RxCe - Human Trafficking & FL Reporting Mandates Materials

HUMAN TRAFFICKING AND FLORIDA REPORTING MANDATES

Faculty:

Steven Malen, PharmD, MBA

Steven Malen graduated with a dual degree in Doctor of Pharmacy (PharmD) and Master of Business Administration (MBA) from the University of Rhode Island. Steven Malen has worked as a clinical pharmacist in the retail, specialty, and compounding sectors.

Pamela Sardo, PharmD, BS

Pamela Sardo, PharmD, BS, is a freelance medical writer and licensed pharmacist. 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.

Abstract

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. 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 pharmacy personnel who suspect human trafficking. This program provides education and guidance for Florida pharmacy staff who suspect a patient is a victim of human trafficking.

Accreditation Statements

In support of improving patient care, RxCe.com LLC is jointly accredited by the Accreditation Council^TM for Continuing Medical Education (ACCME^®), the Accreditation Council for Pharmacy Education (ACPE^®), and the American Nurses Credentialing Center (ANCC^®), to provide continuing education for the healthcare team.

Joint Universal Activity Number: The Joint Accreditation Universal Activity Numbers assigned to this activity are as follows:

Pharmacists: JA4008424-0000-26-093-H99-P

Pharmacy Technicians: JA4008424-0000-26-093-H99-T

Credits: 1 contact hour(s) (0.1 CEU(s)) of continuing education credit.

Credit Types:

Pharmacy - 1 Credit(s)

Type of Activity: Knowledge

Media: Computer-Based Training (i.e., online courses)

Estimated time to complete activity: 1 contact hour(s) (0.1 CEU(s)), including Activity Pre-Test, Post-Test, and Activity Evaluation.

Release Date: July 1, 2026 Expiration Date: July 1, 2027

Target Audience: This educational activity is for Pharmacists and Pharmacy Technicians

How to Earn Credit: From July 1, 2026, through July 1, 2027, participants must:

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

Take the “Educational Activity Pre-Test;”

Study the section entitled “Educational Activity;” and

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

CE Credits: Credits for this course will be uploaded to CPE Monitor^® for pharmacists and pharmacy technicians.

Statement of Need

Human trafficking is considered a form of modern slavery, and it is global in its reach and impact. There is often little guidance available for pharmacists and pharmacy technicians to identify and support victims of human trafficking. To address this gap, this program provides education and guidance for Florida pharmacy staff who suspect Human Trafficking so they can identify, report, and refer victims of human trafficking, and direct them to available resources.

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

Disclosures

The following individuals were involved in planning, developing, and/or authoring this activity: Steven Malen, PharmD, MBA; and Pamela Sardo, PharmD, BS. None of the individuals involved in developing this activity has a conflict of interest or financial relationships related to the subject matter. There are no financial relationships or commercial or financial support relevant to this activity to report or disclose by RxCe.com or any of the individuals involved in the development of this activity.

Educational Activity Pre-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.

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

abandonment

substance use

sexual abuse

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.

Educational Activity

Human Trafficking and Florida Reporting Mandates

Highlights

The Florida Department of Children and Families provides a Community Human Trafficking Identification Guide for Commercial Sexual Exploitation of Children (CSEC) and Labor Trafficking for frontline professionals, including healthcare providers. These tools support trauma-informed screening in the pharmacy and clinical settings.

Take-home message: If you see something, say something.

Introduction

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.

Prevalence of Human Trafficking

According to the National Human Trafficking Hotline’s 2024 data, 11,999 cases of human trafficking were identified nationally involving 21,865 victims. Florida ranked among the top states, with 1,830 signals (5.66% of the national total), resulting in 832 identified cases involving 1,874 victims.¹ Florida continues to rank among the states with the highest reported prevalence nationally due to tourism, agriculture, and metropolitan demand factors. The state of Florida is ranked tenth in the number of human trafficking cases at 2.85 cases per 100,000 population.² It is third nationally in the total number of human trafficking cases.² The 2024 Annual Report, prepared by the Trafficking in Persons Risk to Resilience Research Lab at the University of South Florida, reported that approximately 540,000 individuals were the victims of labor exploitation and/or labor trafficking, and approximately 200,000 were victims of sex trafficking.³

