Sammy Mack, WLRN
A inexperienced van was parked on the sting of downtown Miami, on a nook shadowed by overpasses. The automobile serves as a cellular well being clinic and syringe change, the place individuals who inject medication like heroin and fentanyl may swap soiled needles for contemporary ones.
One of the clinic’s common guests, a person with heavy black arrows tattooed on his arms, waited on the sidewalk to get clear needles.
“I’m Arrow,” he mentioned, introducing himself. “Pleasure.”
This cellular unit in Miami-Dade County is a part of the IDEA Exchange, the one authorized needle change program working within the state. But Florida’s Republican governor, Ron DeSantis, signed a brand new regulation final week that goals to vary that.
Needle exchanges have been authorized in lots of different states for many years, however Southern, Republican-led states like Florida have solely recently started to adopt this public well being intervention.
The timing of the statewide legalization of needle exchanges comes as Florida grapples with an enormous heroin and fentanyl drawback. When individuals share soiled needles to inject medication, it places them at excessive threat for spreading bloodborne infections like HIV and hepatitis C. For years, Florida has had America’s highest charges of HIV.
Even so, Arrow mentioned, he and each consumer he knew at all times put the medication first. Clean needles have been an afterthought.
“Every once in a while, I did use someone else’s and that was a thrill ride — wondering whether or not I was going to catch anything. But I’m blessed; I’m 57 and I don’t have anything,” Arrow advised a reporter on the cellular clinic over a yr in the past.
Kaiser Health News agreed to not use his full identify due to his unlawful drug use.
“Now I can shoot with a clean needle every time,” he mentioned.
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The Miami Experiment
According to the Centers for Disease Control and Prevention, needle exchanges stop the unfold of viruses amongst customers of injection medication.
But the advocates who need to provide needle exchanges face challenges. For instance, carrying round a great deal of needles handy out with out prescriptions can violate drug paraphernalia legal guidelines.
Many states mapped out authorized frameworks many years in the past to permit needle exchanges as a public well being intervention. But in Florida, it was unlawful to function exchanges. Then, in 2016, the state legislature gave Miami-Dade County momentary permission to pilot a needle change program for 5 years.
“This is more than just a needle exchange,” mentioned Democratic state Sen. Oscar Braynon.
“This has become a roving triage and health center.”
In three years of operation, Miami’s pilot program has pulled greater than a quarter-million used needles out of circulation, in response to studies this system filed with the Florida Department of Health. By handing out Narcan — a drug that reverses opioid overdoses — the change has prevented greater than a thousand overdoses. The program additionally gives purchasers testing for HIV and hepatitis C. Finally, this system connects individuals to medical care and drug rehab.
This yr, Braynon launched Senate Bill 366 to permit the remainder of Florida’s counties to authorize comparable applications.
“We have made it so easy for people to get into HIV care now, and we have so many people who we never would have known were infected — and would have infected countless other people — who are on their medications,” mentioned Dr. Hansel Tookes, who heads Miami’s needle change pilot program.
Tookes was in Tallahassee, the state capital, in May when the growth invoice handed its closing vote — an extended shot within the conservative-dominated legislature that nonetheless handed by an awesome margin. He mentioned he spent the return flight house to Miami staring out the window.
“I looked down at Florida the entire ride,” he mentioned, “and I just had this overwhelming feeling like, ‘Oh, my God, we just did the impossible and we’re going to save so many people in this state.’”
Why Harm Reduction Trumped Politics
Six years in the past, Republican state Sen. Rob Bradley forged a “no” vote after contemplating a proposal for needle exchanges.
“You’re trying to make sure the person has a clean needle, which is outweighing the idea of the person breaking the law,” he declared in 2013.
This is the first objection of conservative lawmakers: the priority that these applications promote unlawful drug abuse. Responding to this skepticism with knowledge has been central to altering lawmakers’ minds.
Decades of analysis exhibits that needle exchanges don’t encourage drug abuse, and that they decrease different well being dangers for people who find themselves susceptible and sometimes onerous to achieve. It’s a part of a public well being strategy referred to as “harm reduction.”
In Miami, the needle change pilot undertaking has additionally earned the assist of regulation enforcement.
Officers say it’s a aid to know extra injection drug customers are holding their syringes in particular sharps containers, supplied by the change, to soundly get rid of soiled needles.
“Now, for our officers, when they’re doing a pat-down … that sharps container is really protecting you from a loose needle,” mentioned Eldys Diaz, government officer to the Miami police chief. “That’s an extraordinary source of comfort for us.”
This yr, when Bradley heard dialogue of the needle change invoice once more, he had a distinct response.
“I just want to say, when I started my career in the Senate, I voted against the pilot project — and I was wrong,” he mentioned as he voted for the invoice this time. “And the results speak for themselves. It’s very good public policy.”
The invoice handed unanimously within the Florida Senate and by a 111-Three vote within the Florida House. It took impact Monday.
Arrow Points To His Future
If it weren’t for the tattoos operating down his arms, it might be onerous in the present day to acknowledge Arrow as the person who as soon as slept below freeway overpasses. His pores and skin is now clear, and he has some meat on his bones. He seems to be more healthy throughout a go to to a clinic the place needle change purchasers get follow-up care, however it’s been a tough yr.
In May of final yr, Arrow’s girlfriend died from a coronary heart an infection — a severe situation that may occur to individuals who inject medication. After that, Arrow mentioned, he overdosed on goal. Narcan from the needle change introduced him again.
But he saved utilizing.
Arrow mentioned he doesn’t bear in mind rather a lot from that interval however does bear in mind utilizing a lot heroin that he ran out of contemporary needles between visits to the change. So he grabbed different individuals’s used needles.
And then he examined constructive for HIV and hepatitis C.
Tookes and his colleagues threw Arrow one other life raft: They bought him an inpatient drug therapy mattress.
Now Arrow sports activities a string of keychains from Narcotics Anonymous.
“My chain of sobriety,” he mentioned of the hyperlinks. “I got 30-days, 60-days and 90-days chips,” he mentioned.
Arrow’s HIV is below management. And he related with well being companies for individuals residing with HIV, together with getting remedy that cured his hepatitis C.
Now, he’s centered on staying sober, in the future at a time. He has been sober for about six months.
Tookes, Braynon and different supporters hope extra needle exchanges throughout Florida will give extra individuals the possibility to get well from habit — and shield themselves from needle-borne sicknesses.
Kaiser Health News (KHN) is a nationwide well being coverage information service. It is an editorially unbiased program of the Henry J. Kaiser Family Foundation which isn’t affiliated with Kaiser Permanente.