By 10 a.m. Wednesday, November 11, the health professionals in white coats and green scrubs have already filed into Jackson Health System's $2 billion medical complex north of downtown Miami. But across NW 17th Street, scores of homeless individuals half-asleep on the sidewalk pull tarps and cardboard over their eyes as the sun rises higher overhead. A few people nervously pace, counting coins in their palms as they try to scrounge about $4 each for their morning fix.
South Florida's heroin epidemic is especially pronounced here. Used, uncapped needles are sprinkled in the bushes and empty lots. It's all too common for low-income intravenous drug users, desperate for a fix, to pick these off the ground or share needles with others, who may harbor infections. The consequences can be fatal.
"Oh, it'll catch up with you eventually," warns Jose DeLemos, a tall, scraggly man who walks with a limp. "It always does."
For the past three legislative sessions, medical professionals have been working with state legislators to try to pass a bill — the Infectious Disease Elimination Act — that would establish a needle exchange program at the University of Miami's Miller School of Medicine, adjacent to Jackson Hospital. (In earlier versions of the bill, it would be run through Florida's Department of Health.) Anyone could bring in a dirty needle and exchange it for a clean one. Staff would examine injection sites for infection and provide pamphlets about drug treatment centers. There are 194 similar programs in America. This bill would create the first one in Florida.
Proponents of needle exchange concede that such a program would not stop users from being addicted. But they insist it would drastically halt the spread of infections, route drug users into rehab, and save taxpayers millions of dollars. Still, in medicine, the idea of "harm reduction" can be controversial. Critics say giving away needles enables and encourages drug use.
But drug use is already rampant. The Centers for Disease Control and Prevention found that heroin use increased significantly across all demographics after Florida's pill mills shuttered in 2011. According to the National Institute on Drug Abuse, there were 15 heroin-related deaths in Miami in 2011. By 2014, that number had soared to 60. There are an estimated 10,500 intravenous drug users in Miami-Dade.
These users are at high risk of contracting HIV; it's estimated that one-third of all HIV cases are acquired by injecting drugs. Statistics for 2014 from the Department of Health show there were 26,445 people living with HIV/AIDS in Miami-Dade and 17,214 in Broward.
"I try to tell as many people my story as I can," DeLemos says, "to scare them so they think of me whenever they want to pick up a needle."
DeLemos, a soft-spoken giant, was born in the Dominican Republic. In 1968, he moved with his mother, father, and sister to Newark, New Jersey. He grew up in a working-class family, was a decent student, and hung out with good kids. The first time he tried drugs was with his cousin. Cocaine. He was 17 and hated it.
After high school, DeLemos attended the Culinary Institute of America in Hyde Park, New York. In 1984, he moved to Orlando for a job at Disney World as a sous chef. He fell in love with a kind woman, and for the next 17 years, life was good. Then, in 2005, a nasty breakup sent him on a downward spiral.
A heartbroken DeLemos fled to Miami for a change. He snorted cocaine and dabbled in crack. Then he started snorting heroin to calm him down. "My friend told me that I was doing it wrong and wasting it," he says. "I was scared to mainline it, but he showed me how to do it." The sensation of doing heroin "was pure love."
Soon, his heroin habit would cost him as much as $800 a day. He quit his job and turned to credit card fraud. He was arrested 19 times. In 2010, he tried to detox on his own. He lasted ten days. By 2011, DeLemos gave up on a normal life. He moved out of cheap motels and started sleeping in Pine Heights Park, behind Jackson's health district.
A county ordinance prohibits the sale of syringes to any person without a prescription, and at a cost of $18 for a box of 100, DeLemos could barely have afforded to buy enough needles to satiate his habit anyway. On the streets, dealers would sell clean insulin syringes they pilfered from diabetics for $3, but gathering enough money for a clean needle was an afterthought. DeLemos cooked heroin with collected rainwater in unsterilized Coca-Cola cans.
Like dozens of other addicts who hang out by the public hospital, DeLemos' life operated on a tragic rhythm: using dirty needles, inevitably contracting diseases, roaming across the street for treatment, and then winding up back on the sidewalk or in jail on possession charges.
Since 2011, DeLemos has been grappling with abscesses and infections. He nearly lost his left leg. He flatlined when an infection spread through his blood and to his heart. In 2013, he was diagnosed with HIV. He takes three medications for treatment.
His medical costs are passed on to taxpayers, as most injection drug users who contract diseases rely primarily on Medicare or Medicaid. The estimated cost of a hospital stay for an injection drug user averages $4,449. The lifetime cost of treating an HIV-positive person is more than $600,000. Care of indigents at Jackson costs nearly $500 million a year.
As DeLemos cycled through the hospital, he ran into Dr. Hansel Tookes, a 34-year-old medical resident specializing in infectious diseases. Tookes has done extensive research studying how injecting drugs spreads disease. In 2009, he and a team
"The research is out there. Needle-exchange programs like the ones in San Francisco work," Tookes says. "And it's so much more than getting a clean needle — there are people working there who will examine any abscesses and make sure they aren't infected. It prevents these common infections from getting worse."
In 2012, Tookes began working closely with legislators to craft the Infectious Disease Elimination Act, which would have made needle exchanges legal in Florida (otherwise, possessing needles without a prescription could be a misdemeanor charge of possessing drug paraphernalia) and dictated they be supervised and funded by the Department of Health . It didn't pass. The following year, Tookes tried again. It was promising, since it passed quickly through committees but was tied up in a 9-8 vote in the House committee, and the session ended before it could pass.
Tookes tried again. In 2013, the bill passed three Senate committees but got blocked in the House by Rep. Michael Bileca, a Republican from South Miami and chair of the government appropriations committee, who refused to hear it (and had voted against it the year prior). This year, Tookes and his colleagues published a cost-analysis study that found a needle-exchange program would save Jackson $11.4 million.
Bileca, who was a Jackson Health System board member until resigning in 2014, did not return calls seeking comment.
Rep. Katie Edwards of Broward, who sponsored the bill, is optimistic that the fourth legislative session is the charm. She has reintroduced the bill, with some tweaks. This one specifies that a single pilot program would be set up at the University of Miami and would be paid for privately by grants and donations. Because it would no longer rely on government funding, the bill does not go through Bileca's committee. It has so far passed one committee in the House and two in the Senate, and Edwards hopes it will make it to a vote when the Legislature convenes in 2016.
"For the good of a city, where more than one out of every 100 people has HIV, where we have an explosive drug epidemic," Tookes says, "let's hope 2016 is the year the Legislature helps us do what's best for Miami."
"It is just unfortunate that Florida has to experience such a severe heroin epidemic for policymakers to respond," Edwards says.
For DeLemos, who was diagnosed with HIV as the bill was killed over and over, it's too late.
"I think all the time where I might be if there [had been] a needle exchange for me to go to," he says. "I'll tell my story to as many people as it takes to bring needle exchange here and keep this from happening to anyone else."