Welcome to the 2019

1. Welcome to the 2019 #KYHarmReduction

2. Principles of Harm Reduction • Health and Dignity • Participant-Centered Services • Participant Involvement • Participant Autonomy • Sociocultural Factors • Pragmatism/Realism

3. HEROIN • First synthesized from Morphine in 1874 • Made illegal in US in 1924 • Signs of a heroin overdose include slow and shallow breathing, convolutions, coma, skin is pale. • One safety measure is to discourage from someone using heroin alone. • Naloxone can reverse the effects of a heroin overdose • Opioid Substitution Treatment (OST) include Methadone and Buprenorphine. • Syringe Exchange Programs can help decrease the spread of infectious disease from intravenous drug use.

4. Principles of Harm Reduction:Health and Dignity • Establishes quality of individual and community life and well-being–not necessarily cessation of all drug use–as the criteria for successful interventions and policies.

5. METHAMPHETAMINE • Stimulate drug also referred to as crystal meth • Developed in Japan in 1919 • Decreases appetite for food , increases appetite for sex • Can be smoked, injected, snorted, or ingested • Chemical cousin is amphetamine. • Condoms should be part of harm reduction strategy

6. Principles of Harm Reduction:Participant-Centered Services • Calls for the non-judgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm. Services need to be accessible and low-threshold for people who use drugs. Abstinence is not a requirement for services.

7. FENTANYL • Synthetic opioid • Discovered in 1960’s for use in surgery • Incidental skin exposure to fentanyl powered is extremely unlikely to immediately harm you • Heroin is sometimes laced with fentanyl. • Fentanyl test strips should be part of a harm reduction strategy

8. Principles of Harm Reduction:Participant Involvement • Ensures that drug users and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them.  “Nothing about us without us is ever for us.”

9. MDMA • Also called Molly or Ecstasy • First made in 1912 • Often cut with other drugs • Overdosing on MDMA can happen but is rare • Often found at music clubs, and festivals

10. Principles of Harm Reduction:Participant Autonomy • Focus on solutions that maintain autonomy for service recipients and not paternalistic solutions that dissolve personal choice. Affirms drugs users themselves as the primary agents of reducing the harms of their drug use, and seeks to empower users to share information and support each other in strategies which meet their actual conditions of use.

11. COCAINE • Crack is a smokable form of cocaine made into small “rocks” by processing cocaine with sodium bicarbonate (baking soda) and water • Comes from the leaves of the coca plant • Highly addictive

12. Principles of Harm Reduction:Sociocultural factors • Recognizes that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination and other social inequalities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm.

13. Principles of Harm Reduction:Pragmatism/Realism • Accepts, for better and or worse, that licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them.

14. Principles of Harm Reduction • Health and Dignity • Participant-Centered Services • Participant Involvement • Participant Autonomy • Sociocultural Factors • Pragmatism/Realism

15. 54 Kentucky Counties with Increased Vulnerability to Rapid Dissemination of HIV/HCV Infections Among People who Inject Drugs and Preventive Syringe Exchange Programs (SEPs) National Ranking by County* 1 Wolfe 3 Breathitt 4 Perry 5 Clay 6 Bell 8 Leslie 9 Knox 10 Floyd 11 Clinton 12 Owsley 14 Whitley 15 Powell 17 Knott 21 Pike 23 Magoffin 25 Estill 30 Lee 31 Menifee 34 Martin 35 Boyle 39 Lawrence 40 Rockcastle 45 Harlan 48 McCreary 50 Letcher 53 Johnson 54 Russell 56 Elliott 65 Laurel 67 Carroll 75 Taylor 77 Grant 93 Adair 97 Lincoln 99 Wayne 101 Cumberland 108 Gallatin 125 Bath 126 Grayson 129 Greenup 132 Green 153 Casey 154 Carter 163 Monroe 167 Garrard 175 Robertson 178 Lewis 179 Edmonson 180 Allen 187 Boyd 191 Hickman 202 Breckinridge 212 Campbell 214 Mercer 220 U.S. Counties at Risk Campbell Kenton Boone Gallatin Bracken Pendleton Carroll Grant Trimble Mason Lewis Greenup Robertson Owen Harrison Henry Boyd Fleming Oldham Nicholas Carter Spencer Scott Franklin Shelby Bourbon Rowan Jefferson Bath Elliott Lawrence Fayette Woodford Montgomery Bullitt Anderson Menifee Morgan Clark Meade Jessamine Johnson Powell Hancock Martin Nelson Mercer Washington Henderson Breckinridge Madison Wolfe Magoffin Daviess Estill Hardin Garrard Union Boyle Lee Floyd McLean Breathitt Marion Webster Pike Larue Ohio Grayson Lincoln Owsley Jackson Crittenden Taylor Knott Rockcastle Hopkins Casey Perry Hart Green Livingston Hickman Butler Muhlenberg Edmonson Clay Caldwell * Vulnerable Counties in RED have Operating SEPs Letcher Leslie McCracken Laurel Adair Pulaski Ballard Metcalfe Lyon Russell Warren Christian Marshall Barren Knox Specific concerns regarding Kentucky Counties: Dense drug user networks similar to Scott County Indiana Lack of syringe exchange programs Vulnerable Counties Carlisle Logan Harlan Todd Trigg Wayne Graves Cumberland Allen Whitley Hickman Simpson Clinton Monroe Bell McCreary Calloway Operating Syringe Exchanges as of 03/25/2019 Fulton Approved but Not Yet Operational NOTE: CDC stresses that this is a REGION-WIDE problem, not just a county-specific problem.

16. Thank you to our sponsors Cabinet of Health and Family Services Kentucky Department for Public Health KADAP Income Reinvestment Program Kentucky Public Health Association Kentucky AIDS Education Training Center Kentucky Pharmacists Association

17. Wi-Fi access : NKYCCPUBLIC • No password needed