This desert city of 5,000 seems to have it all - a small-town feel, breathtaking recreation sites, a thriving economy and an expanding cultural scene.

It also has a drug problem and an alarmingly high rate of hepatitis B. And many health officials believe needles used to shoot methamphetamine into addicts' veins are spreading the virus.Since April 23, nine cases of the potentially deadly, blood-borne illness have been confirmed by local health officials. Results of tests on a 10th reported case aren't back yet.

By contrast, there were only two or three cases in all of the rest of Utah in the past four months, and until this year there had not been a case in Moab since 1995.

Indeed, figures show the infection rate for the southeastern district that includes Moab is more than eight times that of the rest of the state - .16 cases per 100,000 compared to .02 for the rest of Utah.

"The outbreak is linked to drugs," said Aalie Mondt, substance abuse coordinator of the Intensive Outpatient Program at Four Corners Mental Health. "Methamphetamine has become the drug of choice for adolescents. The majority of our clients who use speed are shooting it up or smoking it. Adolescents are risk-takers, and addicts are risk-takers."

David Cunningham, health director of the Southeastern Utah District Health Department in Price, hesitates to link the outbreak directly to meth. He did, however, say Moab's first reported case was definitely tied to IV drug use.

Gerrie Dowdle of the Utah Department of Health said sharing of needles contributed substantially to the hepatitis spread in Moab.

"We agree it's a problem, but we're not right now investigating which drug is being shared," she said.

Other health professionals decline to discuss the outbreak, some unwilling to break personal confidences that might prove embarrassing in a small town like Moab. Others said that without complicated DNA testing, any connection between cases is speculative.

"Unfortunately, you can't prove . . . the drug link," said Dr. Steven Rouzer of the Moab Medical Center, where six of the nine cases were treated. "Most of these people have multiple risk factors. . . . It may be the critical factor here, but there's no way to prove it."

Dr. Glenn Etzel treated three hepatitis B patients at the Moab Medical Center. Since moving to Moab three months ago, he has already seen 10 patients who shoot meth. "It really surprised me when I first moved down here how much meth was being used," he said.

How many people in Moab are using methamphetamine?

Detective Sgt. Scott Mallon of the Grand-San Juan County Drug Task Force said 60 percent of 1997 drug arrests were methamphetamine-related.

"The last two years, between arrests and intelligence reports, I'd estimate around 250 meth users in Moab," Mallon said.

He said people generally snort or smoke methamphetamine, "but we're running into a lot more people shooting it."

Mondt has seen similar trends. "Five years ago, very few used needles. Now, roughly a third of our adult drug program people use needles," she said. "One of the things that we hear is that sharing needles is fairly common - especially among the kids."

Mallon said 70 to 80 percent of those in their late teens and early 20s interviewed by the task force use the drug intravenously. And it's that segment being hit hardest by the disease.

"I think it's about 65 to 75 percent teenagers," said Etzel. "The rest are in their early 20s. These kids are doing what they see their older brothers and sisters doing."

The Utah State Division of Substance Abuse Data System, which tracks substance abuse reports, shows Grand County ranks third in the state in teen drug arrests and 1 percent of its high school students have used heroin.

But Alan West, chief of the Moab Police Department, believes more adults than teens are using methamphetamine. "I've even heard of people in their 60s shooting speed," he said.

Everyone has their own idea on how to attack methamphetamine use. Neither West nor Mallon has seen evidence of methamphetamine production in Moab.

"From what I'm aware of, most of our meth comes from Salt Lake," said West.

"Some cities have decreased the spread of disease by making needles available for free," said Cunningham. "But that's kind of a hard one in Utah."

Mondt suggests enrolling as many drug users as possible in rehab programs, but inpatient resources are not available locally. Etzel said it costs $1,000 for a program in Salt Lake City that generally is not covered by insurance.

Bob Greenberg, supervisor of the Moab Office of Four Corners Mental Health, offers another solution.

"We need to do a better job of parenting," he said. "But it's not just teens. Adults have to be the ones providing the drug."

Margaret Thiele is the team leader of the local Department of Child and Family Services. She sees the effect adult users have on children.

"Of the 27 kids we have in foster care here, 15 have parents with meth problems - either using it or dealing it," she said. "It may only be a couple of hundred (parents using), but that's a large number if they have kids. And it affects them. It's destroying families."

And she said she has seen numerous cases where adults use drugs to woo young girls.

"I'm talking about 19- to 30-year-old men preying on junior high school girls," said Thiele. "It's a sex-for-drugs offer. In the last year, we've had about 10 to 12 cases like that."

Thiele predicts meth use will spread further. But she also sees some signs of hope, at least with regard to Moab's willingness to deal with substance abuse problems.

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"There's a lot of people here who've come together to help on this problem," Thiele said.

Last year, she and Greenberg initiated the Substance Abuse Advisory Council, made up of representatives from Four Corners Mental Health, the health department, schools, law enforcement, child welfare and the juvenile courts. It has created an outpatient substance abuse treatment program specifically for teens.

Cunningham believes an education campaign - including an assembly for high school students - has helped curb the spread of the disease.

"Hopefully we won't see any more," he said. "I think we've got a pretty good hold on it right now."

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