On weekends and after work when he has time, Marc Burrows loads a flat plastic box — the kind you would slide under the bed — full of syringes, condoms, medical waste containers and pamphlets in the trunk of his sedan.

He finds a spot in a troubled Greenville neighborhood and sets up a little table with water bottles scattered on top, to draw people in. And he waits.

It may not be legal but that's not important to Burrows, an addiction counselor who has been trying with all his energy to give drug users clean needles in his spare time.

He's not worried about getting arrested, though technically he could be popped if he were carrying around drug-tainted syringes. Every chance to have what he sees as a positive impact on a drug user's life is a thrill to him.

"I can’t cram it down their throat, I can’t force anyone to believe in it, but I can educate them about the facts," he said.

Maybe it was his own brush with the liver infection hepatitis C. Or seeing patients with addictions in his counseling practice with sores on their arms.

Or the frustration of how cheap new needles are compared with how much it costs to treat HIV or hepatitis C.

With deaths from prescription opioid overdoses on the rise, the state's drug agency is not focused on IV drug use. But heroin deaths are increasing every year and meth is on its way back. Injection drug use and infectious disease come hand in hand. Burrows didn't want to wait for South Carolina to get a law on the books.

About half of the people he talks to think he's crazy, he said.

The syringe exchange strategy has proven useful in other states. It is has been accepted by the research community for decades. Burrows' is the only one listed in South Carolina. Anywhere.

Twenty-nine states have no law on the books allowing for a needle exchange, including South Carolina, according to the Centers for Disease Control and Prevention. But only 11 states don't have an exchange, according to the Kaiser Family Foundation, suggesting Burrows is not alone. Neighboring Georgia has a program in Atlanta, but no law allowing for it, for example.

"It's really a form of civil disobedience, but one that has a load of scientific research behind it," said Paul LaKosky, executive director of the North American Syringe Exchange Network, based in Washington.

There is some personal history for 33-year-old Burrows: He grew up in suburban New Jersey where he and his friends would sometimes share needles to shoot up. When one of his friends got arrested and tested for viral hepatitis in jail, he told Burrows he should get himself checked. He was 18 when he found out he was positive for hepatitis C.

"It was devastating at the time. It destroyed my life," he said. "I thought it was a death sentence."

Burrows has been drug-free for about seven years. He got the drug Harvoni, expensive but miraculous, about three years ago. Burrows said he's been lucky to have good health insurance. 

Passage of disease by intravenous drug use is common. There were 4,293 new cases of hepatitis C diagnosed in the state in 2015; 689 people were diagnosed with HIV. Treating each of the viruses is costly, and both are on the rise in South Carolina.

In 2014, patients who visited the hospital with hepatitis C were charged $45,950 on average in 2014, according to the federal Healthcare Cost and Utilization Project. 

Jimmy Mount, spokesman for the state's Department on Alcohol and Drug Abuse Services, said advocating for needle exchanges is not an agency priority. 

Prescription opioids, such as painkillers like Oxycontin, remain the top concern for most agencies because they account for more deaths than heroin, according to information from the state Department of Health and Environmental Control. 

LaKosky pointed out most prescription opioid abusers go on to use heroin, the cheaper option. And he said anything that can be swallowed or smoked can also be injected.

"I understand that people struggle with this idea," LaKosky said. "When you really take a good look at it, it is the best approach available to a terrible problem."

Michael-Devereux Louis Bertin, executive director of the S.C. Harm Reduction Coalition, said his group has also been advocating for a syringe exchange law. At the moment, it's a bit of a legal gray area. Having a used needle could count as possession of drug paraphernalia.

The harm reduction coalition is working on setting up mobile HIV and hepatitis C testing. They also advocate for making Narcan more widely available, and not only to police and treatment clinic staff.

Burrows said he met with the Greenville County Sheriff's Office, and they agreed to hand out some of his information when they respond to opioid-related calls. Sgt. Ryan Flood, spokesman for the office, couldn't confirm there was an agreement with Burrows but he said it was possible.

Burrows began dispensing syringes years ago with the clients at his addictions counseling practice. He was noticing sores on their arms or they would admit they were using. So he would give them packs of clean needles.

Today, almost every weekend, Burrows loads the trunk of his white sedan and finds a place to camp out. He's been met with skepticism and distrust at times. Some think he's promoting drug use. 

It's all a work in progress.

On the side of the car and emblazoned on his T-shirt: a decal showing a man struggling up a steep cliff and someone reaching a hand down to help.

Reach Mary Katherine Wildeman at 843-937-5594. Follow her on Twitter @mkwildeman.