Defining the Scope of Human Trafficking

Human trafficking is a crime and a violation of a person’s human rights.^4,5 Human trafficking involves exploiting a person against the person’s will. The victim may be recruited, transported, harbored, transferred, received, solicited, enticed, purchased, patronized, procured, or obtained for the purpose of exploitation.^4,5 This includes sexual exploitation or forced labor.^4,5 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.⁶ Florida human trafficking law, section 787.06, defines human trafficking in much the same way.⁷

Human trafficking is often considered in its narrow scope as a criminal justice matter, but it is also a serious healthcare issue.⁶ 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. This means that healthcare professionals may encounter victims of human trafficking while providing medical services.⁶

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.⁶ Trafficking occurs in agriculture, food service, sales, domestic services, construction and landscaping, commercial sex, and marriage.⁸

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 2000.^4,9 The most common forms of TIP appear to be sex trafficking, labor or forced labor trafficking, and child soldiering.¹⁰

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.”¹¹

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.”¹² 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….”¹³ The term “commercial sex act” means any sex act on account of which anything of value is given to or received by any person.¹⁴

Severe forms of TIP also include labor trafficking.¹⁵ 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.”¹⁵

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.”¹⁶ 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.”¹⁷

The TVPA also provides increased protection 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. ¹⁷

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.⁸

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:¹⁸

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

9) a member of the LGBTQ community

Risk factors for labor trafficking are similar to sex trafficking, except that reports of labor trafficking indicate that male gender is a greater risk factor.⁸ 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.”⁸

Emerging data from the USF 2024 TIPSTR Annual Report emphasizes digital recruitment via social media, online ads, and platforms as a growing risk factor, with over 300,000 commercial sex ads posted in Florida in a 90-day period and more than 1,200 illicit massage businesses identified.³

Adverse childhood experiences are a risk factor for victimization in human trafficking.¹⁹ Cumulative trauma is more harmful than single instances of trauma; however, sexual abuse during childhood was the most damaging adversity.¹⁹ This adverse event was linked to victimization in human trafficking, and it appeared to make boys and girls more susceptible to exploitation.¹⁹ Sexual abuse may function as a ‘gateway’ trauma, initiating increased exposure to other forms of victimization.¹⁹

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

Table

Examples of Locations of Sex and Labor Trafficking

SEX TRAFFICKING	LABOR TRAFFICKING
Pornography	Agricultural trafficking
Forced Prostitution	Day labor
Massage parlor	Sweatshops/factories
Nail salon	Domestic servitude/nanny
Online ads	Food service
Modeling agencies	Peddling
Escort services
Strip clubs

Consequences of Human Trafficking

Trafficked individuals experience many adverse physical health issues.^18,20 Negative impacts on a victim’s psychological and emotional state are also a consequence of human trafficking.^18,20 The abuse may even lead to trauma bonding by the victim, which 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.¹⁸ A victim may be forced to take drugs, with the intent being that the victim will become dependent on the perpetrator.¹⁸ Some traffickers engage in what is called tattooing, which is a way to “brand” the victim.¹⁸

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.¹⁸ Sexual assaults may result in sexually transmitted diseases, pubic lice, human immunodeficiency virus, and AIDS.¹⁸ 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.^18,20

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.²¹ Skin or respiratory problems can be caused by agricultural or other chemical exposure.²¹ 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.¹⁸ These psychological traumas control and manipulate the victim.¹⁸ In many instances, these traumas are compounded by childhood experiences of the victim, such as abandonment, poverty, and physical and sexual abuse.¹⁸ These psychological traumas may lead to mental disorders, e.g., anxiety, depression, suicide, self-harm, and post-traumatic stress disorder.^18,20

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.^22-24 This paradoxical, psychological phenomenon is called trauma bonding.^22-24 Although trauma bonding may be more likely when a victim is imprisoned for a meaningful 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.^23,24

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.²³ 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.²³ These responses are similar to a theory known as Stockholm Syndrome.²² Stockholm syndrome is when hostages develop a psychological bond with their captors.^22-24 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.²⁴

Bonding is not always unilateral. There are cases where positive feelings are reciprocal between the captor and victim. This contrasts with the situation in which the captor’s apparent affection is not genuine but calculated to cultivate the victim for profit.²³ 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.²²

