Just Out of Reach: Women Who Use Drugs, Stigma and Barriers to Care Erin Bortel and Lyla Hunt AIDS Institute Office of Drug User Health

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1 Just Out of Reach: Women Who Use Drugs, Stigma and Barriers to Care Erin Bortel and Lyla Hunt AIDS Institute Office of Drug User Health March 12, 2018 Envisioning a socially just system where all New Yorkers who use drugs can access stigma-free and culturally competent health care and harm reduction services.

2 March 12, Objectives 1. Increase understanding of key trends among women who use drugs in New York State. 2. Demonstrate the efficacy of multidisciplinary harm reduction approaches as opportunities to support and care for women who use drugs. What is NYS currently doing? 3. Increase practitioner competence to delivering destigmatizing care, trauma-informed care, and culturally competent care for women who use drugs.

3 March 12, Mission The AIDS Institute is committed to eliminating new infections, improving the health and well being of persons living with HIV, AIDS, sexually transmitted diseases and viral hepatitis, and improving LGBT and drug user health. This mission can be concisely stated as follows: End epidemics, fight stigma, promote health. 3

4 March 12, Who We Are New York State Department of Health AIDS Institute Office of Drug User Health SEP ESAP OOPP HUB BAP N-CAP

5 March 12, Fentanyl Reports, by State, of Law Enforcement Drug Seizures, 2001 U.S. Drug Enforcement Administration, Diversion Control Division. (2017). NFLIS Brief: Fentanyl, Springfield, VA: U.S. Drug Enforcement Administration.

6 March 12, Fentanyl Reports, by State, of Law Enforcement Drug Seizures, 2015 U.S. Drug Enforcement Administration, Diversion Control Division. (2017). NFLIS Brief: Fentanyl, Springfield, VA: U.S. Drug Enforcement Administration.

7 March 12, Percentage of Opioid Overdose Deaths, United States and New York United States New York State

8 March 12, Pregnancy and Pregnancy Opioid Abuse among Substance Treatment Admissions in the U.S.,

9 March 12, 2018 Women in New York Understanding Key Health Trends among Women Who Use Drugs and Their Neonates

10 March 12, NYS Opioid-related Overdose Deaths vs. Motor Vehicle Deaths, Opioid-related Overdose Deaths Motor vehicle-related Injury Deaths

11 March 12,

12 March 12, Overdose in NY and Women 900 Overdose Deaths Among Women in NYS Overdose Deaths Among Women in NYS

13 March 12, NYS NAS crude rate per 1,000 newborn discharges (any diagnosis)

14 March 12, Female Male Female Male Female Male Total Hepatitis C by Age, Sex and Year, New York (Excluding NYC)

15 March 12, Total Hepatitis C Among Females: NYS (Excluding NYC) Percent by Year & Age Group 100% 2,168 2,200 90% 1,726 1,832 1,902 80% 1,700 70% 60% 50% 40% 1, % 1,424 1, % 43.3% 1,307 1,620 1, % 48.4% 51.1% 48.2% 1,394 1, % 58.8% 43.0% 40.6% 1, % 34.7% 20% % 0% 0.3% 0.2% 0.4% 0.3% 0.3% 0.4% % < 15 % % 45 + # # 45+ Source: NYS DOH Communicable Electronic Disease Surveillance System. Data as of August, 2017

16 March 12, Perinatal HCV Vertical transmission occurs in < 6% of infants born to moms infected with HCV only Doubles for HIV/HCV coinfected moms and moms with high HCV viral loads No post exposure prophylaxis for infants born to HCV infected moms Safety and efficacy of new treatments not yet established in pregnant women and pediatric population Breastfeeding is not contraindicated for HCV + moms Unless nipples are bleeding or cracked

17 March 12, HIV Among Women in 2016 Among females, Non-Hispanic Black women were more likely to be diagnosed with HIV than any other race/ethnicity. Most new HIV diagnoses were attributed to heterosexual contact, followed by injection drug use. *Data as of September Data presented excludes NYC and female inmates data sets.

18 March 12, Women and HIV in NYS Women represent 21.8% of all new HIV diagnoses in % of women newly diagnosed in 2016 experienced a concurrent AIDS diagnosis. 29.6% of all women LWDHIA died.

