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The public health benefits of a syringe-exchange program are obvious to Salt Lake County health officials, but they face a huge hurdle in providing a way for intravenous drug users to trade their used syringes for new ones: money.
Lawmakers didn't allocate any funds toward the program when they passed a measure establishing it earlier this year, but Gary Edwards, county Health Department executive director, estimates it would cost his department $500,000 to cover an on-site therapist and comprehensive education options, among other things.
Edwards' department is just one agency that has expressed an interest in operating such a program, which could begin as early as mid-November if a rule governing these agencies is approved. The rule is open for public comment until Oct. 31 and includes requiring agencies to develop a safety protocol as well as a syringe disposal plan.
Rep. Steve Eliason, R-Sandy, said he sponsored the measure making this type of program legal in Utah because of the concerning rate of opioid overdoses in the state — Utah is ranked fourth in the country for drug overdose deaths — and the equally concerning potential for disease transmission through dirty syringes.
His concerns are echoed by AIDS.gov, which states that the opioid drug epidemic has led to "unsafe injection practices" and put people at risk for HIV or viral hepatitis. But that risk can be reduced if someone uses a sterile needle and syringe for each injection, according to the Centers for Disease Control and Prevention.
Thirty-four other states and Washington, D.C., have syringe-exchange programs, according to the North American Syringe Exchange Network.
Exchange programs are "very helpful and don't increase drug use," said Heather Bush, the Utah Department of Health's viral hepatitis and syringe exchange coordinator. But the programs do "provide people with that point of contact so when they are ready for treatment, they can access it more easily, and [the programs] do, in the long run, reduce HIV and hepatitis C transmission."
Of the 118 new HIV diagnoses in Utah in 2014, the Health Department identified intravenous drug use as the most likely way 12 percent of women and 1 percent of men contracted the infection.
HIV, or human immunodeficiency virus, destroys cells that fight infections and therefore weakens a person's immune system. There is no cure, the CDC states.
Last year in Utah, eight of the 32 individuals recently infected with hepatitis C reported intravenous drug use, according to the state.
Hepatitis C is a liver infection that can become a long term, chronic infection. Many people with the infection do not know they are infected because they are not "clinically ill," according to the CDC.
The state Health Department is in charge of enrolling agencies interested in operating an exchange, according to the proposed rule.
That proposed rule would require agencies to submit a safety protocol to the department to prevent injuries, as well as submit a syringe disposal plan.
Those agencies must provide new, clean syringes free of charge, but they also must give individuals receiving them instructions on how to prevent the transmission of diseases such as HIV, and referrals for HIV and hepatitis C testing as well as drug and alcohol treatment programs. They also must inform individuals of how and where to get naloxone, a medication that can reverse an opioid overdose.
Those that decide to conduct an exchange program must report data — including how many people who exchanged syringes and how many referrals were provided — to the health department each quarter.
The Utah AIDS Foundation also might operate an exchange, but Tyler Fisher, the organization's programming director, said it likely would be a small operation.
He estimated fewer than 100 of the foundation's clients have identified themselves as intravenous drug users and the program likely would be serving only those individuals at first. The foundation would use a small amount of grant money to get the program started, he added.
"We recognize there should be services available to those who inject drugs. ... Syringe-exchange programs, I know, have had great success in other areas not only in preventing HIV, but also hepatitis C," Fischer said. "It also provides an opportunity to engage with substance users and when they're at that place, to help them make a decision about treatment services."
Bush expects the program to start slowly at first due to the lack of funding from the state. It also will take time for individuals exchanging needles to trust the program — that they won't be turned in to police, for example.
"As user trust and access goes up," Bush said, "hopefully we'll start to see some good results."
Twitter: @alexdstuckey Syringe-exchange rule
• The proposal can be found at: http://www.rules.utah.gov/publicat/bulletin/2016/20161001/40765.htm
• Utahns can submit comment on this rule by 5 p.m. on Oct. 31 at:
Disease Control and Prevention, Epidemiology
Cannon Health Building
288 N. 1460 West
Salt Lake City, UT 84116-3231