Identifying the Victims of Human Trafficking

According to studies, up to 88% of persons who are victims of human trafficking see a healthcare provider.^6,25 This means that healthcare professionals, including pharmacists, are uniquely positioned to identify and assist trafficked individuals and report trafficking to the appropriate authorities.^25,26 Pharmacists who receive training to help identify human trafficking are more likely to identify and report the crime.²⁶ Pharmacists are particularly accessible to patients, and they can play an important role in identifying victims and guiding them to safety.²⁷ Only 42% of surveyed U.S. healthcare workers have received formal training, while 93% report they would benefit from it. Many victims may be citizens of the country or foreign nationals who are in the U.S., legally or who are undocumented.⁸

Regardless of gender, age, or background, the victims of human trafficking are part of a vulnerable group within society.¹⁸ Factors that make a person vulnerable are seen in almost every risk factor associated with human trafficking. Patients with any of the following risk factors may be victims of human trafficking:^8,18,28

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 are 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

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.^25-27,29,30 Some of these tools offer multilingual applications. These tools support trauma-informed screening in pharmacy and clinical settings:

Screening for identifying victims of human trafficking in the emergency department setting.²⁷

Quick Youth Indicators for Trafficking (QYIT) for identifying human trafficking among homeless young adults.³⁰

Screening tools for identifying potential victims of sex and labor trafficking.²⁵ This questionnaire is currently available for open access on PubMed.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

Electronic screening tools that can be implemented and evaluated across the healthcare sector.³²

The Florida Department of Children and Families, Community Human Trafficking Identification Guide for Commercial Sexual Exploitation of Children (CSEC) and Labor Trafficking.³³ This guide is designed for professionals and community members outside of child protective investigations to assist in identifying potential child trafficking victims and recognizing children who may be at high risk of trafficking. When discussing this sensitive topic, always use a trauma-informed approach that avoids placing shame or blame on the child. This screening tool advises people not to ask any of the questions in this guide to a suspected child victim directly.³³

In addition to the above screening tools, Rosenthal (2019) provides pharmacist-specific questions to help 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?”²⁶

Factors Suggesting Human Trafficking

There is a significant social stigma for human trafficking victims who attempt to access health and social services. Clinicians need to know the factors that can guide them in identifying victims, including the following:^26-30

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 often accompanied by a friend who insists on always being with them, is very controlling, and answers for the individual who is injured or sick. The injured or ill 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 reveal 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 can afford.

The patient appears exceptionally fearful and nervous during questioning and examination.

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

The patient’s complaint seems to have been 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.”²⁰

Further investigation may be appropriate when healthcare professionals notice red flags, such as the above-mentioned risks and psychosocial factors. However, screening for victims of human trafficking in the healthcare setting is difficult. There is a significant social stigma for human trafficking victims who attempt to access health and social services. In addition, 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.

Interviewing a Suspected Human Trafficking Victim

When human trafficking is suspected, a focused private interview, away from the trafficker, should be done. It is important to ask questions to affirm there is reasonable evidence of human trafficking before reporting it. The interview questions and responses should be documented in the patient’s medical record. Providers must use their clinical and ethical judgment to discern when to ask questions, what questions are appropriate, and whether to refer the matter to law enforcement. As a guide, the approach to interviewing a suspected human trafficking victim is to be patient-centered (i.e., victim-centered), trauma-informed, and culturally competent.^30-32 The 2025 U.S. Trafficking in Persons Report highlights ‘Promising Practices for Responding to Survivors in the Healthcare Setting,’ recommending trauma-informed training, universal education on health impacts, nonjudgmental approaches, and connections to safe housing/case management directly applicable to pharmacy encounters.⁴

A patient- or victim-centered approach focuses on the needs and concerns of the patient or victim.³¹ It seeks to minimize re-traumatization through the interview process.³¹ Build trust with the patient and communicate hope. Use the same words the patient uses. Refrain from correcting their terminology. Be open to unfamiliar narratives or stories.

