Harm Reduction June 13, - PowerPoint Presentation

Slide1

Harm Reduction

June 13,

2017Slide2

Presenters

Sarah ChessConnecticut Coalition to End HomelessnessShawn Lang

AIDS-CT

Christie Corrigan

Hartford No Freeze ShelterSlide3

House Keeping

Because this is a webinar, attendees are muted

Please type any questions you have into the Questions or Chat Box

We are recording this webinar

and will send out the link to everyone who registered later

todaySlide4

Housing First,

Harm Reduction and Overdose ResponseSlide5

Housing First

Housing First is simple: Provide housing first, and then combine that housing with supportive services in mental and physical health, substance use, education, and employment.Pathways to Housing

founded in

1992

, with the creation of the Housing First model to address homelessness among people with psychiatric disabilities and addiction

disorders.Slide6

Housing First

Housing is provided in apartments scattered throughout a community. This scattered site model fosters a sense of home and self-determination, and it helps speed the reintegration of clients into the community.Housing retention rates have remained at 85 – 90 percent

even among individuals who have not succeeded in other programs

.

Housing First is cost-effective

. Providing homes and support

services costs less than the expensive cycling through of emergency rooms, shelters, jails, and psychiatric hospitals.Slide7

Housing First

Housing First fits perfectly into a Harm Reduction Model.Slide8

Guiding Principles

Low threshold admissions policyHarm reduction based policies & practicesSeparation of housing and servicesReduced service requirementsEviction

prevention program access

Consumer

education

Staff training and supportSlide9

Definitions

Addiction/dependence - is a diseaseInitial decision to try a substance is voluntary.Increased tolerance for the drug, may result in the need for greater amounts of the substance to achieve the intended effect. May become obsessed

with securing the drug and with its

use

Persistence in using the drug in the face of serious

physical, psychological and legal problems.

“Addiction is the only disease where we put people in jail instead of treatment.”Slide10

Definitions

Drug Use - a broad term to cover the taking of all psychoactive substances within which there are stages: non-use, experimental use, recreational use and harmful useDrug Misuse - “... any taking of a drug which harms or threatens to harm the physical or mental health or social well-being of an individual or other individuals or society at large, or which is illegal.”Substance use disorder(s) - (the most severe form of which is referred to as “addiction”) is a chronic brain disorder from which people can and do recoverSlide11

Harm ReductionSlide12

Harm Reduction

Harm Reduction is a perspective and a set of practical strategies to reduce the negative consequences of drug use, incorporating a spectrum of strategies from safer use to abstinence.Slide13

Examples of HR Based P&P

Harm Reduction approach and staff has a strong conceptual understanding.Program only terminates consumers who demonstrate violence, threats of violence, or excessive non

payment

of

rent

.

Program provides or requires ongoing training in harm reduction and crisis intervention for staff.Program doesn’t terminate clients for alcohol/drug use or alcohol/drugs in units.Slide14

Harm Reduction

Drug use exists along a continuum Abstinence is one of many possible goals Meet people “where they are at

”

Drug-related harm can not be assumed

Drugs can meet important needs

Drug users are more than their drug useSlide15

Harm Reduction

Harm reduction recognizes that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination and other social inequalities affect vulnerability to, and capacity for, effectively dealing with drug-related harm.It does not attempt to minimize the real dangers associated with licit and illicit drug use, and how those issues impact lives.

Understands that relapse is not a sign of failure.Slide16

Harm Reduction

Designs & promotes public health interventions that minimize the harmful affects of drug use.Understands

use

as a complex, multi-faceted issue that encompasses behaviors from severe abuse to total abstinence

.

Focuses on behavior

– especially when related to housing, employment, parenting, and other relationships.Slide17

Harm Reduction – Efficacy and Outcomes

Syringe access programs are the most effective, evidence-based HIV/Hep

C

prevention tool for people who inject drugs

.

In cities across the nation, people who inject drugs have reversed the course of the HIV epidemic by using sterile syringes and harm reduction practices

.Syringe service programs are low threshold, and often the only contact that drug users have with providers.

SSPs provide in person contact for assessments, and referrals.Slide18

Challenges

Harm Reduction Housing is complex.Not all Harm Reduction Housing programs look the same.Barriers to full implementation are okay, but: It is important that they are recognized.

