A typical syringe costs about seven cents, but for Hansel Tookes, it's worth much more.
For 13 months, the University of Miami doctor and medical professor and a team of staffers have been exchanging used needles for clean ones as part of a five-year pilot program in Miami-Dade County to cut down on the spread of HIV, hepatitis C and other blood-borne diseases among drug users.
Each syringe is more than just pennies: It's one less opportunity to spread disease and one less chance to injure someone who might come across discarded needles in the street, Tookes says. It also means one more opportunity to work with hundreds of drug users who might not otherwise get access to the program's life-saving overdose reversal drugs or substance abuse counseling.
Amid a ballooning opioid crisis across the state, advocates in areas including Tampa and Palm Beach County want similar programs. But the same 2016 law that created Miami-Dade's test run underscores a reality for the rest of the state: needle exchanges elsewhere are still not legal.
Tookes, who spearheaded the push for his pilot program, wants to change that by passing another law in Tallahassee that would allow similar needle exchange programs to start statewide. "A lot of people said when we first came back, 'Isn't the pilot five years? Why are they back?' We're back because people are dying. We're back because people are becoming infected with HIV and hepatitis C, and it's all avoidable."
Since the five-year test program — the IDEA Exchange, for the Infectious Disease Elimination Act — launched in December 2016, more than 600 people have passed through the program's doors since it opened in December 2016, Tookes said, and more than 330 units of overdose-reviving naloxone, or Narcan, have been distributed and used. Though it will take years to measure a decrease in HIV infection rates, Tookes said the number of used naloxone units indicates the number of overdose deaths have already likely decreased since the program began.
Injection drug use is of particularly pressing concern in South Florida, where rates of new HIV infections in Miami-Fort Lauderdale have consistently topped those in the rest of the country, according to the Centers for Disease Control and Prevention. Though dirty needles are only one risk factor for transmission, needle exchanges are a way to draw users somewhere they can connect to disease testing and treatment, advocates say.
"The idea of a needle exchange is a way for us to truly connect with the most vulnerable people," said Matt Zweil, who wants to start an exchange program in Tampa. "They're dying by the droves."
Zweil, a 37-year-old consulting engineer, helped found Safe Exchange Tampa seven months ago after a friend died of an overdose the day she left rehab. After co-founder Steven Spector told him about needle exchange programs, he was so spurred that he started incorporating the group the following morning — only to discover as he was about to file paperwork that the practice is, with the exception of Miami-Dade's pilot program, not allowed.
Zweil has since traveled to Tallahassee with Tookes and other advocates to support the new bill, and turned his efforts to distributing naloxone and holding weekly trainings at clinics in Tampa in the meantime.
When Tookes first came to Tallahassee in 2012 to advocate for changing needle-exchange laws in the state, lawmakers were much less receptive to that message, concerned that needle exchanges might just encourage drug use.
But the rising number of opioid deaths — and increased use of needles after Florida shut down "pill mills" starting in 2011 — have made the legislation much more appealing since. Advocates have also hammered a cost-saving argument for the legislation, citing the high costs for treating transmitted diseases compared to the relatively low price tag for funding a preventive program like needle exchanges.
The new legislation, which would allow groups like Zweil's to run their own versions of Miami-Dade's pilot program, sailed through House and Senate subcommittees with unanimous votes this week. The legislation is supported, too, by a bevy of municipalities and healthcare groups, including Broward County, the Florida Hospital Association and the AIDS Institute.
"This is a bipartisan effort to save lives in the state of Florida," said Rep. Shevrin Jones, D-West Park, who is sponsoring HB 579.
There may yet be a legislative fight as it winds through the House, but Sen. Oscar Braynon, D-Miami Gardens, who is sponsoring SB 800 in the Senate, says he expects it to pass in that chamber.
The new legislation, like the bill that came before it, would not provide state funds and would require such programs to rely entirely on private funding. A recent amendment to the House bill also changes language so the additional programs will not be run by the Department of Health or require additional administrative funds.
Zweil said he has already spent about $20,000 on the weekly trainings in Tampa this year, buoyed by a generous engineer's salary, and expects to spend another $60,000 to $70,000 should the legislation pass next year. But compared to the UM program's nearly $500,000 budget, his funding would be shoestring, he acknowledged. He said he would rely on volunteers to staff the program — the biggest overhead cost — and plans to apply for private funding after the bill is passed.
"I'm buying us a bus on day one when it's signed by the governor," said Zweil, who has been funding the project out of his own pocket. "We're going to be the first through the door at the Department of Health to be certified to be a new pilot program."
Justin Kunzelman, who directs the non-profit Rebel Recovery in Palm Beach County, began handing out naloxone and syringes on his own to friends in 2015. A former drug user, he would also advocate at municipal meetings for policy changes, carrying stacks of peer-reviewed studies on the positive outcomes of needle-exchange programs in other states.
"For a long time it was just me yelling in public meetings — 'we need syringe exchange' — and being told that's never going to happen," he said. "We're not going to help people use drugs."
The group also surreptitiously handed out needles for about a year until Rebel Recovery officially incorporated last February, he said, and is waiting for the legislation to pass before they resume their work.
But passing the bill is also one step — though a large one — toward reducing the stigma toward drug users and making headway against the transmission of blood-borne diseases, he said. Building a successful syringe exchange also requires building up the community's trust and encouraging people to use the program.
"The exchanging of syringes is not the real work — that's easy, I could do that out of my house if I wanted to," Kunzelman said. "It's changing the culture where people feel like that's something that's OK.
"That's the message: We actually care about you as a person. Just because somebody uses drugs doesn't mean they deserve to live with HIV or hepatitis C for the rest of their lives."