19 March 12,

20 March 12, Intersectionality Women s Healthcare Legal System Child Welfare System

21 Harm Reduction Practice in New York NYSDOH Office of Drug User Health Initiatives March 12, 2018

22 Syringe Exchange Programs and Drug User Health Hubs Harm reduction programs that use innovative approaches to engage disconnected PWUD & prevent opioid overdoses March 12, 2018

23 March 12, Funded Harm Reduction Initiatives DUH Health Hub 2016 Increasing Access to Buprenorphine Initiative Opioid Overdose Prevention Program Expanded Syringe Access Program Syringe Exchange Program

24 March 12, Syringe Exchange Program (SEP) Outreach Syringe Exchange Peer Training Syringe Clean Up Activities in the Community HIV/HCV/STI prevention Risk Reduction Education and Counseling Individual and Group Counseling Referrals to Other Services Specialized Case Management Acupuncture Risk Reduction Education and Counseling Safer Sex items distributed Overdose Prevention Training Naloxone Distribution 4 PrEP for HIV Pilot Sites 18 Youth IDU Pilot Sites

25 March 12, Drug User Health Hubs Referral Sources Core Services Emergency Department Family EMS Hubs Law Enforcement

26 March 12, Health Hubs Unique People by Gender (n = 1003) Trnsgndr-Id as Male 1 0% Trnsgndr-Id as Female 2 0% Female % Male %

27 Opioid Overdose Prevention Program Regulating the training of overdose responders & the distribution of naloxone March 12, 2018

28 March 12, A Multi-Systemic Approach to Address Opioid Overdose Community Programs Law Enforcement Firefighters Basic Life Support EMS School Settings Corrections & Parole Pharmacy

29 Naloxone Co-payment Assistance Program (N-CAP) Making Naloxone more affordable for New Yorkers March 12, 2018

30 March 12,

31 March 12, How N-CAP works Go to local pharmacy Ask for Naloxone Get co-pay covered up to $40 Do you need a prescription to get Naloxone? Patient Specific Prescription OR Standing Order at Pharmacies N-CAP covers both!

32 March 12,

33 Buprenorphine Access Initiative Preventing overdoses by curbing cravings & blocking the effects of other opiates March 12, 2018

34 March 12, Support and Embrace What Works Buprenorphine is life saving and is safe for use during pregnancy. Stops withdrawal symptoms Don t need to use to feel normal Prevents cravings Lowers interest in using Blocks effects of opiates No point in getting high

35 March 12, Buprenorphine Access Initiative Reducing consumer barriers to accessing buprenorphine Funding Syringe Exchange Programs to provide lowthreshold and on-demand buprenorphine in non-healthcare settings Increasing number of waivered providers Funding Harm Reduction Coalition to conduct consumer listening sessions Convening an expert working group of providers

36 March 12, Promote Breastfeeding for Women on Buprenorphine Endorsed by: American Academy of Pediatrics (2012) American College of Obstetricians and Gynecologists (2012 and 2017) Academy of Breastfeeding Medicine (2009) Breastfeeding has been found to reduce the severity and shorten the duration of newborn opioid withdrawal, thus shortening the length of the hospital stay.

37 March 12, Systems Transformation in Action Addressing stigma against PWUD Increasing capacity of systems to meet the needs of PWUD Normalizing harm reduction Informing and influencing drug policy

38 A Vision for the Future Best and Recommended Practices to Bring Back to Your Health System March 12, 2018

39 March 12, Address Interconnected Epidemics

40 March 12, Gold Standard for Treating Women with Opioid Use Disorder Behavioral Counseling Prenatal Care Medication Opioid Agonist Treatment

41 March 12, Mother-Baby Dyad Care

42 March 12, Care for the Whole Person: Client-Centered Practice Venerate the people we call clients or patients. Clients/patients are the center of all practice and organizational activities and decisions. Ultimate marker of organizational performance and success is based on client/patient outcomes. Practice a healthy disrespect for the impossible.

43 March 12, Care for the Whole Person: Trauma-Informed Care Safety Empowerment Trustworthy TIC Choice Collaboration

44 March 12, Making the Change to Person-Centered Language Instead of this Say this Addiction Drug Addict, Abuser Clean or Dirty toxicology Got clean Junkie, Crackhead, Tweaker, etc. Addicted Newborn, or Born Addicted Substance Use Disorder A person who uses drugs Test was Negative or Positive ; test was unexpected or expected A person who formerly used drugs A person who uses (specify drug/s) Babies born with prenatal substance exposure, or, Newborn Opioid Withdrawal

45 March 12, What can the use of Person-first language do? Improve quality of life Improve self-worth Increase chances of meaningful engagement in medical care Reduce isolation from service providers Increase access to lifesaving care

46 March 12, Questions? Erin Bortel Lyla Hunt

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