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On the edge of Overtown, the hot zone for Miami’s heroin and fentanyl crisis, about 20 drug users a day stop by offices in two unremarkable tan trailers.
In one, they give a blood sample to test for HIV and answer questions about their drug habits and life on the streets. In another trailer, the users carefully discard used needles while getting tools to keep their drug use sanitary: alcohol swabs, new sterile needles and even tourniquets.
And now, some of those users are coming away with something else: Narcan, a life-saving drug most often deployed by emergency-room doctors and paramedics tending to opioid overdose victims.
For the past month, public-health authorities have trained 70 participants in this ground-breaking needle exchange program to use Narcan, also known as Naloxone, which reverses the effects of opioids on overdose victims.
So far, they’ve reported using Narcan at least nine times to help someone else overdosing on heroin or another opioid, said University of Miami Dr. Hansel Tookes, the founder of the needle exchange known as IDEA Exchange.
“That’s nine lives of our fellow Miami citizens that have been saved through this program,” Tookes said at a press conference held Thursday to update the progress of the program.
Megan McLemore, a senior researcher at Human Rights Watch, said more must be done to make the drug accessible to users.
“It literally brings people back to life. It’s safe. It’s generic,” McLemore said. “It can be administered with very little training by lay people like you and me.”
Thursday’s press conference was a celebration of sorts for IDEA Exchange, the first needle exchange program authorized by lawmakers in Florida.
Tookes, who studies infectious diseases at UM and Jackson Memorial Hospital, spent five years fighting to start the needle exchange program – which many lawmakers, particularly in the South, had decried as endorsing illegal drug use.
But IV drug use in South Florida was rampant and dirty needles used over and over were causing more than just overdoses. In 2014, the federal government ranked the Miami-Fort Lauderdale region ranked No. 1 for the rate of new HIV infections in areas with more than 1 million people.
The rise in illegal fentanyl and its synthetic cousins, much of it trafficked in from secret labs in China, has been particularly deadly in Miami-Dade.
According to the Miami-Dade Medical Examiner’s Office, there were a staggering 279 overdose deaths involving variants of fentanyl last year. The pace has seemed to slow this year; so far, there have been only 65, although toxicology testing can sometimes take months to complete.
It was against this backdrop that Florida Legislature last year approved the Infectious Disease Exchange Act, a pilot needle exchange program.
In November, after intense fund raising efforts, IDEA Program opened on a lot at 1636 NW Seventh Ave, across from the venerated Camillus House homeless shelter and near the heart of the University of Miami health district.
The location was key.
To the west lies the impoverished neighborhood of Overtown, long a hub for drug sales. Last year, it exploded as ground zero for fentanyl, with users collapsing and sometimes dying in vacant lots and street corners at a furious pace.
So far, 240 drug users have participated in the program, about half of them from the streets nearby, others driving in from other parts of Miami-Dade County.
For every clean needle, a user must turn in a dirty one. And they must answer questions, all anonymously, about their backgrounds, when they first used and how often they use – data that will be analyzed, researched and turned into a quarterly report.
Inside one of the trailers, stacks of neatly organized supplies await, everything from condoms to gauze to pamphlets about rehab centers and medical clinics. A display case shows the various dimensions of needles available – users usually prefer smaller ones for injecting in the neck, longer thicker ones for the bigger veins in the legs.
As for the Narcan, staffers give out the small boxes of the single-use nasal spray only after training users to spot the signs of an overdose and call 911.
“You’re going to lay the person on their back. It goes right into the nose,” said Carlos Padron, a research associate who teaches drug users. “You wait two to three minutes. If the person doesn’t wake up, you’re going to use a second one. This drug really does work wonders.”
Staffers don’t just stay in the air-conditioned trailers.
A couple times a week, they walk the streets, backpacks in tow, to exchange needles and give out supplies of Overtown.
In the coming weeks, the program will debut the IDEA Exchange bus – a converted mobile dental clinic –that will allow the program to help drugs users as far away as Homestead.
“We’re going to go up to Liberty City and even Miami Beach,” said Phoebe Hughes, a health student employee.
And the bus, of course, will include Narcan.