For the last year and a half, injection drug users from across Florida have come to a tan, dented collection of shipping-containers-turned-offices nestled on the corner of a barren dirt lot in Miami’s health district.
Some come from as far away as Jacksonville, others from under a busy highway overpass just blocks away. They arrive on foot, in expensive cars and everything in between.
What has drawn them is Florida’s only legal needle exchange, where they can turn in used syringes for clean ones to avoid sharing blood-borne diseases. But they can do more than that: The IDEA Exchange, as it’s known, tests for HIV, drains abscesses, dresses their wounds. They connect with social services, homeless shelters and drug treatment programs. And they have already handed out more than a thousand doses of Narcan, a nasal spray that can reverse the effects of an opioid overdose, to save lives.
Soon, the tan shipping container will not be the only place they can go. The Florida Senate voted 40-0 Wednesday to expand the successful Miami-Dade pilot program, an emotional landmark for advocates and families that some frankly admitted they never expected. Under SB 366, drug users will be allowed to exchange used needles for clean ones statewide if their county governments agree groups can establish their own needle exchanges.
Sen. Oscar Braynon, D-Miami Gardens, the Senate sponsor, rattled off benefits of the program — “the AIDS test, the [hepatitis] C test, the naloxone, the treatment they receive” — before the bill passed unanimously. In the gallery, Hansel Tookes, the University of Miami doctor who led the statewide push, watched the bill pass for the final time with two colleagues.
Afterward, outside the Senate chamber, his phone lit up with excited messages as friends and fellow lobbyists approached him with congratulations.
“If you had told me as a medical student in 2012 this was going to pass in 2019, I wouldn’t have believed you,” Tookes said. “This legislation is just going to save so many people. It’s amazing.”
The bill now heads to Gov. Ron DeSantis, who has told a sponsor of the bill he is likely to sign the legislation. Advocates across the state, from Orlando to Tampa Bay to Palm Beach are already taking strides toward creating their own exchanges once the law goes into effect.
Eddy Suarez Jr., who has driven the program’s mobile exchange van to connect with people on the streets of Overtown, Homestead and Liberty City, said the program has the potential to save hundreds of thousands of lives.
“They can finally go into the shadows and pull people into the light of compassion,” he said.
‘A lot of skepticism’
But the path to legalizing needle exchanges in Florida started long before a student-driven initiative in Miami-Dade County evolved into the first legal needle exchange program in the American South.
Needle exchanges had been legalized for years in several states, including California, to help curb HIV transmission rates and to provide an avenue for drug users to get connected to additional resources. But in Florida, lawmakers in the Republican-controlled Legislature remained opposed to the idea. Past efforts to change the law fizzled. Providing clean needles to users had often happened quietly, sparsely and out of sight.
“It happens, and it’s been happening all over the country for a long time,” said Julia Negron, a harm reduction advocate from Sarasota who said she knew some who had quietly distributed clean needles long before the bill was passed. Her own organization in the Suncoast region has distributed naloxone for years to people who might need a dose of the overdose-reversing drug on hand, she said. “As state laws change, there have always been underground operations of harm reduction services and needle exchanges.”
Tookes, as a medical student in 2012 focused on addressing rising rates of HIV transmission, sought to change the policy. He first came to the Capitol in 2013 to ask for statewide needle exchanges, and his bill was quickly downgraded into a pilot program to test out the idea in Miami-Dade County.
His hopes that year were not high. The year before, he brought the idea of legal needle exchanges to the Florida Medical Association, where he was told the Legislature was too conservative and the idea would never pass.
“There was so much debate about what this legislation would mean for the future of the FMA,” Tookes recalled recently. “It was wild.”
But he and other students prevailed in establishing some support, and that brought him to Tallahassee for the first time. Despite long odds, the bill received a hearing in 2013. It was received favorably, but the proposal did not pass.
“It took a long time to bring our conservative members along with why it would be helpful — there was a lot of skepticism,” recalled Rep. Cary Pigman, R-Avon Park, an emergency room doctor who convinced some of his colleagues over several years. “For someone who is not involved in public health it’s hard to accept that giving people needles is a benefit.”