The questions should be respectful, non-judgmental, open-ended, and framed to encourage the patient to share their thoughts.^26-28,31 Victims are more likely to be open and candid if the healthcare professional appears to be knowledgeable about trafficking (trauma-informed). A trauma-informed clinician understands the need to take action, the prevalence of human trafficking, and the physical, social, and emotional impacts of trauma on the victims, as well as on the professionals who help them.³¹ It may also be appropriate to look for signs of “feelings of helplessness, shame, humiliation, distrust, self-hatred, disbelief, denial, suicidal thoughts, disorientation, confusion, and phobias.”²⁰ Seeing these signs is important because, for example, victims sometimes believe they will bring shame to their families or communities.³⁴

Finally, the clinician’s approach should be culturally competent.^30,32 An interviewer should consider the patient’s cultural setting before an interview.³² If the victim does not speak English, the interview must be done in the victim’s language. A professional interpreter should be used because a poor translation could complicate the matter or exacerbate the issue. The clinician should be prepared to provide the victim with referral information in the victim’s language regarding appropriate legal, health, shelter, social support, and security services, and to assist with referrals upon request.³⁴ This requires that clinicians develop a network of professionals, such as professional interpreters and professionals who can provide legal, health, shelter, social support, and security services.

When a healthcare provider decides to interview the suspected victim, several ethical and safety considerations must be addressed.³⁵ Among the concerns is that a clinician does not want to undertake an interview that will worsen the victim’s situation in the short term or long term. This is why it is essential to ask these questions in a private setting, such as a consultation room, where no one else can overhear. Victims are often afraid that their abusers may find out that they disclosed the crime and punish them.^34,35

Learn the risks associated with trafficking and each victim’s case before undertaking an interview. For children, interviews should be conducted in an informal setting by interviewers trained to communicate effectively with children.^29,36 When patient presentation warrants concern regarding possible human trafficking, young victims should be asked gentle questions.³⁷ These may include the following:

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 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.³⁸ For example, some states have requirements for reporting sex trafficking, while others have laws for reporting labor trafficking.³⁸ 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.³⁸

Sometimes, healthcare providers are faced with uncertainty as to whether suspected cases of human trafficking can be reported without patient consent.³⁸ In situations that fall under mandatory reporting or that 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.

Florida Enforcement Update

In 2024, Florida recorded 138 statewide human trafficking arrests, with 83% of identified victims being adults. The average cost to prosecute a single case is $100,749.20.³⁹ Pharmacists and pharmacy staff play a vital role in early identification that supports these enforcement efforts.

Visit the National Human Trafficking Hotline online at:

https://humantraffickinghotline.org

Reports of human trafficking may be made to the National Human Trafficking Resource Center (NHTRC).⁴⁰ 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.⁴⁰ 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.⁴⁰ The USF TIPSTR 2024 Report notes that only 9-12% of survivors report to law enforcement, underscoring the importance of pharmacy teams using these confidential hotlines. From January-June 2025, the state hotline received 301 tips (a 48% increase post-rollout).³⁹

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.⁴¹ 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.⁴²

Florida has updated the hotline number on human trafficking awareness signs to the Florida Human Trafficking Hotline 1-855-FLA-SAFE.⁴³ 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.⁴⁴ Virtually all healthcare professionals, including pharmacists, are mandatory reporters.⁴⁵ The report must be made to the Florida central abuse hotline.⁴⁶ They are required to provide their names when reporting child abuse, abandonment, or neglect; however, this information is held confidential.⁴⁷ The Florida Central Abuse hotline or resources to report child or vulnerable adult abuse are:

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

Florida Relay Service 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)⁴⁸

Report Online: https://reportabuse.dcf.state.fl.us/

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

Key Takeaway:

Florida Human Trafficking Hotline 1-855-FLA-SAFE

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 (https://report.cybertip.org/) or call 1-800-THE-LOST (1-800-843-5678)

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

In addition to the above, on January 1, 2025, healthcare professionals licensed by a specified Florida Board were 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 the following:⁴⁹

“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 Florida Human Trafficking Hotline, 1-855-FLA-SAFE, to access help and services. Victims of slavery and human trafficking are protected under United States and Florida law.”

This updated version of the sign, which features the new Florida Human Trafficking Hotline at 1-855-FLA-SAFE, replaces the current sign requirement that contains the National Human Trafficking Resource Center contact numbers. The Department has also provided Mandarin translations of these signs for use in offices where Mandarin is spoken.

