Jefferson County Syringe Exchange Program (SEP) Annual Report 2017

Transcription

1 615 Sheridan Street Port Townsend, WA Jefferson County Syringe Exchange Program (SEP) Annual Report Jefferson County Public Health has provided a Syringe Exchange Program (SEP) since 2000 to reduce the risk of HIV and other blood-borne infections among injection drug users (IDU), their families, and communities. SEP services include access to clean syringes, disposal of used syringes, prevention materials, risk reduction education, naloxone overdose prevention, and referral services. Education includes information on HIV, hepatitis, STDs, overdose prevention, encouraging one time use of needles, health alerts (for example, wound botulism and recent heroin overdoses/deaths), and immunizations. Internal referrals include, HIV, hepatitis C, and STD screening, family planning, tuberculosis screening, and immunizations. External referrals include drug and alcohol treatment, medical care, dental care, mental health care, domestic violence, food, clothing, and shelter. State HIV prevention dollars partially funded the SEP from CDC guidelines shifted in 2011, focusing HIV Prevention Program funding on high risk populations based on local HIV prevalence. Jefferson County is a low prevalence county, so JCPH hasn t received direct State Department of Health (DOH) SEP funding since Currently, DOH has given each SEP a fixed budget and supply list from which we can order supplies. We expect this to continue for Jefferson County s syringe exchange program success is not easily measured in disease prevention numbers, but the number of clients seen and syringes exchanged reflect the disease transmission prevention capacity of this program. SEP utilization increased in, with 308 client visits and 91,290 syringes dispensed. See tables and graphs on the following pages for details. Naloxone is a medication used to reverse opioid overdose, providing time for transportation to the ER for additional treatment if needed. JCPH worked with the Center for Opioid Safety Education (COSE) at the University of Washington in and to develop protocols and training for a naloxone distribution program. JCPH started dispensing naloxone kits supplied by COSE in February,. COSE received a grant from SAMHSA in to be able to continue to supply naloxone to SEPs. We expect this supply to continue through In January, JCPH provided 40 Evzio kits (auto-injector naloxone product), and training for their use, to the Jefferson County Sheriff s Department. These kits were obtained through a Kaleo naloxone donation grant. JCPH distributed 135 naloxone kits in, along with training, to SEP clients, their friends, and family. Forty one of these kits were reported as used for treatment of an overdose. In, JCPH distributed 61 naloxone kits, six were reported as used for treatment of an overdose. Throughout staff continued to encourage uninsured clients to apply for health insurance through Many clients signed up for Apple Health in 2014 and. Community Health Environmental Health Developmental Disabilities Water Quality (f) Always working for a safer and healthier community (f)

2 2018 Goals Continue anonymous, safe, services to reduce the risk of HIV and hepatitis C infection in our communities by providing clean supplies, risk reduction education, referrals for healthcare and treatment services, promoting revisits by clients, and encouraging clients to tell others about SEP. Continue to educate clients on the importance of using each syringe one time only. Offer the naloxone overdose prevention program to clients at risk for opioid overdose and update program procedures as needed. Continue to inform clients at each visit of resources available at JCPH and in the community. Encourage uninsured clients to sign up for health insurance through as long as this option is available. Refer clients internally for HIV and Hepatitis C testing, STD screening, and Family Planning services. If State DOH support for purchasing supplies is discontinued, explore other possible funding options. If SAMHSA funding for naloxone is discontinued, explore other possible funding options. If State support for purchasing supplies is discontinued, prioritize supplies to be stocked, keeping only those deemed most necessary to maintain safer practices among IDU clients. Inform clients of alternative safe materials, such as using plastic bottles for the collection of used syringes in lieu of sharps containers. Continue to advocate for increased access for opioid treatment, including local access to medicationassisted treatment (MAT). The lack of local access to MAT from providers that accept Medicaid is a recurring issue brought up by SEP clients. SEP staff will continue to request updates from the Community Health Improvement Plan (CHIP) Substance Abuse and Mental Health work group, and from the Olympic Community of Health (OCH) Regional Opioid Response Project. Annual SEP Report 2

