OVERVIEW. NCHRC Harm Reduction Pills Ingestion to Smoking/Injecting Harm Reduction Legislation, Services and Advocacy Ban the Box/Fair Hiring LEAD Q+A

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2 OVERVIEW NCHRC Harm Reduction Pills Ingestion to Smoking/Injecting Harm Reduction Legislation, Services and Advocacy Ban the Box/Fair Hiring LEAD Q+A

3 North Carolina Harm Reduction Coalition (NCHRC) is North Carolina s only comprehensive harm reduction program. NCHRC engages in grassroots advocacy, resource development, coalition building and direct services for law enforcement and those made vulnerable by drug use, sex work, overdose, immigration status, gender, STIs, HIV and hepatitis.

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7 CARS AND HARM REDUCTION Seatbelts Side Impact Beams Speed Limits Side Impact Beams Don t text! The Volvo Airbags

8 Deaths per 100,000 population Death Rates* for Two Selected Causes of Injury, North Carolina, β Motor Vehicle Traffic (Unintentional) Year National Vital Statistics System, multiple cause dataset Source: Death files, , CDC WONDER Analysis by Injury Epidemiology and Surveillance Unit *Per 100,00, age-adjusted to the 2000 U.S. Standard Population α - Transition from ICD-8 to ICD-9 β Transition from ICD-9 to ICD-10 8

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10 WHY DO SOME PEOPLE USE TOBACCO? Pleasure Stress Pain management To Stay Awake Dependence Health Insurance Fitting in Housing Woes LGBTQI Racism Pain Management Trauma Management Mental Health Love Trouble Management Social Culture

11 WHY DO PEOPLE INJECT/SMOKE DRUGS? Pleasure Dependence Mass Incarceration Exposure to injecting practices Purity of the drug Type of drug Supply of drug Cost of drug Law enforcement practices Love Fitting in Health Insurance Housing Sex Work LGBTQI Racism Pain Management Trauma Management Mental Health Staying Awake

12 FROM PILLS TO SMOKING AND INJECTING: WHAT ARE POTENTIAL PROBLEMS Syringe Access Abscess Wounds Endochronitis HIV, HBV, HCV Vein health Pipe Access Abscess wounds HBV, HCV Open Wounds Overdose Dosage Fentanyl Laced Drugs Environment Drug Purity Safe Spaces to Use Drugs-SIF Dangerous Drug Trade Encounters Sex Work Criminalization Racist war on drugs Re-Entry Issues Employment Housing Education Treatment Access Law enforcement encounters Breakdown of family structure Healthcare- Law enforcement interaction Access to Treatment with a criminal record Stigma Medical care for pregnant users

13 2013 -SB 20: 911 Good Sam/ Naloxone -HB 850: Syringe/ Sharps Decriminalized if Declared to a Officer HARM REDUCTION/NALOXONE LEGISLATION IN NORTH CAROLINA SB 154: Expansion of 911 Good Sam Immunities/ Naloxone Access -$50,000 for naloxone in State Budget -HB 712: Decrim of Residue in Syringes/Sharps if Declared to a Officer AND Establishes Biohazard Collection Programs HB 972: Amendment on Law Enforcement Body Cams to legalize Syringe Exchange -SB 734: DHHS Medical Director Can Issue Naloxone Standing Order for Pharmacies -LEAD Funding in Governor s Task Force on Substance Abuse 2017 All Legislation Pending -HB 243: STOP ACT, Mandatory Use of Prescription Drug Monitoring System, Decreases CBO Naloxone Distro Liability, Changes SEP Funding Guidelines -State Budget: Naloxone Funding & Naloxone Coordinator Funding -HB409 Fair Hiring/ Ban the Box (Just passed House)

14 INJECTION DRUG USE AND HARM REDUCTION: SYRINGE EXCHANGE HB 972 Legalizes syringe exchange in NC

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17 SYRINGE EXCHANGE BENEFITS Lower incidence of HIV infection by up to 80% and Hep C infection by up to 50% Participants are five times more likely to enter drug treatment than non-participants Decrease law enforcement needle stick injuries by 66% Decrease crime by 11% through programs that connect persons who use drugs to public and private social services Improve community by helping to eliminate improper disposal

18 NCHRC SEP: WILMINGTON 77,922 syringes given out in New Hanover and Brunswick since July ,445 collected back for disposal since July % return rate

19 SEP WRITTEN VERIFICATION

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21 INJECTION DRUG USE AND HARM REDUCTION: OVERDOSE PREVENTION

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26 FENTANYL AND HEROIN RELATED DEATHS IN NC-NC MEDICAL EXAMINER Fentanyl is a drug available by prescription for cancer and chronic paid and manufactured in illicit drug labs. Fentanyl analogues are drugs with the main structural features of fentanyl that have been modified to bypass current US drug laws and/or changes the pharmacological profile of the drug.

