Unique Programs to Address Drug User Health February 16, 2017 Valerie White & Narelle Ellendon, RN Office of Drug User Health, AIDS Institute NYSAM Conference February 3 rd, 2017
Office of Drug User Health brings together the AIDS Institute s Harm Reduction Unit, Opioid Overdose Program and the Expanded Syringe Access Program, and the newest addition Increasing Access to Buprenorphine February 16, 2017
February 16, 2017 3 DRUG USER HEALTH INITIATIVES Syringe Exchange Program (SEP) - Enacted in 1992 Expanded Syringe Access Program (ESAP) - Enacted in 2000 Opioid Overdose Prevention Program (OOPP) Enacted in 2006 Increasing Access to Buprenorphine Enacted in 2016 Drug User Health Hubs Enacted 2016
February 16, 2017 4 Getting to Zero Governor Cuomo announced on World AIDS Day 2016 that there would be zero HIV transmissions through injection drug use by the end of 2020 Ambitious goal Implementation strategies being developed
February 16, 2017 5 HIV/AIDS/HEPATITIS PREVENTION Syringe Exchange and the Expanded Syringe Access Program are public health initiatives designed to reduce the transmission of HIV and Hepatitis A,B,C. Both use a harm reduction approach and focus on engaging individuals who are not ready or able to abstain from drug use or enter drug treatment. Both provide individuals access to new syringes without a prescription to prevent reusing or sharing of syringes.
February 16, 2017 6 WHAT IS HARM REDUCTION? Recognizes the fact that some behaviors people engage in are harmful, cause harm or have harm associated with them. Reality is that people will engage in those behaviors or activities anyway even though they know they are harmful or despite others attempts to dissuade them. Harm reduction is an approach to lower the risk of potentially hazardous behaviors or activities.
February 16, 2017 7 SYRINGE EXCHANGE PROGRAM (SEP) SERVICES Syringe Exchange services be provided as part of a comprehensive harm reduction model. Outreach Syringe Exchange HIV prevention education, peer training/skills building Condom and bleach kits distribution/demonstrations Referrals (31% for substance use treatment services) HIV and HCV screening Opioid overdose prevention training and equipping individuals with naloxone Individual and group counseling Incorporating on-site buprenorphine prescribing in many programs
February 16, 2017 8 SEP UTILIZATION - 2016 Total clients served: 24,449; New clients: 9,554 Transactions: 137,800 Syringes Furnished: 7.4 million Referrals: 36,578 Substance Use Treatment: 6,934 Medical Services: 16,618 Misc: Housing, Legal, Entitlements, Food: 12,253
February 16, 2017 9 OUTCOMES OF SYRINGE EXCHANGE PROGRAMS NYC 1990: 52% of new HIV cases were among IDUs; NYC 2014: Surveillance data showed <3% of new AIDS case are among IDUs
February 16, 2017 10 YOUNG IDU INITIATIVE An emerging heroin epidemic is among young injection drug users. 18 SEPs were given enhancement funding to target young injection drug users for enrollment in SEP, primarily using young IDU peers to reach youth. Approximately 3,000 young IDUs have been enrolled in SEPs between July 1, 2015 and June 30, 2016 Provide safer injection practices & safer sex education and supplies. Opioid overdose prevention training; active referrals to health, mental health and substance use treatment/buprenorphine.
February 16, 2017 11 Expanded Syringe Access Program (ESAP) The law allows the sale or furnishing of hypodermic syringes or needles by ESAP registered: Licensed pharmacies Article 28 health care facilities Health care practitioners Physicians Physician assistants Nurse practitioners
February 16, 2017 12 NYS Safe Sharps Collection Program The program provides, at no cost, kiosks to be placed in the facilities for proper disposal of syringes. THIS KIOSK MEASURES 54" X 24" X 20" AND IS MADE FROM HEAVY GAUGE STEEL
February 16, 2017 13 The Point is a tool locater designed to find locations near you where you can obtain hypodermic needles and syringes without a prescription, as well as locations where syringes and drugs can be disposed safely in secure kiosks. The locator can be accessed through the use of one of these URL addresses: http://www.nydropboxes.org http://www.thepointny.org With a Smartphone, you can also access the locator by scanning the QR Code provided here.
