Editor’s note • Through a grant from the Local Media Association, The Salt Lake Tribune is reporting on homelessness in Utah communities outside of the Salt Lake Valley.
St. George • Skyler Marshall, a tie-dye-wearing outreach worker at the nonprofit Youth Futures, sees the back of his van as his “bat cave,” crammed with intake forms, socks and hygiene kits so he can help homeless teens and adults at a moment’s notice.
Back at the office, he keeps an old Tide Pod container filled with condoms, ready to offer to young people who need them. And when he’s doing street outreach, he picks up discarded candy wrappers and soda bottles from sites where unsheltered individuals might be camping, partly to keep their sleeping spots hidden from people who’d try to force them out.
To Marshall, though, these efforts don’t go far enough to protect homeless adults and teens, especially those who are dealing with addiction. There’s a personal stake in this for the St. George native, who said he’s lost several of his friends to hepatitis and AIDS — and believes their deaths might have been prevented if they’d had access to substance abuse counseling and clean syringes.
His hope is to see a needle exchange program come to St. George. But he’s not sure if the conservative southern Utah community will embrace it.
“It’s something that’s desperately needed,” he said, adding that the challenge is in “the image.”
Since the Utah Legislature legalized syringe exchanges in 2016, groups have been working to provide new needles and collect used ones in counties including Salt Lake, Tooele and Weber. At exchanges around Utah, providers also perform hepatitis and HIV tests, and pass out doses of naloxone, medication that can reverse opioid overdoses.
But the consensus among Washington County area police chiefs and sheriffs is that a needle exchange program would “not necessarily be a good thing,” said County Commissioner Victor Iverson, who attended a meeting local law enforcement held on the issue more than a year and a half ago.
“I don’t think you would see Washington County support that at this time,” he said in a recent interview. “We are progressive in a lot of ways or forward thinking in a lot of ways — but we’re not willing to go there yet.”
The difficulty in building buy-in for a needle exchange program points to a wider community distaste for strategies that involve harm reduction, a public health approach that accepts some people will engage in risky behaviors. Instead of condemning such conduct, the strategy aims to reduce its negative impacts — by offering condoms, for instance, rather than solely abstinence messages.
Providers at Youth Futures said they have felt similar disapproval as they provide shelter and other services to runaway and homeless youths in St. George. “Harm reduction in general is seen as enabling,” Marshall said. “Enabling drug use. Even enabling homelessness as a lifestyle.”
Researchers have found needle exchange programs to be “effective, safe and cost effective,” according to a 2014 review of harm reduction studies published in the Journal for Clinical Psychology. And harm reduction practices as a whole, the study found, have succeeded at engaging people experiencing homelessness and others “that conventional treatment programs rarely reach.”
Though syringe exchanges have been a flashpoint in many conservatives states, the evidence in favor of these programs was strong enough to persuade Utah lawmakers to legalize them and many communities in the state to embrace them. The Utah Harm Reduction Coalition, one of the groups that runs needle exchanges in the state, has been working with partners to get a program off the ground in Washington County, too.
But Mindy Vincent, executive director of the coalition, said she’s resigned to the fact that not everyone in the community will back the idea.
“You can’t just not serve a huge, vulnerable group of people that are desperately in need,” she said, “because some people in the community refuse to accept science.”
‘Meeting their basic human needs’
Opponents of the harm reduction philosophy in Washington County have previously critiqued a St. George youth homeless service provider for offering teens shelter and assistance even if they’re struggling with drug or alcohol use.
Youth Futures, a 16-bed shelter for 12- to 18-year-olds in St. George, doesn’t allow substance use within its walls but does take in young people who might be facing addiction. (Youth Futures’ executive director declined to be interviewed for this story.)
But the shelter’s approach has prompted criticism from some in St. George’s conservative community, which holds strong values of personal responsibility and accountability, according to Krista Whipple, a local advocate for homeless youth.
