Florida counties can now authorize needle exchanges, after a bill aimed at reducing HIV and hepatitis C was signed into law by Governor Ron DeSantis.
"With the implementation of needle exchange--which is probably the toughest of the HIV prevention tools to get people to accept--I think that we’re going to have an era where Florida’s going to join the rest of the country in controlling HIV infections," says Dr. Hansel Tookes, an associate professor of clinical medicine at the University of Miami.
Tookes has been instrumental in pushing for the legislation since he was a medical student. He leads the IDEA Exchange—a pilot needle exchange project in Miami-Dade—that was a model for the statewide law allowing for more needle exchanges.
The new law allows individual counties to authorize needle exchanges--an opt-in approach that does not automatically establish needle exchanges. The law bans the use of state or municipal funds for needles. And it creates oversight standards.
Decades of research show needle exchanges are an effective way to reduce HIV and hepatitis C infection among injection drug users.
Needle exchanges work like this: bring in one dirty needle and swap it for one clean needle. That means no need to share dirty needles. Each time somebody comes in to make an exchange, it's also an opportunity to get voluntarily tested for HIV and hep C, and to receive referrals to rehab and other medical care.
But it's taken years for Florida lawmakers to come around to the idea of statewide needle exchange networks.
When Republican state senator Rob Bradley first deliberated over a needle exchange proposal in Tallahassee six years ago, he was incredulous.
"You're trying to make sure the person has a clean needle, which is outweighing the idea of the person breaking the law," he said back in 2013, before casting his vote against a similar bill.
This is the primary objection of conservative lawmakers — that these programs promote illegal drug abuse.
Responding to this skepticism with health benefits backed up by data has been central to changing lawmakers' minds.
Research shows needle exchanges do not encourage drug abuse, and that they lower other health risks to people who are vulnerable and often hard to reach. It's part of a public health approach known as "harm reduction."
HIV rates in South Florida are consistently among the highest in the country.
"Nationally we're ground zero, the South is, for some of the opioid addictions, for the AIDS epidemic, because we haven't been doing those things that help stop that," says Florida Democratic state senator Oscar Braynon who sponsored previous needle exchange bills that didn’t pass in the Legislature.
Although Tallahassee was initially hesitant to move on needle exchanges, in 2016, Miami-Dade County got permission to try a pilot program, the IDEA Exchange, for five years. The data collected from this exchange has been a key to winning over skeptics.
"And that's because the numbers don't lie," says Braynon.
In three years, the program pulled more than a quarter million used needles out of circulation, according to reports filed with the Florida Department of Health.
When people come into the exchange, either at a building located near downtown Miami or at the IDEA Exchange’s mobile clinic, users get special plastic "sharps" boxes to hold their needles in between visits, safely containing them and keeping them off the streets until they can be deposited at the exchange.
Beyond the infectious disease prevention component, the exchange has a partnership with South Florida Behavioral Health Network to hand out the drug that reverses overdoses, Narcan. That Narcan distribution has prevented more than a thousand overdoses, according to data collected by the pilot
"We are actually stopping the spread of HIV. We're actually reducing the overdoses. We are saving the state and saving the county money," says Braynon.
Braynon says there were compromises to get the bill through. Mainly, counties have to opt in, and they are barred from using state or local money for needle exchanges.
In Miami, the pilot exchange gets support from the University of Miami and private donors like the drugmaker Gilead.
Getting support from law enforcement also helped sway lawmakers. Though that didn't happen immediately, says Eldys Diaz, executive officer to the Miami Chief of Police.
"We got off to a bit of a rocky start with the needle exchange," said Diaz at a community forum about the IDEA Exchange in Miami ahead of the final votes in the legislature. "It would seem that law enforcement would be a natural antagonist to an organization like the needle exchange."
The head of Miami's police union at the time vehemently opposed the exchange when it opened. He suggested the exchange encouraged drug use and he blamed the exchange for an officer getting stuck with a dirty needle.
But Diaz said the department largely sees the needle exchange as a positive force.
"I don't know if anybody here has ever reached into someone's pocket and felt a loose needle, but that is terrifying," said Diaz. "Now for our officers, when they're doing a pat down, every time you feel that sharps container—which is really protecting you from a loose needle 100 percent of the time that you're feeling it—that's an extraordinary source of comfort for us."
Those are the kinds of results that changed the minds of a lot of republican legislators who started out against the exchanges—like Rob Bradley of Orange Park.
"I just want to say when I started my career in the Senate, I had voted against the pilot project and I was wrong," said Bradley during this most recent legislative session when he voted in favor of the statewide expansion bill.
"And the results speak for themselves," he said. "It's very good public policy."
The Florida senate voted unanimously in favor of the needle exchange bill this past session. The Florida house voted overwhelmingly, too—111 to 3.
"And I just had this overwhelming feeling like, ‘Oh my God we just did the impossible and we're gonna save so many people in this state,’" said Tookes, the University of Miami doctor who oversees the IDEA Exchange.
Prior to the official passage of the bill at the state level, Palm Beach County had already begun the process of authorizing needle exchange.
The law is effective as of July 1.