Tookes and other advocates — who met at committee meetings testifying on similar issues, or through mutual contacts — had to lobby three more years before lawmakers agreed to approve the pilot in 2016 with a host of restrictions. It had to be run by the University of Miami. It could not take public money. They had five years before the pilot period ended.
Yet the clinic opened that December, with unexpected success. They signed up hundreds of users, picking up tens of thousands of used needles off the streets. People they handed naloxone to came back with empty cartridges, reporting they’d saved lives.
Some former users, including Kevin Woldt, 51, who has been drug-free six months now after connecting with rehabilitation services and shelter through IDEA, recently credited the program’s comprehensive model with helping turn his life around.
He had struggled with addiction for years, and lost multiple friends to overdoses. Once when he woke up from an opioid high he discovered his roommate, slumped dead on the kitchen floor, had not.
It’s been slow work, with Woldt now taking steps to eventually work in peer recovery to help people like him. “I can’t repair 36 years worth of damage in six months,” he said. “But I’m doing what I need to do every day to meet my goals.”
As stories like Woldt’s began to add up, Tookes and other advocates began to wonder. Could they make needle exchange happen statewide before their own five years were up?
Needle exchanges go statewide
They brought a statewide bill back in 2018. That year, opposition from the Florida Sheriffs Association, which had objected to expanding programs without county commissions’ approval, helped stall the bill in negotiations.
This year, the bill’s fortunes seemed to change when José Oliva, the powerful Speaker of the House, visited the tiny Overtown clinic in December.
A small-government conservative from Miami Lakes, Oliva had previously voted for the initial pilot program in committees but was among those lawmakers who had reservations about the program. On that December day though, Oliva — out of place in his typical suit — stayed for nearly an hour. He met a user waiting in the shipping container office to go to rehab, a week after he’d signed up.
Oliva was “intrigued by the out-of-the-box thinking going on,” he told the Herald/Times shortly afterward. “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.”
The bill moved easily through both chambers this year, and with a mea culpa even from the powerful chair of the Senate’s budget committee Sen. Rob Bradley, R-Fleming Island, who acknowledged he had doubted the proposal in the past.
The new statewide bill still prohibits county funds from being used to operate such programs, and is stricter about requiring dirty needles be exchanged on a one-to-one basis for clean ones. But Reps. Shevrin Jones, D-West Park and Rene Plasencia, R-Orlando, who cosponsored the bill this year, watched it pass the House nearly unanimously, with only two votes against it.
Five years after Tookes and advocates first started walking the Capitol halls, attitudes in Tallahassee have changed, Jones said.
What helped convince some of those members was how much the program has accomplished despite its thin $700,000 budget run entirely on private funds: “It’s important you share with them the money we’re saving on the front end, preventing the individual from overdosing, saving the state dollars on Medicaid.”
For some of the 66 other counties without needle exchanges, the expected passage of the bill had already set plans for their own programs in motion.
The IDEA Exchange intends to expand its operations to neighboring Broward County, which has already indicated it would eagerly support such a program. A sister program, Rebel Recovery, is expected to obtain approval easily in Palm Beach County as well, meaning the state’s three most populous counties — spanning a population of more than 6 million people — will soon have access to needle exchanges in their borders.
Advocates in other regions of the state are also laying out plans. In Tampa Bay, advocate Matt Zweil said he is starting the process of “romancing” Pinellas, Pasco and Hillsborough county commissioners to back his own needle exchange operation in the region. For more than a year, his group Safe Exchange Tampa has been operating a naloxone distribution program out of local methadone clinics, which has reached more than a thousand people.
A needle exchange program, Zweil said, will reach thousands more. He also started a cryptocurrency business last year to help raise money for Safe Exchange, and $80,000 has already gone toward renting office space and hiring two full-time staffers.
The process will nonetheless be complicated: reaching agreement to establish a program, creating operating and oversight plans, ensuring adequate and trained staff are available.
But Zweil wants to start as soon as possible: “I’m going to start operating in whichever county starts allowing me first.”
The success of the needle exchange legislation also proves bipartisanship can still achieve good things in today’s polarized atmosphere, he added.
“We had some people that overcame reasonable objections and idealistic differences to find compromise in the name of helping people,” he said. “We had this really huge win in Florida. We should celebrate it.”