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29 911 GOOD SAMARITAN LAWS Immunity: Paraphernalia Arrest, Charge, Prosecution Immunity: Controlled Substance Possession Arrest, Charge, Prosecution Immunity: Other Violations Protective/Restraining Order, Pretrial, Probation or Parole Conditions, Other Protections Reporting, Mitigating Factor, Civil Forfeiture

30 North Carolina 911 Good Samaritan Laws 2013: SB 20 Effective April 9, 2013, states that individuals who experience a drug overdose or persons who witness an overdose and seek help for the victim can no longer be prosecuted for possession of small amounts of drugs, paraphernalia, or underage drinking. The purpose of the law is to remove the fear of criminal repercussions for calling 911 to report an overdose, and to instead focus efforts on getting help to the victim. 2015: SB154 Add protections for people on probation, parole and pre-trial release

31 NCHRC s program has 6,934 rescues NALOXONE Non-addictive prescription medication reverses opiate overdose Distribution is associated with up to a 50% drop in OD fatalities Administer via intramuscular injection or nasal spray Cannot be abused nor cause overdose Restores breathing and consciousness Onset: One to three minutes Duration: 30 to 90 minutes

32 NALOXONE LAWS Immunity: Dispensers Civil, Criminal, Disciplinary Immunity: Lay Administrators Civil, Criminal Immunity: Prescribers Civil, Criminal, Disciplinary Prescribing Permitted? 3 rd Party or Standing Order Distribution: Lay Distribution or Possession with Prescription

33 NC NALOXONE LAWS 2013 s SB20: The Naloxone Access portion of SB20 removes civil liabilities from doctors who prescribe and bystanders who administer naloxone, or Narcan, an opiate antidote which reverses drug overdose from opiates, thereby saving the life of the victim. SB20 also allows community based organizations to dispense Narcan under the guidance of a medical provider. As a result, officers may encounter people who use opiates and their loved ones carrying overdose reversal kits that may include Narcan vials and 3cc syringes s SB 154: Pharmacists are now immune from civil or criminal liability for dispensing naloxone to people at risk of an opioid overdose s SB 734: Allows DHHS Medical Director to issue standing orders for naloxone at pharmacies.

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41 HARM REDUCTION AND STIMULANTS

42 STIMULANTS AND SEXUAL FLUIDS/BLOOD EXPOSURES Smoking stimulants with a pipe can lead to open sores, burns or cuts on the lips, which can transfer blood to a pipe. If the pipe is shared, or someone gets cut with a pipe, even a speck of infected blood can transmit hepatitis C, which can live on a pipe for months. People who smoke stimulants, like almost everyone else like to have sex. Stimulants often decreases one s inhibitions, and possibly deceases condom negotiation skills, which leads to exposures to HIV, STIs and Hepatitis (especially HBV).

43 STIMULANTS AND SEXUAL FLUIDS/BLOOD EXPOSURES Law Enforcement are at especially high risk of being cut by chipped pipes when handling them with no gloves or just latex gloves s HB850 and 2015 s HB712 protect law enforcement health against chipped pipes blood exposures.

44 STIMULANT HARM REDUCTION

45 FAIR HIRING/BAN THE BOX

46 FAIR HIRING/BAN THE BOX

47 FAIR HIRING/BAN THE BOX

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49 What is LEAD? LEAD is an innovative arrest diversion program co-designed by police, prosecutors, public defenders, civil rights leaders and public health experts Allows officers to use law enforcement discretion to divert low level drug users or sex workers to social workers who assist with connecting them to housing, drug treatment, mental health services, job training, harm reduction or other referrals Offers an alternative to incarceration for people who would more likely benefit from social services LEAD Programs currently operate in Seattle (WA), Albany (NY), Santa Fe (NM), Fayetteville (NC), Huntington (WV), Baltimore (MD), Portland (OR). Wilmington (NC), Atlanta (GA), Statesville (NC) and Waynesville (NC) in the US South plan to launch in 2017.

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53 NC LEAD PROGRAMS Active: Fayetteville (Fall of 2016) NCHRC, FPD, TASC, Cumberland County DA Wilmington (May 2017) NCHRC, WPD, TASC, New Hanover DA, Coastal Horizons, RHA Starting by August, 2017 Brunswick County NCHRC, Brunswick County Sheriff, Brunswick DA, TASC, Brunswick County Volunteer Network Starting in 2017 Waynesville NCHRC, WPD, Haywood DA Statesville NCHRC, SPD, Iredell DA

54 Seattle program has operated since 2011 Compared to a control group, participants in the LEAD program: Had a 58% lower recidivism rate Spent 39 fewer days in jail per year Showed significant reductions in felony cases Cost about $5000 less per year in criminal and legal costs Law enforcement report improved relationships with the people they encounter on the streets

55 REVIEW NCHRC Harm Reduction Pills Ingestion to Smoking/Injecting Harm Reduction Legislation, Services and Advocacy Ban the Box/Fair Hiring LEAD Q+A

56 Robert Childs, MPH Executive Director (336)