Needle exchange in Florida gains new support to go statewide

Bills have been filed in Tallahassee for the upcoming legislative session to expand the simple exchange program that advocates say has combated the spread of HIV/AIDS and viral hepatitis through dirty needles and saved lives.
Published Jan. 27, 2019

MIAMI -- The sun is setting in Overtown on a balmy Thursday in January, and Eddy Suarez Jr. is trying to make a yellow light.

For the last several months, the University of Miami doctor has pulled the weekly van-driving shift in the downtown Miami neighborhood, where he trades injection drug users’ old needles for fresh ones, as part of the IDEA Exchange, the county’s pilot syringe-exchange program.

On this trip, Suarez is stopping under a nearby overpass for two participants who are waiting to exchange needles nearby. It’s been a hectic few months for IDEA, which has used the exchanges as a conduit to providing other care. In October, they worked with local health officials to persuade several people to go into treatment as Miami city hall politicians sought to move out a group of homeless people living under one of the highway overpasses in the neighborhood.

“This was the shooting gallery, right here,” Suarez says, as he drives the van by an abandoned lot under the overpass. The bright orange caps of needles speckle the ground even in dim light. “All this was just people shooting up.”

The program, in that month, “got 20 people into treatment in 30 days,” he recalled. They drove out daily — stocked with needles, cookers and sterile equipment — to exchange syringes and offer HIV and hepatitis C testing and to help those looking for treatment get care. “The floodgates were open.”

With the new year starting, Suarez and other advocates are gearing up again to take that model statewide. Bills have been filed in Tallahassee for the upcoming legislative session to expand the simple exchange program that advocates say has combated the spread of HIV/AIDS and viral hepatitis through dirty needles and saved lives.

The program signed up its 1,000th participant in January and has reported at least 1,075 overdose reversals, according to a letter sent to the Department of Health. It has also collected more than a quarter million syringes, and despite the rise of opioid-related deaths statewide, Miami-Dade’s toll has dipped.

But in the two years that program has been running, lawmakers have declined to expand the program.

Advocates are hoping now that this may be their year. The House bill is being co-sponsored by a Republican, and Speaker Jose Oliva, who hails from Miami-Dade, visited the clinic in December and signaled his approval.

Last year, the push to expand the needle exchange program statewide stalled because of opposition from the Florida Sheriffs Association, which expressed concerns about some sheriffs and county leaders who would not have control over needle exchange programs opening up in their areas.

This year’s bills — sponsored by Reps. Shevrin Jones, D-West Park, and Rene Plascencia, R-Orlando, in the House and Sen. Oscar Braynon II, D-Miami Gardens, in the Senate — included “opt-out” language for counties that don’t want the program. Matt Dunagan, a spokesman for the sheriff’s association, said the group is still reviewing the new legislation and has not yet taken a position on the bill.

Advocates are also stressing the program’s cost efficiency in a year in which Oliva, newly-minted as speaker, is pressing for more price transparency and curbing healthcare costs.

Oliva “was intrigued by the out-of-the-box thinking going on,” he told the Times/Herald after visiting the clinic. “Equally impressive was the shoestring budget this program operated under, proving, once again, that more money for a problem is usually not the solution to that problem.”

He praised the program as “cost-effective and solution-centric, two great attributes for success.”

Oliva’s position is a far cry from the opposition needle exchange first faced when Dr. Hansel Tookes, who has fostered the program, first traveled to Tallahassee in 2012 to get an agreement to start the pilot.

Lawmakers were concerned then that needle exchanges would simply encourage more drug use. But the pilot became more appealing as opioid deaths continued to rise, and users turned increasingly to needles after Florida shut down “pill mills” starting in 2011.

They agreed to let Miami-Dade run a five-year pilot program, buoyed by arguments it was preventive care that could preclude high costs for treating diseases transmitted by dirty needles and that it could connect users to treatment and disease testing.

But the way the law is written means needle exchanges are still not legal in the rest of the state. In other places like Tampa Bay, advocates are still waiting for the ability to swap dirty needles for safe ones.

Matt Zweil, who wants to start an exchange program there, has been unable to do so without breaking the law. Instead, he has distributed naloxone and held regular trainings at methadone clinics in the area in lieu of trading needles.

Not legally having an exchange, he said, “keeps us from having places that people who are actively using are coming where we can reach them and connect them to services. They do everything in secret, and there’s nothing but shame and criminality associated with the use of injection drugs, and so they die.”

His naloxone distribution program has helped reverse at least 105 overdoses in the last year. But “Narcan doesn’t stop people from getting HIV and AIDS,” he said. “The massive financial consequence of that is hard to overstate.”

Zweil also added that the statewide needle exchange bill still would not provide state funding if it passes, describing it as “the thinnest sort of compromise to open the door to needle exchange.” He has so far paid to run his program out-of-pocket but said he would apply for federal grants or other funding if the bill becomes law.

In Miami-Dade, the program has become a mainstay for participants who regularly look for the van on its rounds in Overtown and other neighborhoods. The clinic’s three-trailer outpost in Overtown is filled regularly with a half-dozen UM medical students volunteering to provide wound care, draining abscesses that develop from repeated injections, and connecting users to resources about treatment or sterile use of needles.

Suarez, the UM doctor, and his colleague, Elisha Ekowo, have become a regular sight under the overpasses, where some of the homeless residing there will call them by name.

On their recent visit, Chris Rivera, 34, stops by the van to exchange a needle, spurred by word-of-mouth about the program from other users. Rivera, who has used heroin since his teens, says he’s tried twice to get to treatment before, but it hasn’t stuck.

He worked in roofing and construction until he started using again late last year, and became homeless about a month ago: “I fell right back into the same cycle.”

But he’s heard positive things about the program and says he wants to eventually get back into treatment. His motivation: his 5-year-old daughter, who he doesn’t want to see him dealing with addiction.

He signs up to participate in the needle exchange and rides the van back to the clinic a few blocks away, where he’s tested privately for HIV.

Before he leaves, he stands outside the clinic, watching the medical students chat between abscess draining and waiting for more participants to stop by. He says he’ll be back, before he walks away.