Seven colorful painted bricks lie at the base of an oak tree next to a cracked sidewalk and empty lot in Overtown, a tree adorned with a white cross in memory of a man claimed by addiction there 2 1/2 years ago. The monument is weathered, three of its bricks fractured. They bear the man’s name: Kyle Dodds.
In 2016, the 24-year-old was on his way to work when he stopped to buy drugs near the oak tree. He snorted the drugs on the spot and died before he even made it back to his car, killed by a lethal mix of heroin and synthetic opioids.
In her grief, his mother, Cindy Dodds, began talking to people about opioid abuse. She offers clothes, food and water to people living on the sidewalks. She asks them about their lives and talks to them about how they can save their lives from the monster of addiction.
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On a recent morning, she met Philip Sylverin, a former production manager who now lives on Overtown’s streets. Sylverin already knows one of Dodd’s major talking points — the help that’s available at the IDEA Needle Exchange. There, Sylverin gets clean needles to inject drugs in exchange for used ones, keeping dirty needles off the street and helping prevent the spread of HIV and hepatitis.
IDEA doctors work from their main location at 1690 NW Seventh Ave., out of a van they drive to Liberty City once a week, and even on foot with backpacks in Florida City. They give out naloxone, a lifesaving drug that reverses the effects of an opioid overdose. They distribute condoms, and provide anonymous HIV testing and antiretroviral drugs. The program provides strips to test whether heroin contains fentanyl, a powerful synthetic painkiller that has ravaged the neighborhood, and connects people to treatment through partnerships with shelters and rehabilitation programs.
Sylverin and his girlfriend struggle with addictions that they manage while homeless. Among the belongings Sylverin hauls around in a shopping cart, duffels and suitcases, he keeps a small black box that fits 27 syringes. Sylverin and his girlfriend have used the naloxone spray, known by the brand name Narcan, to bring back others from an overdose the same way they’ve been brought back themselves.
“I remember one week we saved 11 people,” Sylverin said. “You know, people that just get out of jail and think they have the same tolerance, some people not knowing the higher potency of what they’re taking.”
As a nationwide opioid epidemic surged, the Florida Legislature approved the program in 2016. Hansel Tookes, a University of Miami doctor who fought for years to get the law passed, opened Miami-Dade’s exchange in December that year. That 2016 law only allowed one needle exchange in Florida, run by UM. The law prohibits public financing for the program, so private donations and grants fund IDEA.
Now, with mounting evidence that the program is producing results, lawmakers in Tallahassee are considering a bill that would allow counties to create similar programs across Florida. So far, the proposal has seen broad bipartisan support. On Tuesday, the Senate Health Policy Committee unanimously passed a version of the bill that would allow counties to approve starting their own exchange program.
Dodds and Sylverin praised IDEA for reducing harm while offering a way to get better. No judgment. Just medical care and a focus on preventing the spread of disease while giving people a chance to keep living and keep trying to fight addiction. Through partnerships with several local agencies, IDEA also offers a path toward shelter, detox and rehabilitation.
Cindy Dodds believes IDEA would have at least given her son a better chance at recovery.
“My son was not a needle user ... however, who knows,” she said. “Maybe it was coming. I don’t know. I’m just really passionate about it because I see the hearts of the people who are doing this.”
Not everyone agrees. Some Overtown residents don’t want people living on their streets using drugs because they feel IDEA enables addictions. They say that while they understand the public health value of controlling HIV and preventing overdose deaths, they want to protect the quality of life of a historically marginalized neighborhood.
The exchange has faced opposition since the day Tookes first proposed it in 2013, when he went to Tallahassee with research he and other UM medical students gathered by interviewing injection drug users on Miami’s streets. The Republican-dominated Legislature rejected his proposal twice.
Then in 2016, lawmakers passed the Infectious Disease Elimination Act (IDEA) as a five-year test program. This year, the statistics and anecdotes emerging from the program’s modest three-trailer outpost show growing success. The program recently reported figures to the Florida Department of Health:
▪ 1,075 overdose reversals
▪ More than a quarter-million syringes collected
▪ A significant decrease in opioid-related deaths in Miami-Dade at a time when deaths are surging in other parts of the state.
