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SALT LAKE CITY — The syringe fell into the canister with a rattle, joining dozens that had already been dropped off that afternoon.
Here, behind the Rio Grande, syringes are known as "points,” and used needles are called “dirties.”
Mindy Vincent has made it her job to tackle this dangerous aspect of life on the streets: the passage of communicable infections like hepatitis C and HIV due to the sharing of dirty needles.
After Utah lawmakers legalized needle exchange programs in March, the social worker pounced.
Last month, Vincent opened the first syringe exchange program in the state.
An IV drug user for 17 years, Vincent is now the founder and executive director of the Utah Harm Reduction Coalition.
She formed the coalition two years ago after her sister died of an opioid overdose. At the time, her younger brother was still hooked on heroin.
That's when Vincent switched from what she calls an "abstinence" mindset to a "harm reduction” mentality.
"The day my sister died, I was trying to figure what I could do to save my brother," Vincent said, tearing up. "It was so hard to lose my sister. I couldn't lose two siblings."
On a frigid Monday morning, dozens of people pass by her booth to drop off used needles and pick up clean ones. Their breath condensing in the air, Vincent and other volunteers stuff syringes, foil, cotton balls and “cookers” — similar to bottle caps — into paper bags.
Each has a safety purpose.
Many drug users share bottle caps or spoons to cook their drugs, a practice that spreads infections; the cooker means that they don’t have to share. The cotton acts as a filter to block dirty particles from entering the syringe. And the foil is so users can set their needles on a clean surface instead of on the ground.
A man with a pair of ski goggles is the first in line. He declines to give his name, but he’s open about his story.
A long time ago, he had the life: the houses, the cars, the boat, the wife and two kids. Then he fractured his back wrestling and was put on a regimen of prescription painkillers. After his doctor cut him off, he turned to heroin.
He's now been on the streets for 14 years.
He's never shared needles, but he’s seen people more desperate than him pick used syringes off the ground or pass them among each other.
“For me, it’s so much cleaner,” he said of the needle exchange program. “I get myself tested every two to three months. I don’t want to get hep C.”
Others are not so careful. A young woman wrapped in a blanket, a heroin and crack user, says she’s shared needles but only with her boyfriend, who started using drugs at the same time she did.
People on the streets will sell clean needles for money. But when the cash runs out, desperation sets in, she explained.
"You just know you're going to get sick soon," she said. "You have the drugs right in front of you."
Needle exchange programs have faced controversy because of the perception that they enable people to continue abusing drugs.
But decades of research have shown that such programs significantly reduce the spread of viral infections like HIV, hepatitis B and hepatitis C and are associated with increased participation in treatment programs.
And because purchasing syringes is far cheaper than the cost of treating a patient with a viral infection, studies show that needle exchange programs save taxpayers money.
One of the best-known examples of a successful exchange was in Indiana, where Vice President-elect and current Gov. Mike Pence overrode his own anti-drug policies to authorize a needle exchange program after an HIV outbreak infected nearly 200 people last year.
In response, the Centers for Disease Control and Prevention identified 220 counties across the U.S. that are at the highest risk of being hit by an HIV or hepatitis C outbreak.
Three of them — Carbon, Beaver and Emery counties — are in Utah.
Heather Bush, the viral hepatitis prevention coordinator at the Utah Department of Health, partnered with Vincent to start the needle exchange program.
Bush pushed back against criticism that such programs increase crime and encourage abuse. She described one participant who recently told her that the program made him want to cut back on re-using his needles.
Reusing the same needle on yourself does not carry the same risk as sharing needles with other people, but it can lead to infection or tissue damage due to bacteria on the skin.
“Little baby steps,” Bush said. “They’re starting to think about that — that I can make healthier decisions and that somebody cares about them making healthier decisions.”
“That little seed?” she continued. “I’d like to talk to that same guy in six months or a year.”
Participants in the program have to sign up for a card so coordinators can keep track of them for research purposes. They get between 10 and 30 syringes twice a week — more if they bring back "dirties."
Vincent knows many of the participants personally, greeting them with a hug and smile. Many of them are in a bad way.
One man asks for just three syringes. It turns out he doesn't even want the needles to shoot drugs — he wants them to pull a blood clot out of his leg. Vincent encourages him to go to the hospital.
Many talk about wanting to seek treatment. Vincent steers them that way, too.
"I just love these guys," Vincent said. "Even when they're using, I love them."
Virtually all the volunteers with the program are former drug users themselves.
Damon Harris, who is assisting Vincent, used to live in San Francisco, which has a large and robust needle exchange program. Harris frequented them until he got tired of the cycle of prison and addiction and eventually got clean.
“It was either share or buy them for a couple bucks apiece,” Harris said. The choice can seem clear, but it becomes blurry in the grip of addiction, he explained.
“Sometimes, you gotta meet an addict where they’re at,” he said.
Vincent plans to expand to Utah County and Weber County soon and statewide by the end of the month.
Funding is an issue. Although Utah’s lawmakers legalized needle exchanges, they did not budget any money for them.
The Utah Department of Health purchased 360,000 syringes to get the program started, but the rest has come out of Vincent’s pocket. They go through about 4,000 syringes every week.
"We're enabling people to be safe," Vincent said. "We may want people to get sober. That doesn't mean they will. While we’re wishing away drug addiction, we will also be helping these people to stay safe and ultimately to not die.”
Later that afternoon, the guy with the ski goggles came back to drop off a dirty needle he found on the ground. Then he waves goodbye.
"This might be the last time you see me," he informs the volunteers.
He's going to First Step House next week. After 14 years, he's decided that he's had enough.
"It's time to get back to my life," he said.
With the paper bag clutched in his arms and the crunch of snow underfoot, he stepped back out into the cold.
