Carbon County has the highest rate of overdose deaths from heroin and prescription drugs in Utah, but health workers and law enforcement don’t always agree on how to address that problem. Recently a compromise was reached by these two sides allowing one syringe exchange to operate there.
At his office in Salt Lake City, Patrick Rezac pulls a handful of drug prevention kits out of a big plastic tub.
"This is the wound care kit we use down in Carbon County. There’s sterile water, gauze, alcohol pads," Rezac said. He runs a syringe exchange program called One Voice Recovery.
Rezac wears all black and has thick glasses. He looks more like a member of a rock band than a health worker. Rezac himself is a recovering drug user. He contracted HIV from injecting drugs when he was 32. But his life is different now. Now he’s clean. And he’s “virally suppressed” from medication he takes. With One Voice Recovery he makes house calls by car in places hit hard by drug use and opioid overdoses.
He pulls out a round metal tin, the size of a contact lens case.
"These little tin caps right here, that are used to mix drugs in, could be considered paraphernalia by law enforcement standards," he said. "From a disease prevention standard they’re absolutely critical."
This is the problem: some people think that by giving out these kits, syringe exchanges are enabling drug users by giving them everything to shoot up except the actual drugs.
Carbon County Sheriff Jeff Wood was one of those people.
"We were concerned that it was kind of a dark, clandestine operation that wasn’t following the law, and wasn’t very transparent," Wood said.
But Rezac is following the law. Two years ago, in 2016, the legislature allowed syringe exchange programs in Utah to provide IV drug users with sterile injection equipment. The goal is to prevent the spread of diseases like HIV and hepatitis C. Syringe exchanges have proven to save lives and money.
Besides disease testing, Rezac and his sole coworker provide sterile injection equipment for drug users, give out the overdose drug naloxone and collect used syringes. They also tell people about treatment options.
Earlier this year Rezac's focus on health suggested a compromise to Sheriff Wood: reframing this program from the stigmatized “needle exchange” to a public health issue.
"I believe it’s a disease prevention program ... is a better explanation than a needle exchange," Wood said. "A needle exchange to me almost seems like you’re just trading one problem for another, whereas a prevention program you’re helping overcome a problem."
Wood’s support helped One Voice Recovery to come into Carbon County after they offered to leave out parts of the kit including the small metal caps as well as tourniquets and cotton used to filter debris out of drugs.
"So, from a disease prevention standpoint, is it the best? No. But from a getting down into the community and building relationships, is it the best? It’s the best we can do at this time and I’m comfortable with that," Rezac said.
These days, the two men are allies in the opioid fight.
Wood and Rezac sit at a small table in the food court on the Utah State University campus in Price. Rezac is complimenting Wood on his department’s drug treatment programs.
"You know, what your jail is amazing too," Rezac said.
"Oh yeah," Wood said.
"There are not a lot of jails that will invest the money to offer Suboxone or naltrexone to people because those are expensive. It takes commitment."
"Well, and that’s one advantage we have for being so small. Our jail only hold 88 folks when it’s completely full. We usually average about 60," the sheriff said.
Rezac has made other allies in the area too. Karen Dolan is the executive director of Four Corners Community Behavioral Health. They provide substance use and mental health services in Carbon, Emery and Grand counties. She says when she first heard about syringe exchanges she was skeptical, but after learning more she sees their benefits.
"We have a really high-risk population and if we can reduce hepatitis C and HIV not only for the person who has addiction issues but for the crisis workers and law enforcement and medical workers; if we can reduce disease in our communities it’s better for all of us," Dolan said.
In other parts of southeast Utah syringe exchanges still aren’t universally accepted. Sheriff Greg Funk in neighboring Emery County won’t allow them to operate there. He considers it illegal.
When asked about other counties like Grand or Emery that also have high overdose rates but few resources, Sheriff Wood had the following advice about syringe exchanges.
"I would just tell them to look at it from an open-minded standpoint. I don’t make the laws, I enforce the laws. And like I say, there is a law that allows for this. Don’t close it off just because you think you’re enabling people to use. Look at it from the disease prevention angle and listen to what folks like Patrick have to say and it does make sense," Wood said.
In Rezac’s first four visits to Carbon County, which started in January, he got reports of seven people being saved from overdosing because of the kits One Voice Recovery gave out.