Sometimes, this group believes that kids who abuse substances “deserve their consequences,” said Whipple, who formerly worked at Youth Futures.
This “small but vocal group of detractors,” which she said mostly airs its opinions online, would prefer a zero-tolerance approach to drugs, believing that anything but an abstinence-only policy sanctions and encourages people to use, she said.
But Whipple argues that “kids are safer inside than they are on the street, even if they’re struggling with some kind of behavior issue or addiction or something like that.”
Once they have shelter and their other basic needs are met, providers can start to “address those behavioral issues or their mental health problems,” she said.
The abstinence-only approach has backfired for some families, Whipple said. One teen ended up in the St. George youth shelter after his mother, who’d taken away his Xbox and tried everything she could think of to stop him from drinking, “finally put her foot down” and told her son he couldn’t come home drunk anymore.
That weekend, neighbors found the teen at 4 a.m. on their front porch on a cold winter night.
“The kid knew he couldn’t come home drunk,” Whipple said. “So he tried to sleep on their porch swing, and he’d fallen off and had thrown up and was in his own vomit. And he had hypothermia and alcohol poisoning. They rushed him to the emergency room. He almost died.”
It wasn’t inappropriate for the parents to set a boundary, Whipple said, and she understands how they got to that point.
“But that kid needs a place,” she said, “where he can come home drunk and sober up with safe adults who can get him some water or call the paramedics if he’s got alcohol poisoning or keep him from harming himself or whatever it is.”
Providers shouldn’t encourage alcohol or drug use and can talk to kids about changing their behavior, but should also “forgive them” and not “judge them,” she said.
‘A community and collaborative discussion’
The Salt Lake Valley has wrestled in recent years with many of the same questions about harm reduction in its homeless services that St. George is now grappling with: What should shelter rules be? Should service providers call police every time they find drugs on a client? When is banning someone from a shelter appropriate?
Michelle Flynn, executive director of The Road Home nonprofit, which runs three resource centers in Salt Lake County, said providers, officials and other community members must come together to find answers.
“That’s not a decision, I don’t think, that an individual agency can make by itself,” she said. “It is definitely a community and collaborative discussion.”
It’s understandable that people want to live in safe communities, she said, and are sometimes wary of shelters or services that they fear might bring additional drug use into their neighborhoods.
At the same time, if a shelter turns away people for having substance use disorders, their only option is to sleep outside or in an abandoned building — putting them at greater risk of harm and compromising public safety in another sense, she said.
Utah Rep. Walt Brooks said he commends the impulse to do something about drug use, but St. George Republican argues that needle exchanges create more problems than they solve.
“I’ve looked at some of these larger cities that do it. In my opinion, it doesn’t look like it’s effective,” he said. “It looks like we have more needles just carelessly tossed about. So we have more very hazardous litter around that’s going to affect other people.”
State health department data, however, suggests that exchange programs in Utah have been fairly effective in cleaning up used needles, with 0.82 dirty syringes taken off the streets for every clean one distributed during the first three months of this year.
Vincent, the leader of the Utah Harm Reduction Coalition, said she’s spoken with leaders in Washington County who seemed receptive to the idea of needle exchange programs but also felt that the community isn’t ready for one.
In places like Salt Lake City or Tooele, harm reduction advocates have been able to make the case that syringe exchange programs reduce the number of discarded dirty needles, she said. But drug use isn’t as visible in the “beautiful, clean little community” of St. George, she said, so residents have a harder time seeing the value in harm reduction programs.
“Literally, people will just say, ‘Oh well, we don’t have that problem down here, and we don’t want that,’” she said.
Until the St. George community opens up to needle exchanges, Marshall, the outreach worker from Youth Futures, says he’ll continue feeling like his “hands are kind of tied” in helping some of the people he meets on the streets.
The best he can do now, he said, is distribute harm reduction kits with latex gloves and a few Band-Aids.