The North Carolina Harm Reduction Coalition. Logan Graddy, MD Medical Director NCHRC

Transcription

1 The North Carolina Harm Reduction Coalition Logan Graddy, MD Medical Director NCHRC

2 I. Background II. Harm Reduction Table of Contents III. North Carolina Harm Reduction Coalition (NCHRC) in Action

3 Background: US Opioid Prescriptions SOURCES: National Vital Statistics System, ; Automation of Reports and Consolidated Orders System (ARCOS) of the Drug Enforcement Administration (DEA), ; Treatment Episode Data Set,

4 Background: Overdoses (U.S.) Drug overdose deaths involving opioids, by type of opioid United States, Source: National Vital Statistics System, Mortality file.

5 Background: Prescription Opioid Overdoses (NC) Deaths Source: N.C. State Center for Health Statistics, Vital Statistics-Deaths,

6 Deaths Background: Heroin overdoses (North Carolina) Source: North Carolina State Center for Health Statistics

7 I. Background II. Harm Reduction III. NCHRC in Action Table of Contents

8 Harm Reduction: What is Harm Reduction? Harm reduction programs focus on limiting the risks and harms associated with drug use. Provide essential health information (education) and services while respecting individual dignity and autonomy. Adapted from Human Rights Watch s article: We Know What to Do, Harm Reduction and Human Rights in North Carolina, with permission by Human Rights Watch

9 Harm Reduction: What is Harm Reduction? Promoting evidencebased methods of mitigating health risks. Overdose prevention and syringe exchange Adapted from Human Rights Watch s article: We Know What to Do, Harm Reduction and Human Rights in North Carolina, with permission by Human Rights Watch

10 Harm Reduction: Benefits Provide a gateway to drug treatment programs for drug users. Help protect law enforcement officers from needle stick injuries. Reduce the number and consequences of contaminated syringes circulating in a community. Adapted from Human Rights Watch s article: We Know What to Do, Harm Reduction and Human Rights in North Carolina, with permission by Human Rights Watch

11 Harm Reduction: Ways to Reduce Risk Primary Prevention Increasing access to treatment Harm Reduction strategies of Overdose

12 Harm Reduction: Harm Reduction Strategies to Reduce Overdoses Individual Naloxone OD Education Friends & Family Naloxone access Overdose education Good Samaritan & Liability laws Community Naloxone for first responders OD education Naloxone distribution Harm Reduction orgs State Government PMP optimization Good Samaritan laws Third party prescribing laws Criminal and Civil Liability Prescribers PMP utilization Evidence-Based Prescribing Naloxone prescribing Overdose risk assessment Federal Government FDA: Naloxone supply; pricing CDC: Epidemiology, Research NIH: Fund harm reduction research SAMHSA: public education initiatives Adapted from a figure from Hawk et al. (2015)

13 Harm Reduction: Naloxone Naloxone=overdose antidote LAW Good Samaritan Immunity from civil and criminal liability for prescribing and administering Standing order

14 I. Background II. Harm Reduction III. NCHRC in Action Table of Contents

15 NCHRC: Background North Carolina s only comprehensive harm reduction program. NCHRC engages in grassroots advocacy, resource development, coalition building and direct services. In service to law enforcement and those made vulnerable by drug use, sex work, immigration status, gender, STIs, HIV and hepatitis.

16 NCHRC: Harm Reduction Legislation in North Carolina Prior to 2013 harm reduction had little traction in the South. NCHRC tried several times unsuccessfully to get a full harm reduction legislative package passed. HB601 (2011) Syringe decriminalization Democrat sponsored bill Framed as a disease reduction method that would save taxpayer dollars Killed in committee

17 NCHRC: The New Direction action steps: Identify key allies and develop a new strategy NCHRC fostered a partnership with receptive law enforcement officers. Incorporated education about harm reduction into law enforcement trainings. Gathered information and identified key needs and concerns of law enforcement.