February 16, 2017 14 Resources and Directories Include Links to: NYS ESAP Providers NYS Safe Sharps Collection Program NYS Authorized Syringe Exchange Programs Opioid Overdose Prevention New York State's 911 Good Samaritan Law Location of Medical Drop Boxes by County Household Drug Collection Schedule The Point was developed by the Center for Health & Social Research at SUNY Buffalo State in collaboration with the Erie County Department of Health
February 16, 2017 15 Opioid Overdose Prevention Program Expanding Community Program Basic Life Support Law enforcement Firefighters Corrections School Settings Pharmacy 380 programs currently active or recently registered 135 new programs in 2016 alone. More than 2,300 reported naloxone administrations by community responders 635 in 2016. Permissible scope of practice now includes IN naloxone. Frequently first on the scene of an OD. 2920 reported naloxone administrations 1,620 in 2016. As with police, firefighters are often first on the scene Currently in 10 State prison facilities with expansion planned Began in August 2015 with changes in Public Health & Education laws. Currently 58 district registrations covering 226 distinct schools. Over 2,000 pharmacies now able to dispense under standing orders
February 16, 2017 16 October 28, 2015 Overdose Responders Trained: Oct 1, 2014 Sept 30, 2016 25,000 20,000 15,000 11,202 15,677 21,411 16,609 12,724 14,142 Community Responders School EMS Fire Fighters 82,922 3,563 3,532 2,622 10,000 8,358 8,651 Law Enforcement 16,045 TOTAL 108,684 5,000 Note: Data reported by registered programs. 0 2014 Q4 2015 Q1 2015 Q2 2015 Q3 2015 Q4 2016 Q1 2016 Q2 2016 Q3
February 16, 2017 17 October 28, 2015 Reported Naloxone Administrations 311, 6% 2,444, 48% 2,369, 46% Total: 5,124 Data through 11/23/2016 Community Law Enforcement Firefighters
February 16, 2017 18 October 28, 2015 Pharmacy Collaboration Partners NYS DOH Harm Reduction Coalition Accomplishments Managed care coverage for at least one naloxone formulation Pharmacist training CPE with University at Buffalo/HRC/Erie DOH Resources for pharmacists and patients Standing orders: Commissioners, Basset & Burstein & Dr. Stancliff NYC DOHMH OASAS More than 2,000 pharmacies Directory on-line NYS Board of Pharmacy Erie DOH & Albany DOH Pharmacy Societies (NYS & WNY) Pharmacies (chains and Independents) CVS Walgreens Rite Aid Wegmans Kinney Drugs Price Chopper More in Pipeline Stop and Shop Non- Chain
February 16, 2017 19 October 28, 2015 State Prisons Collaboration Partners Accomplishments NYS DOH Training for incarcerated individuals soon to be released Pilot began in February 2015 at Queensboro Correctional Facility Currently in 10 facilities with expansion to all 54 facilities in the future NYSDOCCS Harm Reduction Coalition 5,226 inmates trained; 2,499 have taken naloxone kits upon release 2,785 staff at the facilities trained with 1600 taking kits 2,900 parolees trained with 1,300 taking kits
February 16, 2017 20 Keys for Success Commitment from Governor Support from Legislature Collaborations across State Agencies NYSDOH OASAS Division of Criminal Justice Services DOCCS Fire Prevention & Control State Education Collaborations within NYSDOH AIDS Institute Emergency Medical Services Narcotics Enforcement Occupational Health and Injury Prevention Strong Community Partnerships All registered programs Pharmacies Harm Reduction Coalition Trained Responders Chains NYCDOHMH Independents Schools Associations
February 16, 2017 21 NYS Buprenorphine Access Initiative
February 16, 2017 22 Benefits of Buprenorphine Access To reduce or stop opioid use by: Preventing drug withdrawal Blocking or diminishing the effects of other opioids if taken Preventing the powerful craving that continues for some people long after detoxification
February 16, 2017 23 Benefits of Buprenorphine Access To improve patients general health and wellbeing (psychosocial functioning) by: Reducing mortality (Overdose, etc.) Reducing transmission of blood-borne viruses Improving adherence to other medications/therapies (HIV, HCV, Diabetes, HT, SSI) Providing stability to meet responsibilities (work, childcare, maintain housing, legal, etc.)
February 16, 2017 24 My reason for getting on suboxone was because in the last 6 months I have had 6 overdoses. They are putting fentanyl in the heroin every time I get a bag I m dropping. When I got out of rehab (I was) still having the cravings and I did not want to go back to that lifestyle. I got on the suboxone, because I was on it before. And it really helped me out a lot. I can keep a job, I see my kids, everything falls into place.
February 16, 2017 25 Benefits of Buprenorphine Access To improve well-being & equity of communities: Reduces drug-related crime & recidivism Increases access points for meaningful engagement with services Increases options for service providers Decreased use of EMS, ED, crisis services Increased QOL, stability, productivity Challenges stigma for providers and clients (normalized medication in PC settings, etc.)
