Prevention and Harm Reduction Collaborating to Address Opioid-Related Overdose

Transcription

1 CAPT WEBINAR August 17, 2017 Prevention and Harm Reduction Collaborating to Address Opioid-Related Overdose Sharon Stancliff, Medical Director, Harm Reduction Coalition Daniel Raymond, Deputy Director of Policy & Planning, Harm Reduction Coalition This training was developed under the Substance Abuse and Mental Health Services Administration s Center for the Application of Prevention Technologies task order. Reference #HHSS I/HHSS T. The views expressed in this webinar do not necessarily represent the views, policies, and positions of the Substance Abuse and Mental Health Services Administration or the U.S. Department of Health and Human Services. This webinar is being recorded and archived, and will be available to all webinar participants. Please contact the webinar facilitator if you have any concerns or questions. 2 1

2 Facilitator LaShonda Williamson-Jennings Associate Coordinator Southwest Resource Team SAMHSA s CAPT 3 Webinar Agenda Defining Harm Reduction Where Prevention and Harm Reduction Intersect The Benefits of Collaboration to Prevent Opioid-related Overdose Examples of Successful Partnerships 4 2

3 Presenters Sharon Stancliff Medical Director Harm Reduction Coalition Daniel Raymond Deputy Director of Planning and Policy Harm Reduction Coalition 5 Framing Our Discussion: Things to Remember Prevention and harm reduction have common goals Prevention incorporates some harm reduction strategies when addressing opioid overdose Most harm reduction strategies are outside the purview of substance misuse prevention Collaboration is key for developing a comprehensive approach that can impacts the opioid crisis 6 3

4 What do you think of when you hear harm reduction? 7 Defining Harm Reduction: A History and Core Principles 8 4

5 Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs. 9 Harm Reduction: Principles Employs a set of practical strategies by which harm related to illicit drug use is reduced Recognizes that drug use is common Includes a spectrum of strategies, from safer use to abstinence Uses low threshold entry requirements appropriate for the targeted group Ensures that people who use(d) drugs have a real voice in the creation of programs and policies 10 5

6 Early Years of Syringe Exchange 1984 Amsterdam: Syringe Exchange Program (SEP) instituted by the Junkie s Union as a response to the hepatitis B virus (HBV) 1986 Merseyside, England: SEP developed in response to HIV among people injecting drugs 11 Early Years of Syringe Exchange 1988 Tacoma, WA: First publicly funded Syringe Exchange Program at Point Defiance In the United States, new syringe exchange programs started out of peer initiatives to prevent HIV transmission and to save lives 12 6

7 Syringe Exchange Works 1 As the annual number of syringes exchanged increases, the number of new HIV infections among people who use intravenous drugs decreases 13 What is naloxone or Narcan? A medicine that stops the effects of opioids in injectable or intranasal form Pushes most other opioids off the body s opioid receptors and blocks them for only minutes 14 7

8 The History of Naloxone Access Naloxone over the counter in Italy Chicago Recovery Alliance start naloxone distribution; ramps up in The first conference on overdose Preventing Heroin Overdose: Pragmatic Approaches New Mexico naloxone access legislation New York naloxone access legislation 15 Early Laws Allowing Lay Person Use of Naloxone: Three states have laws regarding naloxone Several cities have naloxone programs (San Francisco and Chicago) 16 8

9 Case Study Case Study: Massachusetts 3 Massachusetts looked at overdose rates in 19 communities before and after Opioid Education and Naloxone Distribution (OEND) programs were implemented 2912 kits distributed 327 rescues, 87% by drug users 98% effective; Emergency Medical Services personnel revived the other three 17 Case Study Community Results 3 Fatal opioid overdose rates (compared to communities with no OEND programs): Naloxone kits given to people per 100K associated with a 27% reduction in fatal overdose Naloxone kits given to >100 people per 100K associated with a 46% reduction in fatal overdose 18 9

10 Overdose Deaths Public Figures Heath Ledger Philip Seymour Hoffman Prince In 2015, there were over 33,000 deaths due to opioid overdose in the US 4 19 Laws Allowing Lay Person Use of Naloxone:

11 Recap Harm reduction is evidence-based and has been shown to reduce morbidity and mortality Naloxone distribution originated in the tradition of harm reduction but has been widely adopted across disciplines Sharing best practices through collaborations is key to success in reducing overdose deaths 21 Intersection of Harm Reduction and Prevention More in here than you think! Prevention Harm Reduction 22 11

12 Target Populations for Prevention Use Misuse Undiagnosed Substance Use Disorder No Use 23 Common Goals Harm reduction and substance misuse prevention both contribute towards: Reducing the adverse health & social consequences of substance use Providing multiple points of intervention across the spectrum of substance use Developing coordinated strategies operating in tandem at both individual & community levels 24 12

13 Common Threads 25 Addressing an Individual s Needs at Different Stages 26 13

14 Breaking Down the Binaries 27 Zooming Out: Family & Peer Group 28 14

15 Exposure to Public Injecting 6,7 Most people who inject drugs (PWIDs) report early facilitation of injection initiation from a current PWID Break the Cycle is an individual-level intervention for current PWID to reduce injection initiation Community-level strategies effective at reducing public injecting: housing, medication-assisted treatment, supervised injection facilities 29 Benefits to Collaboration 30 15

