ARI SHAPIRO, HOST:
Alaska is one of many states with staggering rates of opioid abuse. Three-quarters of Alaska's overdose deaths last year are attributed to prescription painkillers or heroin. Transmission of blood-borne viruses like hepatitis C is also increasing dramatically, and with it health care costs. Alaska Public Media's Zachariah Hughes reports.
ZACHARIAH HUGHES, BYLINE: Inside a cramped supply closet, a volunteer runs through questions as a 26-year-old woman empties dozens of used needles into a red trash can.
ZANE DAVIS: So how many needles did you have?
UNIDENTIFIED WOMAN: I have, like, 80.
DAVIS: Eighty. Awesome. So just so you know, we can only give you 50...
UNIDENTIFIED WOMAN: I know.
HUGHES: The Alaska AIDS Assistance Association, known as Four A's, runs what is by far the state's largest syringe exchange. It's all anonymous. No one gives his or her name when they come in to trade old supplies for new ones.
DAVIS: Any cottons, tourniquets, cookers?
UNIDENTIFIED WOMAN: Everything but cookers, please.
People are prepping for the weekend.
HUGHES: Zane Davis is a college pre-med student who volunteers here every Friday afternoon, the busiest time of the week.
DAVIS: You know, there are a lot of people who just wait until Friday and then they use over the weekend. So they've really got to come in and stock up.
HUGHES: In just a few hours, dozens of people come through, throwing out hundreds and hundreds of needles. Last year, Four A's gave out just under half a million needles, and this year they'll outpace that. This is the only place to trade in needles for hundreds of miles in every direction. Even in small towns where there might be a pharmacy that's no guarantee they'll sell clean syringes over the counter.
KERBY KRAUS: They'll be like, where's your prescription, you junkie?
HUGHES: Kerby Kraus has been clean for four and a half years and now helps run a recovery program. His path to shooting heroin started like a lot of people's across the country - first with pain pills.
KRAUS: It was just being in high school and popping some pills. And then you're snorting some pills. And then you're smoking some pills. And all of a sudden you're IV-using pills.
HUGHES: The town where Kraus is from, Wasilla, it's about 40 miles north of Anchorage. Back when he was using, Kraus would stop at Four A's for clean needles if he happened to be nearby. But if he was broke or sick from withdrawal, that was an insurmountable distance and he'd shoot with used needles, which is how he got hepatitis C.
KRAUS: I know where I - who I got hep C from. But I worried more about not being sick. It was, I feel like absolute crap and I don't want to feel this way no more.
HUGHES: Kraus is part of the demographic in Alaska seeing the biggest uptick in hep C. The virus is exploding among people ages 18 to 29. That trend is mirrored nationally. A recent study in Alaska found that the hep C rate among young people doubled. Rural parts of the state are being especially hard-hit.
JAY BUTLER: We talk mostly about opioid overdose deaths, but there's a lot more that happens related to opioid use than just deaths.
HUGHES: Jay Butler is the chief medical officer for Alaska's health department, and fears about hep C keep him awake at night. If a person gets clean, treating their hep C is extremely expensive. A few years ago, Butler did a back-of-the-envelope calculation for what it would cost to treat the 3 and a half million infected Americans. It was 10 percent of the country's total health care spending.
BUTLER: The price is the downside and why I usually don't say it's a miracle drug, 'cause miracles don't come with a price. They're gifts.
HUGHES: Advocates say syringe exchanges are extremely cost effective in the long term, especially when it comes to hepatitis C. State officials like Butler are pushing for more access to needles, especially in rural areas. The price for curing the virus with medications is around $90,000. That covers almost a full year of running the Anchorage syringe exchange. For NPR News, I'm Zachariah Hughes in Anchorage.
(SOUNDBITE OF THOM SONNY GREEN'S "VIENNA")
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