At a UM research forum this week, students debuted a study that shows the number of syringes littering the streets has decreased by about 50 percent since 2009.
IDEA’s model is unique within Florida’s boundaries, but not in the U.S. Seattle has seen a 37 percent reduction in substance abuse among people using opioid programs available at their needle exchange. The New York Times reported that a 2016 study of the Washington, D.C., needle exchange showed increased funding was associated with a 70 percent drop in new HIV cases. Needle exchange programs have also led to lower costs for public health systems due to fewer HIV infections.
Sylverin said he has seen the difference IDEA has made on the street. He described his experience before IDEA existed — picking up a used needle off the ground to shoot up, knowing it might contain an infectious disease like hepatitis C or HIV. He said now, he and other drug users don’t pick up used syringes to shoot up.
“And it also makes addicts more responsible,” he said “You’re going to do whatever you’re going to do, and now you have the opportunity to do it in a better way, on a clean rig. It’s better for you, better for everyone.”
Joy Fishman used to believe that “tough love” would help break her son’s heroin addiction.
Forced rehabilitation. Forced out of the house when rehab didn’t work.
For a time, Fishman and her son, Jonathan Stampler, were estranged. He reconnected with his mother as he struggled to stay off the drug, including a painful 24-hour wait in an emergency room as he suffered from withdrawal. He managed to get on his feet and even become a drug counselor. But when he got high after being drug-free for a few years, it was too much.
Fifteen years after Stampler died from an overdose, Fishman no longer espouses tough love. She wishes IDEA’s resources had been available to him — clean needles to protect him from hepatitis, fentanyl strips to check that his drugs were not laced with dangerously powerful synthetic opioids.
When she describes her son’s drug-free period, she doesn’t use the word “clean.” Clean implies he was once dirty.
“My son was not a junkie,” she said. “He was a wonderful guy who had a disease.”
Her story is underscored by a tragic paradox — Fishman’s late husband invented the drug that could have saved her son’s life. Jack Fishman synthesized naloxone, but regulations made the drug largely unavailable around the time of Stampler’s death.
From her grief, Fishman fashioned an advocacy for a compassionate approach that she sees working at IDEA. She raised private money for the exchange when the Legislature approved it in 2016, and she said she’s ready to raise more money across the state.
Fishman met Dodds for the first time Friday at IDEA. They greeted each other with a bear hug. The mothers bonded over losing their sons and their belief that across Florida, similar programs would save lives and turn those lives around.
A key point for both women: the environment of acceptance IDEA creates. Empathy, not tough love.
“There’s a level of safety when clients walk in here,” Fishman said. “They feel safe to divulge whatever they’ve been hiding, which is a wonderful thing. This becomes a place of catharsis.”
In one of the trailers where a steady flow of volunteers — UM medical students — regularly offer a range of services, from administering HIV tests to draining abscesses that form after repeated injections, a message is written on a white board in red cursive.
“It’s important to meet people where they’re at, but not leave them where they’re at.”
Margo Kenyon got tired of seeing her friends die.
Her own spiral toward addiction began during her time as adult-film actress “Margo Stevens” in the 1990s, when she was first introduced to hard drugs. Fourteen years ago, she moved to Miami. She became homeless and gripped by her dependence.
Kenyon was losing a couple friends a week. It got worse a few years ago, when powerful synthetic opioid fentanyl hit the street. The 46-year-old recalled seeing ambulances come to Overtown six to eight times a day to respond to overdoses.
“I felt like I was in a war, and I never left Miami,” she said.
The repeated trauma of losing friends to overdoses was compounded by the dangers of life on the street, the fear of having belongings stolen, the fear of being a woman alone on the street. At times, it seemed like the only way out was either jail or death.
Five months ago, when Miami police set up barricades and a surveillance camera under the I-395 overpass where dozens of homeless were living, she told a reporter that everyone in the area feared being rounded up and arrested. She gestured toward streets lined with people shooting up, some sitting on milk crates, holding their heads in their hands. About 10 feet away, a man leaned back against a chain link fence and defecated.
