Could Hawaii's stricter safeguards on prescription drugs cause a spike in heroin use?
It has happened elsewhere and now some say that's what they are seeing on our streets.
Before many addicts shoot up, they visit one of the state's free needle exchange vans. The vans are part of an effort to stop the spread of AIDS, hepatitis and other diseases by discouraging needle sharing by drug users.
The program has worked so well, its numbers are at an all time high.
"In the past year we've had over 800,000 syringes exchanged for the several thousand people that we service," said Heather Lusk with the Community Health Outreach Work project.
CHOW workers are encouraged more drug users are exchanging their needles, but they have also seen a discouraging trend on the street.
"It is disconcerting that the numbers are getting higher. We're also seeing more young people using needles, which wasn't common before," said Lusk.
According to some drug users and those who work with addicts, prescription drugs are behind the increase.
"What we're seeing is a movement from an addiction to pills like oxycontin to moving to heroin or injection of those prescription pills," said Lusk.
In recent years Hawaii has stepped up monitoring of medicines. Patients with multiple prescriptions for the same controlled substance or who see multiple doctors to get the same drug, raise the red flag of the State Narcotic's Division.
Now a program that started this month allows doctors to check patients' medical records even before writing those prescriptions. But some feel tighter control of the controlled substances could lead to even more illegal drug use.
"Because of the increase in prescription pill use, people are turning to heroin to get their withdrawal symptoms to stop. So therefore you are seeing an increase in young people using heroin," said Robin Olsen, a resident who lives on the streets of Chinatown.
A spokesperson for the Honolulu Police Department said heroin arrests and seizures have appeared to remain steady so far.
In other parts of the country where prescription narcotics became harder to get, there were increases in residents turning to illegal drugs.
The head of Hawaii's high intensity drug areas said our islands usually lag a little behind the mainland when it comes to narcotic trends. He added, the sign of more users shooting up -- could be an early indicator of what's to come for the state.