February 16, 2017 26 Buprenorphine Prescribing Regulations Be a qualified physician Complete 8 hours of training: online & in-person (24 hours for NPs & PAs) Or boarded in addiction medicine Register with the DEA Required to have access to appropriate psychosocial services Limited to 30 patients per doctor for the first year then 100 patients per doctor
February 16, 2017 27 Comprehensive Addiction Recovery Act (CARA) of 2016 New law authorizes prescribing privileges of buprenorphine in office-based settings by nurse practitioners (NPs) and physician assistants (PAs) Feb 2017 Practitioners that hold additional credentialing or practice in qualified practice settings or emergency may now treat up to 275 patients per year NOW
February 16, 2017 28 Total number of Bup providers, by region Region SAMHSA DEA Capital Region 45 175 Central New York 36 151 Hudson Valley 100 298 Long Island 201 469 New York City 560 1595 Western New York 103 918
February 16, 2017 29 Average # of public and potential Bup providers Region Average number of public providers per county Average number of potential providers per county Capital Region 2.65 10.29 Central New York 2.57 10.78 Hudson Valley 16.67 49.67 Long Island 100.5 234.5 New York City 112 319 Western New York 5.72 51
February 16, 2017 30 Comparison of SAMHSA and DEA data Western New York Hudson Valley Long Island Central New York Capital Region NYC region 103 100 201 36 151 45 175 298 469 560 918 1595 The graph to the left displays the number of providers publicly accessible via the SAMHSA Buprenorphine provider directory, compared to the potential universe of waivered providers extracted from the DEA dataset. 0 200 400 600 800 1000 1200 1400 1600 1800 SAMHSA DEA
February 16, 2017 31 NYSDOH Buprenorphine Initiatives
February 16, 2017 32 Points of Access for Buprenorphine: Settings: - Harm Reduction/Syringe Exchange Programs - Primary Care - Emergency Departments & Urgent Care - Federally Qualified Health Centers - CBOs (Housing Services, etc) - Correctional & Re-Entry
February 16, 2017 33 Models of Buprenorphine Populations: - Young Adults - Women of child bearing age - Rural/Suburban - Homeless - Re-Entry
February 16, 2017 34 Models of Buprenorphine Prescribing Practices: (Low-threshold) - Short-term & Long-term provision - Non-conditional psychosocial services - Non-conditional abstinence prior to induction - Non-punitive regarding poly-drug use - Shared decision making - Covered by insurance Models: - Care Coordination models - Hub & Spoke Models - Telehealth
February 16, 2017 35 Drug User Health Hubs Outpatient ambulatory care programs for drug users Enhance local providers understanding and ability to provide services to substance users (including but not limited to drug dependence, overdose prevention and response, HIV, hepatitis C, mental health needs and other behavioral health issues that impact the lives of people who use drugs. The programs provide the bridge between prevention and treatment and can positively impact an individual s wellbeing.) Provide on-site medically assisted treatment buprenorphine. Prevent overdoses; provide care post overdose. Law Enforcement Assisted Diversion (LEAD): Low level offenders are diverted to SEP for care services instead of being arrested.
February 16, 2017 36 Hubs Emergency Department Family EMS Hubs Law Enforcement
February 16, 2017 37 CDC Vital Signs; HIV and Injection Drug Use Syringe Services Programs for HIV Prevention, December 2016
February 16, 2017 38 Analysis of current policies and impact Buprenorphine waiver trainings Webinars (CME) - buprenorphine - opioid prescribing - co-prescribing naloxone Buprenorphine Working Group ODUH Activities
February 16, 2017 39 ODUH Activities Material creation - best practices - factsheets Academic Detailing/ Targeted Provider Education
February 16, 2017 40 ODUH Activities ECHO Clinic (OUD, buprenorphine) Consultant warm lines Facilitating mentoring Resource library
February 16, 2017 41 Online resources NYSDOH: HIV and Substance Use Guidelines http://www.hivguidelines.org/clinical-guidelines/hiv-and-substanceuse/appendix-b-guidance-on-the-use-of-buprenorphine-in-hiv-infectedpatients/ Providers Clinical Support System for Medication Assisted Treatment http://pcssmat.org/ SAMHSA information including training and registration http://buprenorphine.samhsa.gov/ Harm Reduction Coalition information and resources http://www.harmreduction.org/
February 16, 2017 42 Valerie White, Deputy Director valerie.white@health.ny.gov Thank You! Narelle Ellendon, RN Opioid Program Manager 212 417 4668, narelle.ellendon@health.ny.gov Office of Drug User Health New York State Department of Health, AIDS Institute www.health.ny.gov/overdose buprenorphine@health.ny.gov