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.²⁵ Care must be taken to protect the victim and to direct the victim to available resources for help and recovery.²⁶

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: https://www.healtrafficking.org/resources/protocol-toolkit.

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, contact the county’s child protective services.²⁶

Other Resources:

The Florida Statewide Council on Human Trafficking combats human trafficking and supports victims of human trafficking.

Access at:

https://www.myfloridalegal.com/human-trafficking/council

Look Beneath the Surface campaign by the Office on Trafficking in Persons, an Office of the Administration for Children & Families, U.S. Department of Health & Human Services.

Access at: https://www.acf.hhs.gov/otip/partnerships/look-beneath-the-surface

The Florida Coalition Against Human Trafficking also provides resources to victims of human trafficking.

Access at: https://www.endslaverynow.org/florida-coalition-against-human-trafficking

Safe Horizon assists victims of trafficking and other crimes.

The Safe Horizons phone number with multilingual staff is 1-800-621-HOPE (4673)

Access at: https://www.safehorizon.org/anti-trafficking-program/

In addition, there are interdisciplinary clinics for victims of human trafficking. Miami has the THRIVE (Trafficking, Healthcare, Resources, and Interdisciplinary Victim Services and Education) Clinic.⁵⁰ 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. There are also 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.⁵⁰

Summary

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 individuals' health by optimizing medication therapy and providing education. Pharmacy teams are accessible, and there is no fee to speak with a pharmacist. Additionally, the individual can remain anonymous during the interaction. If pharmacy staff suspect human trafficking, knowledge and application of approaches to suspected human trafficking can result in action plans and processes to create an opportunity to speak with these patients safely.

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.

References

The National Human Trafficking. Florida. NHTH. 2026. Accessed April 22, 2025. Hotline. https://humantraffickinghotline.org/en/statistics/florida

World Population Review. Human Trafficking Statistics by State 2025. World Population Review. 2025. Accessed June 18, 2026. https://worldpopulationreview.com/state-rankings/human-trafficking-statistics-by-state

Reid, J.A., Wagers, S.M., Carter, K.P., Algerio, T.J., Branscum, C., Lockwood, S., Gray, J., Abeyta, S., McCullum, A., Walker, E., Bilali, K., Khan, S. & Horn, D. TIPSTR Statewide Repository for Human Trafficking Data: 2024 Annual Report. July 1, 2025. Report prepared by the Trafficking in Persons Risk to Resilience Research Lab, University of South Florida, St. Petersburg, Florida. Accessed June 18, 2026. https://cdn.theconversation.com/static_files/files/3997/compressed_2024_TIPSTR_STATE_REPORT_ON_HUMAN_TRAFFICKING.pdf?1764019233

U.S. Department of State. 2025 Trafficking in Persons Report. 2025. Accessed June 18, 2026. https://www.state.gov/reports/2025-trafficking-in-persons-report/

United Nations. Global Report on Trafficking in Persons. 2009. Accessed June 18, 2026. https://www.unodc.org/documents/Global_Report_on_TIP.pdf

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. Undated. Accessed June 18, 2026. https://ctip.defense.gov/Portals/12/New%20Documents/TIP_101_updated%202025_FINAL.pdf?ver=1mRZkzt6d9stuPPi4DW3zg%3D%3D&timestamp=1739282156277

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)

Richie-Zavaleta AC, Villanueva A, Martinez-Donate A, Turchi RM, Ataiants J, Rhodes SM. Sex Trafficking Victims at Their Junction with the Healthcare Setting-A Mixed-Methods Inquiry. J Hum Traffick. 2020;6(1):1-29. doi:10.1080/23322705.2018.1501257

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. Undated. Accessed August 19, 2025. https://www.acf.hhs.gov/sites/default/files/documents/orr/fact_sheet_identifying_victims_of_human_trafficking.pdf

OFFICE TO MONITOR AND COMBAT TRAFFICKING IN PERSONS. TRAUMA BONDING IN HUMAN TRAFFICKING. June 2020. Accessed June 18, 2026. https://www.state.gov/wp-content/uploads/2020/10/TIP_Factsheet-Trauma-Bonding-in-Human-Trafficking-508.pdf

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/s12914-018-0148-4

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. doi:10.5811/westjem.2020.1.41690

Rosenthal M. Human Trafficking: Hiding in Plain Sight. Pharm Pract News. Policy Section. 2019; Sept. 10, online issue. Retrieved at https://www.pharmacypracticenews.com/Policy/Article/0616/Human-Trafficking-Hiding-in-Plain-Sight/55806. Accessed August 19, 2024.

