020;21(3):549-554. Published 2020 Apr 16.


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Greenbaum J. Identifying victims of human trafficking in the emergency department. Clin Pediatr Emerg Med. 2016;17(4):241–8.

Panlilio CC, Miyamoto S, Font SA, Schreier HMC. Assessing risk of commercial sexual exploitation among children involved in the child welfare system. Child Abuse Negl. 2019;87:88-99. doi:10.1016/j.chiabu.2018.07.021

Greenbaum VJ, Livings MS, Lai BS, et al. Evaluation of a Tool to Identify Child Sex Trafficking Victims in Multiple Healthcare Settings. J Adolesc Health. 2018;63(6):745-752. doi:10.1016/j.jadohealth.2018.06.032

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Florida Statutes, § 16.618(4)(b)

Florida Statutes, § 456.0341(1)

Florida Statutes, § 39.201(1)(a)

Florida Statutes, § 39.201(1)(b)2

Florida Statutes, § 39.202

Florida Statutes, § 509.096

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Florida Statutes, § 456.0341(3).

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