18 NCHRC: The Turning point In 2013 NCHRC gained a powerful law enforcement ally. The sponsor encouraged building consensus and compromise. A lobbying strategy was formulated focusing on saving lives and protecting law enforcement. This successful formula led to sponsorship of additional bills. This strategy and our bills has been used as a model subsequently to pass laws throughout the South.

19 NCHRC: Senate Bill 20 (2013) First Overdose prevention/good Samaritan/Naloxone bill in the South (signed into law April 2013). "Good Samaritan" bill because it protects person who has overdosed and the caller who is witnessing an overdose. There are protections from civil and criminal liability for prescribing naloxone, and to a bystander to an overdose who administers it. Also allows for naloxone to be distributed under a standing order.

20 NCHRC: SB20 (Standing order) Authorizes NCHRC to maintain supplies of kits. Authorizes employees, contractors, and trained volunteers to possess and distribute naloxone kits. Contains an order to dispense a kit after completion of a training. All kits are logged. The North Carolina Medical Board has a position statement supporting this program.

21 NCHRC: Outcomes of SB20 NCHRC has distributed nearly 21,500 kits. We have over 1800 documented reversals. We have been able to partner with law enforcement to train and equip them with Naloxone.

22 Number of opioid overdose reversals with Naloxone reported to NCHRC ,510 Source: North Carolina Harm Reduction Coalition, Jan Analysis: Injury Epidemiology and Surveillance Unit NCHRC: Number of Opioid Overdose Reversals with Naloxone Reported 8/1/2013-1/1/

23 Number of opioid overdose reversals with Naloxone reported to NCHRC NCHRC: Number of Opioid Overdose Reversals with Naloxone Reported 1/1/2015-1/1/ reversals by Dare PD reversal by Carrboro PD 1 reversal by Carrboro PD 1 reversal by Cramerton PD 4 reversals by Greenville PD 1 reversal by Pitt Co Sheriff 1 reversal by Guilford Co Sheriff 1 reversal by Fayetteville PD 1 reversal by Henderson Co Sheriff 5 reversals by Fayetteville PD 2 reversals by Fayetteville PD 2 reversals by Pitt Co Sheriff 1 reversal by Fayetteville PD 1 reversal by Winston Salem PD 1 reversal by Fayetteville PD 3 reversals by Winston Salem PD 1 reversal by Winston- Salem PD 50 0

24 NCHRC: Number of Opioid Overdose Reversals with Naloxone (by county) Winston-Salem (72) Elkin (1) Greensboro (309) High Point (194) Rocky Mount (4) Thomasville (26) Asheboro (20) Asheville (415) Maiden (1) Charlotte (62) Fayetteville (31) Burgaw (15) Rocky Point (22) Wilmington (212) 5 reversals in an unknown location in North Carolina and 26 reversals using NCHRC kits from other states reported to NCHRC.

25 NCHRC: Counties with Law Enforcement Carrying Naloxone Graham County Sheriff Winston-Salem PD Guilford Co. Sheriff App State University Police Watauga Co. Sheriff Waynesville Police Dept Haywood Co. Sheriff High Point PD Clyde PD Warren Wilson PD Statesville PD Maggie Valley Canton PD Police Dept Highlands PD Clyde Police Dept Henderson Co. Sheriff Fletcher PD Waynesville Police Dept Brevard Police Dept Transylvania Co. Sheriff Rutherfordton Police Dept Agencies that have reported opioid overdose reversals with Naloxone N.C. State Bureau of Investigation and Alcohol Law Enforcement also carry Naloxone-statewide. Cramerton Police Dept Mount Holly PD Fayetteville Police Dept Butner Police Dept Orange Co. Sheriff Carrboro Police Dept Ayden Police Dept Pink Hill Police Dept Roanoke Rapids Police Dept Halifax Co. Sheriff Bethel Police Department Greenville Police Dept East Carolina Univ Police Dept Pitt Co. Sheriff Kinston Police Dept Lenoir Co. Sheriff Nags Head PD Duck PD Dare Co. Sheriff Nags Head PD Brunswick Co. Sheriff Source: North Carolina Harm Reduction Coalition, Dec Analysis: Injury Epidemiology and Surveillance Unit

