Harm Reduction in Virginia

1. Harm Reduction in Virginia Health Brigade 2019

2. What is Harm Reduction, and what role does it play in the opioid crisis? • An evidence-based public health approach that meets people where they are, reducing the negative health and safety consequences of the opioid crisis. • What can Harm Reduction look like? • Referrals to resources • Syringe access/exchange • Safer use education • HIV/Hep C/STD Testing • Overdose Prevention (Naloxone ) Health Brigade 2019

3. Harm Reduction Principles • Applies evidence-based interventions to reduce negative consequences of these behaviors. Ex: syringe access, naloxone, condoms, PrEP • Incorporates a spectrum of strategies including safer techniques, managed use, and abstinence. • Works to elicit any positive change based on the individual’s needs, circumstances, readiness to change, and believing their abilities to change. • Uses a person-centered approach: understands that substance use is one part of a person’s life but does not define them. Health Brigade 2019

4. “I am what time, circumstance, history, have made of me, certainly, but I am also so much more than that. So are we all.” ― James Baldwin Health Brigade 2019

5. Harm Reduction Works • Program participants are 5 times more likely to enter treatment for substance use disorder (Hagan et al., 2000) • Reduces the risk of needle-stick injuries to first responders (Lorentz et al., 2009) • Reduces overdose deaths (Tobin et al., 2009) • Reduces new cases of HIV and Hep C (Wodak & Cooney, 2006; Institute of Medicine, 2010) • There is no evidence that harm reduction programs increase drug use or crime (Marx et al., 2000; Kidorf et al., 2012) Health Brigade 2019

6. Harm Reduction Isn’t New! Netherlands: 1984 Tacoma, Washington: 1988 New York City: early 1990s 40 States + DC and Puerto Rico have syringe service programs Health Brigade 2019

7. Opioids Highjack the Brain • Research found that those who regularly use opioids see the future differently than someone who doesn’t use opioids. The average non-user can think ahead roughly 4.7 years, whereas the regular opioid users idea of the future is only 9 days. Psychiatrist Dr. Joseph Niezer reports, “There are identifiable changes in the brain of someone dealing with addiction, the same way there are changes with someone who had Parkinson’s disease or Alzheimer’s disease.” • Opioids such as heroin, fentanyl and oxycodone have a powerful effect on brain circuits so that a person can quickly become dependent. As a result, it is clear that addiction to these drugs is driven by biology, not a moral or personal failing. Health Brigade CHR 2018

8. Continuum of Use • v Chaotic Severely Persistent No Use Social Ritual Binge Experiment Situational Regular Use Habitual Daily Credit: Harm Reduction Coalition

9. Zinberg NE, Drug, Set, And Setting: The Basis for Controlled Intoxicant Use (1984)

10. Example of Drug, Set, and Setting • Heroin use by distraught American troops in Vietnam, was excessive and uncontrolled, and was an effort to "blot out" the trauma they were experiencing there. • Once they returned home and were out of the horrific and uncontrolled social setting of Vietnam, 88% did not recommence heroin use, although many had significant problems. Health Brigade CHR 2018

11. Opioid Use in Virginia • Opioid use in Virginia is a public health emergency. • 2017: 1,227 fatal opioid overdoses • Opioids kill more people annually in Virginia than either car crashes or gunfire. • Substance use is shifting from prescription opioid to heroin and synthetic fentanyl. Health Brigade 2019

12. The Opioid Crisis in Virginia Rater per 100,000 people Source: Virginia Department of Health, Office of the Medical Examiner Forensic Epidemiology Fatal Drug Overdose Quarterly Report, 2018

13. Virginia Statistics 2015: 1,382 reported new case of Hepatitis C cases (18-30 year olds) 2017: 2,141 new reported cases of Hepatitis C among (18 -30 year olds). This is a 54% increase in two years.

14. Comprehensive Harm Reduction in Virginia November 2016: Opioid use disorders declared a Public Health Emergency July 2017: HB 2317 allows state-approved harm reduction programs to provide syringes and other safe use materials (expires July 2020) June 2018: Wise County opens first CHR program in VA October 2018: Health Brigade opens CHR program November 2018: Smyth County receives approval from VDH to open CHR program 5 other localities are looking to open syringe exchange programs in Virginia- according to Virginia Department of Health Health Brigade 2019

15. Health Brigade’s Harm Reduction Program • Offers safer using education, syringes, cookers, filters, alcohol swabs, sterile water, tourniquets, clean straws, fentanyl test strips, safer smoking materials, SHARPS containers, and wound care kits • HIV, STI/STD, and Hep C testing • Referrals/navigation to insurance, substance use treatment, medical care, MH care, PREP, and other requested services • Naloxone(Narcan) training and dispensing • Substance Abuse Counselor and a Peer Recovery Coach on-site • All services are free and confidential Health Brigade 2019

16. Richmond Area Participant Map Health Brigade 2019 map credit A. Scialli

17. Health Brigade’s Harm Reduction Program, cont. Committed to community engagement Seeks input from: individuals with lived experience, neighbors, health departments, opioid task forces, CSB’s, treatment centers, hospitals, law enforcement, local government, and participant feedback Health Brigade 2019

18. Health Brigade’s Harm Reduction Program, cont. Community outreach –Targets communities with the most reported overdoses; providing naloxone, bleach kits, education on safer use, HIV home test kits, and condoms. Health Brigade 2019

19. Health Brigade’s Harm Reduction Program, cont. Education in 11 regional prisons and jails - Provides education on the opioid crisis, safer use techniques, overdose prevention, and program details Health Brigade 2019

20. Goal: Any positive change We work with our participants to think about what parts of their use could be adjusted based on what they want to change and provide them the tools/materials to make this change. Health Brigade 2019

21. Safety Basics for those that use substances intravenously • Do a test shot. When using a new supply or dealer, 'test' the strength. Inject slowly.  • Avoid using alone. This can put you at a higher risk of overdosing because no one is there to help you. Keep Naloxone (Narcan)on-hand, even if using alone. • Keep your tolerance in mind. If you have not used in a while, your body can't handle the same amount it did before. Use a smaller amount. • Avoid mixing substances. Mixing uppers (cocaine, meth, alcohol) and downers (heroin , benzo’s) can put you at an increased risk for overdose. Health Brigade 2019 21

22. Stigma in the Opioid Crisis “We must all confront the intangible and often devastating effects of stigma. The key to recovery is support and compassion. Patients in pain and patients with a substance use disorder need comprehensive treatment, not judgment.” Patrice A. Harris, MD, MA, chair American Medical Associations Opioid Task Force Health Brigade 2019

23. More information on CHR in Virginia • Virginia Department of Health (800) 533-4148 or at www.vdh.virginia.gov • The Health Brigade (804) 358-6140 • Lenowisco Health District (276) 328-1926 • Smyth County Health District (276) 781-7460 Health Brigade 2019

24. Questions? Emily Westerholm, CSAC Program Coordinator ewesterholm@healthbrigade.org Anna Scialli, MSW, MPH Program Associate ascialli@healthbrigade.org Richmond Program Open: Monday 5-8pm & Fridays 1-4pm Mobile Coming Soon! Health Brigade 2019