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

Chisolm-Straker M, Sze J, Einbond J, White J, Stoklosa H.. Screening for human trafficking among homeless young adults. Child Youth Serv Rev. 2019; 98: 72–9.

Adult Human Trafficking Screening Tool and Guide. Department of Health and Human Services. January 2018. Accessed June 18, 2026. https://www.acf.hhs.gov/sites/default/files/documents/otip/adult_human_trafficking_screening_tool_and_guide.pdf

Unertl KM, Walsh CG, Clayton EW. Combatting human trafficking in the United States: how can medical informatics help?. J Am Med Inform Assoc. 2021;28(2):384-388. doi:10.1093/jamia/ocaa142

The Florida Department of Children and Families, Community Human Trafficking Identification Guide for Commercial Sexual Exploitation of Children (CSEC) and Labor Trafficking. 2024. Accessed June 18, 2026. https://humantraffickingidentification.myflfamilies.com/

Atkinson HG, Curnin KJ, Hanson NC. US state laws addressing human trafficking: education of and mandatory reporting by health care providers and other professionals. J Hum Trafficking. 2016;2(2):111-138.

Gomez M, Clayton EW, Walsh CG, Unertl KM. Identifying and supporting trafficked individuals: provider and community organization perspectives on existing sociotechnical approaches. J Am Med Inform Assoc. 2026;33(3):641-652. doi:10.1093/jamia/ocaf220

Kaltiso SO, Greenbaum VJ, Agarwal M, et al. Evaluation of a Screening Tool for Child Sex Trafficking Among Patients With High-Risk Chief Complaints in a Pediatric Emergency Department. Acad Emerg Med. 2018;25(11):1193-1203. doi: 10.1111/acem.13497

Browne-James L, Litam SDA, McRae L. Child Sex Trafficking: Strategies for Identification, Counseling, and Advocacy. Int J Adv Couns. 2021;43(2):113-125. doi:10.1007/s10447-020-09420-y

Geiderman JM, Marco CA. Mandatory and permissive reporting laws: obligations, challenges, moral dilemmas, and opportunities. J Am Coll Emerg Physicians Open. 2020;1(1):38-45. Published 2020 Jan 21. doi:10.1002/emp2.12011

Statewide Council on Human Trafficking Florida. 2025 Annual Report. Accessed June 18, 2026. https://www.myfloridalegal.com/sites/default/files/2025-human-trafficking-annual-report-web.pdf

National Human Trafficking Hotline. Accessed June 18, 2026. https://humantraffickinghotline.org

Florida Statutes 2024, § 16.618(4)(b)

Florida Statutes 2024, § 456.0341(1)

Florida Department of Law Enforcement. Florida Human Trafficking Hotline. FDLE. Accessed June 18, 2026. https://www.fdle.state.fl.us/florida-human-trafficking-hotline#:~:text=The%20public%20can%20help%20stop,%2D855%2D352%2D7233

Florida Statutes 2024, § 39.201(1)(a)

Florida Statutes 2024, § 39.201(1)(b)2

Florida Statutes 2024, § 39.202

Florida Statutes 2024, § 509.096

Florida Health. Florida Department of Health. Dixie County. Florida Relay Service and Language Line. Florida Health. 2026. Accessed June 18, 2026. https://dixie.floridahealth.gov/about-us/florida-relay-service-and-language-line/

Florida Statutes 2024, § 456.0341(3).

Jain J, Bennett M, Bailey MD, et al. Creating a Collaborative Trauma-Informed Interdisciplinary Citywide Victim Services Model Focused on Health Care for Survivors of Human Trafficking. Public Health Rep. 2022;137(1_suppl):30S-37S. doi:10.1177/00333549211059833

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