26 NCHRC: House Bill 850 (2013) HB850 decriminalized syringes and other sharps declared to an officer prior to being searched. It did not decriminalize residue. It began as a full syringe decriminalization bill that would have legalized syringe exchange programs but the final bill was a compromise. It was supported by the North Carolina Sherriff's Association. It passed the legislature and was signed into law in December 2013.

27 NCHRC: Senate Bill 154 (2015) This amended SB20 for additional protections for Good Samaritans on parole/probation/pretrial release. It also allows pharmacists to distribute naloxone under a standing order. Passed without a single no vote (June 2015).

28 NCHRC: Senate Bill 377 (2015) As part of a budget allocation, the legislature gave NCHRC $50,000. $25,000 to buy supplies for law enforcement. $25,000 for supplies for kits.

29 NCHRC: House Bill 712 (2015) Began as another attempt at decriminalization of syringes. The final bill was a compromise that passed without a single no vote (September 2015). This set up a needle and syringe disposal pilot program in four counties in NC. It decriminalized residue in declared paraphernalia for the pilot program. It allowed NCHRC to deepen relationships and dialog with law enforcement on the problem of injection drug use (we can offer free biohazard collection).

30 NCHRC: Lessons learned Cultivate a relationship with a respected sponsor. Be willing to compromise. Public health/saving money NO. Saving lives YES. Develop relationships for the long term. Law enforcement is a key ally.

31 NCHRC: Goals 2016 NCRHC will be trying to pass a bill decriminalizing possession of syringes and legalize a syringe exchange Currently possession or distribution of an undeclared syringe for drug use is illegal. Currently North Carolina pharmacies can sell (or not sell) syringes and needles at their discretion. Many pharmacies are no longer sell syringes due to concerns about drug use. Syringes being re-used contributes to the spread of disease.

32 NCHRC: Law Enforcement Assisted Diversion (LEAD) NCHRC is implementing LEAD, a prebooking diversion pilot program to address low-level drug and sex work crimes, in partnership with law enforcement in Fayetteville. The program allows law enforcement officers to redirect low-level offenders engaged in drug or prostitution activity to community-based services, instead of jail and prosecution.

33 NCHRC: Legislative strategies going forward Problem: Conservatives and law enforcement still draw the line at allowing NCHRC to pass out needles. Need to find a benefit other than reducing needle sticks. Observation: Conservatives and law enforcement are frustrated that not enough drug users are entering treatment.

34 NCHRC: Legislative strategies going forward Strategy 1: Change messaging from syringe decriminalization to syringe exchange to emphasize that exchange programs offer wrap around services and treatment. Strategy 2: Convince a few members of conservative party and law enforcement that syringe exchange programs are a holistic solution to problematic drug use with multiple benefits (reduce HIV/HCV, connect users to treatment.

35 NCHRC: Strategies going forward Strategy 3: Use community biohazard collection and naloxone as a way to open dialog with police Strategy 4: Get allies to go on record in support of syringe exchange. Strategy 5: Get media article and op-eds with quotes that we should legalize a syringe exchange. Strategy 6: Approach members of the executive committee from the sheriff's association to get their support for syringe exchange.

36 NCHRC: Other NCHRC Projects Fair Hiring Biohazard and Naloxone funding

37 Video of overdose reversal

38 The End

39 Thank you! NCHRC Team Robert, Tessie, Leilani, James, Hyun, Donnie, Louise Project Lazarus collaborators Law Enforcement partners State Division of EMS Scott Proescholdbell (North Carolina Public Health Department) Gurley s pharmacy Julia Gamble NC Legislators NC medical Board The over 1800 people who have used Naloxone to save a life!

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