3 Number of clinic visits Number of Syringes Exchanged Figure 1: Syringe Exchange Utilization, 2004 Number of client visits Number of syringes exchanged ,585 18,060 13,716 17,905 21, ,156 14, ,405 17, , ,809 35, , , ,000 90,000 80,000 70,000 60,000 50,000 40,000 30,000 20,000 10,000 - Table 1: Jefferson County SEP Clinic Visits/Demographics SEP Visits 1 New Clients Returning Client Visits 1 Secondary Exchange Visits 1 Client Visits 1 Client Visits NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA Note: 1 Represents duplicate clients Annual SEP Report 3

4 Table 2: New Client Visits by Age and Gender < 20 yr yr 30+ yr Total < 20 yr yr 30+ yr Total Table 3: Total Client Visits by Age < 20 years years 30+ years 11 (4%) 142 (46%) 155 () 9 (4%) 71 () 159 (66%) 9 (4%) 68 (29%) 158 (67%) (15%) 100 (29%) 191 (56%) (12%) 77 (42%) 84 (46%) 7 Figure 2: SEP Participant Visits by Zip Code 34% 26% Other within Jefferson County Outside Jefferson County Figure 3: SEP Participant Secondary Exchange 46% No secondary exchange 22% 22% Exchanging for one other person Exchanging for 2-5 other people Exchanging for 6+ other people Annual SEP Report 4

5 Percent of Visits with Drug Choice Figure 4: SEP Participant Reported Drug of Choice 56% 47% 34% 23% 19% 19% 18% 19% Meth Only Heroin Only Meth and Heroin 13% 7% 2% 2% 1% Other, including other opoiods Meth Heroin and Other Most participants reporting other for drug of choice report they are using prescription medications, usually opioids. 8 72% 76% Figure 5: SEP Reported Syringe Use, 69% 17% 15% 11% Each syringe used once Each syringe used twice Each syringe used 3+ times 4% 8% 8% 3% Unknown % 67% 64% 64% Each syringe used once Figure 6: SEP Reported Syringe Use, % 12% 25% 21% Each syringe used 2-5 times 3% 2% 1% 1% Each syringe used 6+ times 26% 22% 14% 7% Unknown Annual SEP Report 5

6 Most participants reporting other for drug of choice report they are using prescription medications, usually opioids. Table 5: Naloxone Distribution and Training Provided First Naloxone Kit Naloxone Refill 1 Refills with known OD treatment reported Total Kits distributed March-December Note: 1 Many refill clients reported the first kit was given away to someone who needed it. Syringes Exchanged Table 4: Materials, Education, and Referrals Provided IDU Condoms/ Educational Prevention Latex Materials 3 Materials 1 Barriers 2 Provided Referral Information 4 Outreach Education 5 91,290 39, ,790 17, ,328 15, ,809 18, ,596 15, ,405 11, ,726 16, ,156 11, ,044 7, ,330 7, ,585 9, N/R 6 Notes 1 IDU Prevention Materials include: Tourniquets, cookers, cottons, sterile water, sharps containers, alcohol preps, antibiotic ointment, band aids and sterile pads for wounds, tape. Individual items are given on an as needed basis. 2 This number is for condoms dispensed in SEP only, condoms may also be picked up in the lobby. 3 Educational Materials include information on hepatitis, HIV, STDs, health alerts (ex. wound botulism, overdose), care of abscesses, street drugs, tattoo safety, needle reuse, IDU safety, domestic violence, immunizations, Apple Health application. 4 Referrals: Internal referrals include STD, HIV, and Hepatitis C testing, tuberculosis testing, family planning and immunizations. External referrals include drug treatment, medical care, mental health care, domestic violence, food, clothing, and shelter. 5 Outreach education is defined as face-to-face education on blood borne pathogens, risk reduction methods, safe injecting practices, overdose prevention, vein care, and other as needed. 6 N/R: Not reported 3/22/2018 Lisa McKenzie lmckenzie@co.jefferson.wa.us Annual SEP Report 6