On a recent Tuesday morning, Emy Martinez walked around a couple of blocks in Overtown, looking for used needles to deposit in the sharps container in her backpack.
She didn’t find any.
Not in the gutters, not tossed in the shadow of the overpass, not shared between the heroin users who sleep on this block and know her by name.
“If there’s no needles on the streets that are thrown out, then there’s one less child that’s going to get stuck by a needle, there’s one less police officer that’s going to get stuck by a needle,” says Martinez, an outreach coordinator with IDEA Exchange—Florida’s first legal needle exchange program.
Twice a week, Martinez drives a big green van—the “Green Machine” she calls it—out to this spot. Injection drug users come here to swap their old needles for free fresh ones—getting used needles off the street and reducing the need to share dirty needles.
For Martinez, needle-free streets are just part of what success looks like. In its first year of existence, the exchange reached more than 500 injection drug users, collected more than 85,000 used needles, and reversed at least 235 overdoses.
Now, Martinez and her colleagues hope legislation proposed in Tallahassee this session can spread this model to the rest of the state.
The IDEA in IDEA Exchange stands for “Infectious Disease Elimination Act”—a 2016 Florida law that allows for legal needle exchange in Miami-Dade County.
Needle exchanges have proven one of the most effective ways to reduce HIV infection among injection drug users, and HIV rates in South Florida are consistently among the highest in the country.
But historically, efforts to stop the spread of the virus through dirty needles have run afoul of drug laws.
“In the ‘90s, we used to do a sort of underground safer injection, where we would give people bleach kits. And we would hide them in condom bags because if we got caught with the bleach kits, we could get arrested for paraphernalia,” says Martinez.
The IDEA bill created a limited, legal pathway to distribute free needles; It’s a five-year test pilot, only in Miami Dade County.
The IDEA Exchange van travels all over Miami-Dade County and has a fixed location in Overtown. Along with needle exchange, the program offers onsite HIV and hepatitis testing. There’s wound care for abscesses, and referrals for infection and addiction treatment.
Running the program costs more than $500,000 a year. Needle exchanges cannot receive state funds. Instead, the IDEA Exchange is supported by the University of Miami and a patchwork of donations and grants from private organizations—including the MAC AIDS Fund, Gilead Pharmaceuticals, the Elton John AIDS Foundation and the AIDS Healthcare Foundation.
Enrollees in the program are tracked with initials and an ID number. This system allows the program to track users and collect demographic data while protecting their anonymity. Participants are asked to carry a card that identifies them as part of the needle exchange in case they get picked up by law enforcement with needles.
“It is a wonderful thing,” says one of the IDEA Exchange regulars who goes by the name Arrow.
Arrow remembers the first time he injected. It was a cold winter in the late 1970s in New York City. He had back pain after a surgery, but not enough medication to dull the pain. A guy he knew gave him heroin. The pain stopped.
He’s been injecting heroin on and off ever since, with an unreliable supply of needles.
“If I didn't have any of my own, I had to try to clean out the ones that I had,” says Arrow. “Every once in a while, I did use someone else's. And that was a thrill ride. I wondered whether or not I was going to catch anything.”
Arrow is HIV negative. He says the needle exchange is helping him stay that way.
The needle exchange marked its one-year anniversary on World AIDS Day in December.
“This was something that should have been in Florida decades ago, but at the same time we were so proud and so happy,” says Dr. Hansel Tookes, who started lobbying for a needle exchange when he was still a student at the University of Miami. Now he’s a professor at UM’s medical school and runs the IDEA Exchange.
It took four tries to get the IDEA Act passed. Tookes says support for the project grew as more legislators saw the effects of opioid addiction in their communities.
Without needle exchange in other places, people have come to Overtown from as far away as the Keys and Palm Beach County to swap needles. So this legislative session, Tookes is behind companion bills—House Bill 579 and Senate Bill 800—that would expand this model of needle exchange access to the rest of the state.
Tookes expects it will take a couple of years to see a dip in new HIV cases as a result of Miami-Dade’s program. But as the opioid epidemic explodes, there’s an immediate impact; The IDEA Exchange also hands out naloxone, or Narcan—the drug used to stop overdoses.
Just like used needles, people can exchange spent naloxone cartridges for new doses.
So far, a couple hundred cartridges have come back to the IDEA Exchange.
“These are 235 lives that were saved. It’s probably the most pro-life thing,” says Tookes. “Everybody’s life is important, and because we’re able to distribute naloxone, these people are getting another chance at life.”
If the proposal passes, Tookes says he’s immediately ready to start helping other counties establish needle exchanges.
“We know how to do it now,” says Tookes. “My team is incredible and I will disperse them to provide capacity-building assistance. And we will make it happen everywhere.“
After all, he says, this van is mobile.