Shortly after that day in October, Kenyon accepted the offers she got at IDEA to help get her into treatment. She was one of a few dozen who entered shelter and treatment as the city prepared to clean up the sidewalks and remove soiled bedding, trash and drug paraphernalia. IDEA coordinated with several other agencies to steer the people toward services.
Now, Kenyon’s in rehabilitation at The Village and she hopes to eventually become a peer counselor. She’s looking for work. The next step: housing.
“For a long time I didn’t want help,” she told the Miami Herald. She changed her mind after realizing IDEA could help her get off the street.
“I would tell anyone to never give up.”
Kevin Woldt, 51, hasn’t given up, but he believes he’s living on borrowed time. He once lost four roommates to opioid overdoses. One of them died when he and Woldt got high together in their South Beach apartment. Woldt passed out. He woke to find his friend slumped over on the kitchen floor, dead.
After referrals through IDEA, he’s been drug-free for four months now. He’s staying at Camillus House, in rehabilitation, and working toward going back to college. His long-term goal is to become a psychologist — just like his father, with whom he speaks regularly about his recovery.
“I wasn’t speaking in complete sentences four months ago,” he said.
Kenyon and Woldt both used IDEA as a gateway to other services, bolstering a reputation for being an important point for services to connect with a vulnerable population.
The doctors “probably loved me more than I loved myself,” Woldt said.
Both especially took notice of the program when they saw fewer discarded needles.
“The streets are a lot cleaner than they used to be,” Woldt said.
A bill expanding the exchange program statewide passed the Senate last year but stalled in the House, where the Florida Sheriffs Association raised concerns about counties where law enforcement officials might oppose a program.
This year’s leadership in the House is significantly more receptive: Speaker Jose Oliva of Miami Lakes visited the clinic late last year and was impressed with what he saw, praising IDEA as “cost-effective and solution-centric, two great attributes for success.” The House bill is cosponsored by a Republican, Rep. Rene Plasencia.
Rep. Cary Pigman, R-Avon Park, who chairs one of the House’s healthcare subcommittees, said he was hopeful for the bill’s success.
The sheriffs’ association has yet to take a public position on this year’s legislation, but a Senate committee advanced a version of the bill Tuesday that adds a a layer of government approval — county commissions would have to approve any needle exchange programs in their jurisdictions — and allows county governments to fund exchange programs.
In Miami, some critics remain skeptical. Some residents don’t accept the idea of more needles in Overtown.
“I’m not happy about the needle exchange program,” said Karen Cartwright, a longtime resident who contends city leaders have ignored residents’ complaints about drug use among the homeless. “As far I’m concerned, they are encouraging the drug addicts to come to Overtown.”
While standing over her son’s memorial, Dodds was greeted by a local activist and businessman. Keon Williams, chairman of the Overtown Community Oversight Advisory Board, struck up a conversation with Dodds about the neighborhood’s concerns about IDEA’s work.
Overtown is seeing investment and growth that Williams is proud to tout. But allowing drug use to continue on streets where kids walk to school troubles him and his neighbors. So does the thought of needles being discarded in public places.
Williams said there’s a delicate balance between recognizing the humanity of those struggling with addiction on the street and paying attention to the quality of life in a historically black neighborhood that residents say has been systematically ignored.
“There’s only so much a neighborhood can take,” he told Dodds. “When are we going to be put first?”
City administrators have said the overall positive impact of IDEA’s work is irrefutable, acknowledging reductions in overdose deaths and infections. Like Overtown residents, they want to make sure needles are properly discarded.
“We support the idea and the principle of distribution of clean needles. We aren’t debating that,” said Milton Vickers, the city’s director of human services. “But we also have an obligation to our general population to make sure that our parks are free and clear of syringes.”
The one-for-one arrangement in Miami, where IDEA participants must turn in old needles for fresh ones, already reduces the chances of needles getting tossed on the ground and sidewalks.
There are plans for a new pilot program to install needle receptacles in six parks in partnership with the city of Miami and health department, Tookes said. “Anything we can do to get syringes off the streets,” he said.