Strategies should be developed to work within limitations.Slide19

What Recovery Looks LikeSlide20

Language and Stigma

Person-first language and accurate health terminology.Avoid language that can be stigmatizing or inaccurate.We refer to individuals as people with a substance use disorder, instead of “addicts

.

”

We

would describe

individuals as abstinent rather than “clean.” We refer to methadone, vivitrol and buprenorphine/suboxone as medications rather than “drugs.”Slide21

Opioid Overdose

Identification and ResponseSlide22

Harm Reduction and Overdose Prevention

Overdose deaths can be prevented and lives saved.Laypeople and family members can prevent overdose deaths.Conversations about overdose prevention and reversal provide another way for providers and clients to connect and develop rapport.

Conveys that users’ lives are worth saving, gives hope.

PEPFAR, the UN, American Medical Association, the US Attorney General, and the New England Governors all view

Narcan

for overdose to be an

essential part of the treatment of drug users.Slide23

Opioids

Examples – Heroin, Oxycodone, Percocet, Fentanyl, Morphine, Codeine, Tramadol, Vicodin.Of the 20.5 million Americans 12 or older that had a substance use disorder in 2015, 2 million had a substance use disorder involving prescription pain relievers and 591,000 had a substance use disorder involving heroin.

It

is estimated that 23% of individuals who use heroin develop opioid addiction

.

The

National Institute on Drug Abuse (NIDA) reports that the relapse rate for drug addiction is 40 to 60 percent. In 2012, 259 million prescriptions were written for opioids, which is more than enough to give every American adult their own bottle of pills4 out of 5 new Heroin users began with prescription opiates.It’s the leading cause of accidental death in the US.Slide24

Overdose Facts in CT

From 2009-2015 there have been over 2,500 accidental/undetermined opiate overdose deaths.152 of 169 CT towns and cities experienced at least one opioid related death during this time period.Benzodiazepines were identified in 42%, and alcohol in 28%.

70% male, 84% white, mean age of 40 years, 70% pharmaceutical opioid involved, 82% occurred in a residence, increase in heroin between 2012- 14.

44% had some history with the Department of Corrections.Slide25
Slide26

Overdose Risk Assessment

Previous overdoseUsing aloneRecent release from prison or treatment or other period of abstinence.Mixing: opioids, especially in combination with benzodiazepines and alcohol.

Quality

of drugs can be

unpredictable.

Administration

– injection, increased use.Other health issues (asthma, liver and heart disease, HIV/AIDS, malnourishment, age).Slide27

Signs/Symptoms of an OD

UnresponsiveConstricted pupils

Breathing is very slow, irregular, or stopped

Pulse (heartbeat) is slow, erratic, or not there

Blue skin tinge- usually lips and fingertips

Body very limp

Face very pale, clammy

VomitingPassing out

Choking sounds or a gurgling/snoring noiseSlide28

OD Response Myths

Salt Water

Ice on Body

Cold Shower

Cocaine

Milk

Burning SkinPunching

SlappingSlide29

Narcan and Opiate OD PreventionSlide30

Forms of Narcan/NarcanSlide31

Narcan/Naloxone

Opioid Antagonist.Store @ 77 degrees (no extreme highs/lows)

Medication that

only reverses an OPIOID overdose

.

Cannot get high on it.

Little to no adverse effects.Stays active for 20-90 minutes depending on metabolism, amount of drug used, quality of drug used.Slide32

Overdose Response

Rub your knuckles on the bony part of the chest (sternum) to try to get them to wake up and breathe.

Call

911.

All you need to say is:

The address and where to find the personA person is not breathing

When medics come, tell them what drugs the person took if you knowTell them if you gave NarcanSlide33

Overdose Response

The AHA now recommends hands-only resuscitation for those untrained in standard CPR.A number of studies have shown that hands-only resuscitation is as effective or more effective in sudden cardiac arrest than standard methods (chest compressions with mouth-to-mouth ventilation).How to Give Hands-Only CPR. If you see a teen or adult suddenly collapse, call 911 and push hard and fast in the center of the chest to the beat of any tune that is 100 to 120 beats per minute. Immediate CPR can double or even triple a person's chance of survival

.

http

://cpr.heart.org/AHAECC/CPRAndECC/Programs/HandsOnlyCPR/UCM_473196_Hands-Only-CPR.jspSlide34

Overdose Response

Intranasal1. Remove small purple and yellow caps from Narcan vial and injector2. Attached vial to injector using three half turns or until stopper is pierced by needle **Do not push vial into injector**

