Mindy Vincent started Utah’s first syringe exchange program in 2016.
That was right after the state legalized it.
“People were appalled,” said Vincent, founder of the non-profit Utah Harm Reduction Coalition. “People were like, ‘oh my gosh, you’re gonna do what? You’re gonna enable drug use. What kind of craziness is this?’”
But sentiments have changed a bit. She said she’s received interest from rural parts of the state wanting to set up exchange programs after people’s worst fears didn’t come true.
“People thought the community was going to fall to pieces, that it was just going to be this haven of people shooting up everywhere and discarding their syringes. And that’s just not what happened,” said Vincent.
Utah’s fatal opioid overdose rate has remained largely unchanged for the past few years. The most recent data is from 2018 and shows more than 430 opioid overdose deaths.
Six years ago, Utah passed a Good Samaritan law that grants immunity for drug possession if someone calls for emergency assistance in the case of an overdose. Another state law makes it easier for people to get a prescription for naloxone, an opioid reversal drug. These laws, along with syringe exchange programs are forms of harm reduction.
“It’s about reducing the harm of drug use for people who are unable or unwilling to stop using,” said Sandra Sulzer, a professor of health and wellness at Utah State University and director of the office of health equity and community engagement. “Anything that’s gonna take someone one step closer to wellness.”
The harm reduction movement started to gain momentum in the United States during the aids crisis in the late 1980s and early 90s.
Researchers learned that the majority of HIV transmission was due to intravenous drug use rather than through sexual activities.
Public health researchers at the time worried about the virus’s spread. Don Des Jarlais, a leader in HIV and Aids research, said the thinking was: “We’ve got to do something about this. We will not be able to get everybody to stop using drugs.”
Harm reduction programs like syringe exchanges were helpful in HIV prevention. But, the country was in the middle of a crack cocaine epidemic.
“That generated a lot of public anxiety and opposition to anything that had to do with trying to ameliorate illicit drug problems,” said Des Jarlais, professor at New York University’s School of Global Health.
But, by the late 1990s and early 2000s the scientific evidence was building up to the point where you could not deny it, said Des Jarlais.
Despite 20 years of evidence that harm reduction approaches work acceptance has been slow in Utah. Sixty-five percent of Utahns are members of The Church of Jesus Christ of Latter Day Saints, which forbids alcohol and drugs and there is a stigma against drug use.
Addiction needs to be reframed not as a moral failing, but as a biological dependency, said Sulzer of Utah State.
“If you shoplift because you’re a thief, that’s perceived really negatively,” said Sulzer. “But if you shoplift let’s say because you have dementia and you literally just picked something up and walked out of the store and didn’t realize. We treat that instance very differently.”
Sulzer said that abstinence-based drug programs have a long history in Utah and the rest of the country, which can make it challenging to convince people to try a harm reduction approach.
“Even if someone has a belief that abstinence is truly the only way to be in recovery the reality is that someone cannot get to that point unless they are alive and unless they are engaging in some capacity with some form of treatment.” said Sulzer.
Before Mindy Vincent started the Utah Harm Reduction Coalition, she herself was an abstinence-based therapist.
Then she lost her sister from an opioid overdose six years ago and then her little brother became addicted to opioids too.
“I was willing to do whatever it took to save his life,” said Vincent.
Medication assisted treatment worked for her brother. It’s a program that has been successful because the treatments lessen the effects of opioid withdrawal.
However, it’s been underutilized, said Sulzer.
“There’s also a misunderstanding that the medications are quote un quote ‘getting people high’, which, when properly prescribed, is not what is happening,” said Sulzer.
Whether treatment is through medication, abstinence or syringe exchange, research seems to suggest that getting people to open up about their own stories is an effective way to help combat the opioid epidemic.
Sulzer recalls a community meeting hosted by her organization’s Youth Coalition in Emery County.
“They asked the question – who in this room has been personally affected by an overdose. And looking around the room, literally every single hand in the room had gone up,” said Sulzer. “These friends and neighbors before that meeting were not talking to each other about it, right? It was sort of, everyone’s quiet personal shame.”
Addressing Utah’s opioid-related deaths will continue to be a challenge. A few of the harm reduction strategies like expanding syringe exchange have been put on hold, as the state confronts another public health crisis — the coronavirus pandemic.