16 All Hands on Deck 31 Translating Across Sectors 32 16

17 Sharing Knowledge for Action 33 Bigger Pool 34 17

18 Joint Action 35 Greater Impact 36 18

19 Examples of Partnerships Between Prevention and Harm Reduction 37 Centers for Medicare and Medicaid Services Opioid Misuse Strategy (2016) Increase access to naloxone by requiring that the antidote appear on all Medicare Part D plan formularies Increase the use and distribution of naloxone for Medicaid beneficiaries Increase access to naloxone by requiring that the antidote appear on all Marketplace plan formularies 38 19

20 Naloxone Available in Pharmacies 5 In 2017, all but 2 states allow naloxone to be available in pharmacies without a [patient-specific] prescription 39 Pharmacy Access Individuals can get a prescription from a primary care provider, emergency medicine department, or other prescribers Individuals can request naloxone from pharmacies authorized to provide it without a patient-specific prescription 40 20

21 Challenges in Pharmacy Access Uptake is still very slow Co-payment is a barrier; individuals need to pay in pharmacies when registered programs distribute at no cost to individuals; Pharmacies sometimes waive Medicaid co-pays but this can t be advertised, and enrollees often don t want to ask 41 New York State Initiative Breaking News! Effective August 8 th, 2017 Collaborators: Pharmacies State and county health departments Medical prescribers Community-based organizations 42 21

22 N-CAP New York State Department of Health will cover the cost of insurance co-pays for naloxone up to $40 The average cost of co-pay is believed to be about $10; the cost of an intranasal naloxone kit is at least $70 N-CAP will be managed by the Office of HIV Uninsured Care Programs using the Pharmacy Benefit Management System 43 A Unique Collaboration in New York NYS Department of Corrections & Community Supervision, NYS Department of Health and Harm Reduction Coalition are collaborating to: Train all soon-to-be-released inmates, regardless of drug involvement, on opioid overdose prevention with naloxone Offer kits upon release to those who would like them 44 22

23 Post-incarceration Overdose Risk of death increases substantially after periods of refraining from opioids Quantities that once brought pleasure can be fatal after a period of abstinence People leaving prison are particularly vulnerable 8,9 Effective overdose prevention can be taught in <10 min New York State Department of Corrections and Community Supervision (NYSDOCCS) NYSDOCCS operates 54 prisons Several facilities are focused on drug involved inmates and parolees About 22,000 people are released each year Department of Corrections and Community Supervision also has a standing order for nurses to employ naloxone at suspected overdoses within the facilities 46 23

24 Training Components Review risk factors for overdose Recognize signs of overdose Describe what naloxone is and how to use it Respond to overdose Report and get refill Describe the legality of naloxone 47 Messaging to Inmates Some of you may have a lapse or a relapse; we want you to live to try again When you leave you are asked to stay away from drug related settings. But in some places drugs are so wide spread that this is very hard. You are now equipped to save a life! 48 24

25 Naloxone Distribution in New York State Prisons Harm Reduction Coalition training in Queensboro Prison, New York In just 3 years, there are over 5,000 formerly incarcerated people carrying naloxone kits in New York 49 Program Success Attributed to: Finding an inside advocate who can provide navigation through the prison system Training staff first Identifying staff volunteers to do the training 50 25

26 Additional resources available on our website 51 Final Questions or Thoughts? 52 26

27 Prevention Collaboration in Action Toolkit 53 Contact Information If you have questions or comments about this webinar, please don t hesitate to contact: Amanda Dougherty Training and Technical Assistance Associate adougherty@edc.org

28 Evaluation Please take the time to complete a brief feedback form: /r/feedback-capt-1977 Thank you for sharing your thoughts! 55 References 1. Des Jarlais, D. C., Arasteh, K., McKnight, C., Feelemyer, J., Tross, S., Perlman, D., &... Campbell, A. (2017). Racial/Ethnic disparities at the end of an HIV epidemic: Persons who inject drugs in New York City, American Journal Of Public Health, 107(7), The Policy Survillienne Program. (n.d.) Naloxone overdose prevention laws. Retrieved from 3. Walley, A. Y., Xuan, Z., Hackman, H. H., Quinn, E., Doe-Simkins, M., Sorensen-Alawad, A.,... & Ozonoff, A. (2013). Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis. BMJ, 346, f National Center for Health Statistics (NCHS), Multiple Cause of Death 2015 on CDC WONDER Online Database, released Data for year 2015 are compiled from the Multiple Cause of Death File 2015, Series 20, No. 2U, Prescription Drug Abuse Policy System (n.d.) Retreived from 6. Werb, D., Buxton, J., Shoveller, J., Richardson, C., Rowell, G., & Wood, E. (2013). Interventions to prevent the initiation of injection drug use: a systematic review. Drug And Alcohol Dependence, 133(2),

29 References 7. Werb, D., Garfein, R., Kerr, T., Davidson, P., Roux, P., Jauffret-Roustide, M., &... Strathdee, S. A. (2016). A socio-structural approach to preventing injection drug use initiation: rationale for the PRIMER study. Harm Reduction Journal, 13(1), Merrall, E. C., Kariminia, A., Binswanger, I. A., Hobbs, M. S., Farrell, M., Marsden, J., &... Bird, S. M. (2010). Meta-analysis of drug-related deaths soon after release from prison. Addiction (Abingdon, England), 105(9), Binswanger, I. A., Nowels, C., Corsi, K. F., Glanz, J., Long, J., Booth, R. E., & Steiner, J. F. (2012). Return to drug use and overdose after release from prison: a qualitative study of risk and protective factors. Addiction Science & Clinical Practice, Behar, E., Santos, G., Wheeler, E., Rowe, C., & Coffin, P. O. (2015). Brief overdose education is sufficient for naloxone distribution to opioid users. Drug And Alcohol Dependence,