3. Remove large yellow cover from injector

4. Make sure there are no air bubbles in injector

5. Twist plastic side of nasal atomizer onto injector

6. Insert side with white foam tip into person’s nostril

7. Push half of Narcan out of injector into person’s nostril, then push remaining half into the other nostril8. Administer a second dose of Narcan if person is not responsive after 3-5 minutes.Slide35

Overdose ResponseSlide36

Liability

“Any person, other than a licensed health professional acting in the ordinary course of such person’s employment, who administers an opioid antagonist in accordance with this subsection shall not be liable for damages in a civil action or subject to criminal prosecution with resect to the administration of such opioid antagonist.”Slide37

Overdose Response

W

hat if police show up?

The CT

Good Samaritan Drug Overdose Law lets bystanders give Narcan if they suspect an overdose.

The law protects the victim and the helpers from prosecution for drug possession. The police can confiscate drugs and prosecute persons who have outstanding warrants.Slide38

Who Should Have Narcan?

It should be in every medicine chest, first aid kit, school nurse’s office, and alongside AEDs in malls, airports and other public places.Anyone completing released from incarceration,

opioid detoxification

, treatment or who has been abstinent for a period of time.

People with

prescription opiates for medical conditions.Any programs working with staff or clients, or family members who fit these descriptions.Slide39

Where can I get Narcan?

Prescription from your medical providerCertified pharmacistsOrder from manufacturers http://prescribetoprevent.org/wp2015/wp-content/uploads/Naloxone-ordering-information-only.16_01_21.pdf Slide40

Applying Harm Reduction to shelter services: Opening doors and breaking down barriersSlide41

Harm Reduction applies to any behavior that is resulting in a negative consequence

(Not just substance use)In applying this to a shelter model the potential harm is that individuals would not be able to access shelter or be “kicked out” due to certain behaviorsSome behaviors that could result in this harm are related to substance use but others stem from things such as:

Domestic violence

Physical health (this can include malnutrition and exhaustion)

Behavioral health

Trauma

Education levelAnd many othersSlide42

Implementing HR at the Hartford No Freeze Shelter: 2017-2018 season

Policy and Procedure reflected Harm Reduction practice regarding shelter access, code of conduct, and suspension.Staff orientation included Harm Reduction philosophyEncouraged to work as a team, “switch out” with another staff if they could not successfully de-escalate a situationThe use of “time outs” for clients to “cool down”

Only asking a client to exit the facility if there was an immediate danger to staff, other clients or the facility with a referral to another shelter if possible

Staff were supported with 24/7 on-call

If client was an immediate danger escort them outside and call emergency personnel if necessary then call Program Manager

If client was not an immediate danger work to de-escalate and reintegrate into shelter and if needed call Program Manager as added supportSlide43

Types of behavior categorized by incidents recorded

Medical issue Intoxication where there is concern for safety of clientIntoxication/overdose where Narcan was administeredIntoxication/overdose where CPR was administration

Disruptive behavior (verbal altercations, threatening verbally, other outburst that were disruptive)

Contraband (possession of weapons, drug paraphernalia, drugs or alcohol)

Drug/alcohol use in building or on property

Indecent exposure or inappropriate physical contact

Physical altercation between clientsVerbal altercation or threatening staff verballyPhysical assault on staffThreatening to tamper w/fire alarmSlide44

Did it work?

551 unduplicated men were served and there were only 40 recorded incidences from December 1, 2016 – March 31, 2017The most common recorded incidents were for medical issues not directly related to substance use and clients returned from the hospital the next dayIn most cases clients were allowed back to the shelter the following day or within 1 weekIn four months we did not suspend/ban any individual for longer than one month (for physically assaulting a staff member)Slide45
Slide46

How to have a successful team

Provide the right training:De-escalation and Conflict resolutionMotivational interviewing/stages of changeSafety trainingHarm reduction

Trauma sensitivity

Cultural sensitivity

Narcan training

CPR/First Aid

Watch for signs of vicarious trauma, compassion fatigue, and general staff burnoutProvide support and appreciation to staffSupervision and all staff meetings Highlight successes and strengths Retreats, trainings, speakers on self careSlide47

Questions?

Contact: Mary Ann Haleymhaley@cceh.orgSarah Chessschess3@gmail.com

Shawn M

Lang

slang@aids-ct.org

Yolanda Potter

ypotter@mercyhousingct.org

Christie Corrigan

ChristieCorrigan@hotmail.com