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  • Writer's pictureOakley Neighborhood Association

Presentation: Harm Reduction: More Than Needles 1.27.22

Oakley Neighborhood Association

Presenter: Amy Upham w/ Eleanor Health Foundation

The Eleanor Health Foundation seeks to expand equitable access to care.

  • They do not turn people away who are still using/in process of recovery.

  • Seek to increase recovery capital meaning helping those who desire recovery find resources, housing, clothing, etc.

Goals for this presentation

1. Create a framework for Substance Use Disorder in the context of a trauma response approach.

2. Review physiology, history and demographics of the overuse epidemic within the context of the “Death of Despair” public health crisis.

3. Define and explore the philosophy of harm reduction, including its relationship to the step and recovery models.

4. Discuss options individuals have to address Substance Abuse Disorder and reduce harm regarding their substance use.

5. Review Naloxone FAQ’s.

6. Learn benefits of Syringe Services Program.

7. Receive and introduction to Housing First.

Risk Factors for Developing Substance Use Disorder

  • Biology: men are more likely than women.

  • Mental health struggles.

  • Trauma: influence of and triggers.

  • Access to drugs.

  • Lack of family involvement.

  • Age at first use: the younger the age of first use, the more likely substance abuse becomes.

Trauma: Main factor for developing Substance Use Disorder

ACE : Adverse Childhood Experience

  • One of the strongest predicting factors for future substance issue.

  • ACE can be emotional, physical, sexual abuse, divorce, neglect, parent w/mental illness, incarceration, racism, etc.

  • People with % or more ACE’s were 7-10 times more likely to have illicit drug problems

  • 81% of women and 69% of men with opioid disorder report physical/sexual abuse starting at age 13 and 11 respectively.

  • Men with OUD (opioid use disorder) more likely to report abuse before age 17.

ACE→Social, emotional, cognitive impairment→adoption of health-risk behaviors→disease, disability, and social problem→early death

Before COVID, opioid overdose and suicide led to decline in life expectancy for 1st time in generations, since COVID, overdose rates have risen - why?

  • Economic stagnation.

  • Rising medical costs.

  • Decrease in immigration.

  • Availability of lethal means (guns, opioids, benzos, etc): states with stricter gun regulations show lower suicide rates.

Principles of Trauma Informed Response

  • Safety, trust, choice, collaboration, empowerment.

  • Ask ‘what’s right with you?’ instead of ‘what’s wrong with you?

  • Avoid actions that could re-traumatize/negatively impact the individual

  • Promote patient-centered, evidence based care.

  • Provide care that is sensitive to the patient’s racial, ethnic, cultural background/gender identity, etc.

*Risks for continued use rises quickly: The number of days supply of first opioid prescription correlates to probability of continuing use→longer the supply, higher the probability.

*Overdose - mostly Fentanyl, but meth is rising.

Harm Reduction

Definition: an evidence-based approach to reducing harms, such as infectious disease and overdose, that can come with injection drug use. It focuses on quality of life vs. an abstinence only approach, which has a low success rate for opioid use.

1. Principles

  • Accepts, for better and/or worse, that licit and illicit drug use is part of our world and chooses to minimize its harmful effects rather than simply ignore or condemn them.

  • Calls for non-judgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm.

  • Ensures that drug users and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them.

  • Does not attempt to minimize or ignore the real and tragic harm and danger associated with licit and illicit drug use.

2. Recovery Principles and Harm Reduction

  • Recovery emerges from hope.

  • Recovery is person-driven.

  • Recovery occurs via many pathways.

  • Recovery is holistic.

  • Recovery is supported by peers and allies.

  • Recovery is supported through relationship and social networks.

  • Recovery is culturally-based and influenced.

  • Recovery is supported by addressing trauma.

  • Recovery involves individual, family, and community strengths and responsibility.

  • Recovery is based on respect.

3. Can People Who Use Choose?

  • Is it a brain disease? If so, do people have a choice?

  • The Founding story of Friends of Bill.

  • It is a both/and situation.

  • People retain some choice everyday, no matter how severe their addiction, unless they overdose.

  • “Any positive change.”

4. Examples of Harm Reduction

  • Naloxone: 886 lives saved by lay people in Bun.Co. in 2019 alone.

  • Who has Naloxone?

    • Buncombe County Health Department

    • Western North Carolina AIDS Project

    • Steady Collective

    • Holler Harm Reduction

  • No prescription needed, can get it at Walgreens, Sona, etc.

Naloxone Administration

Check for signs of overdose:

  • Gagging, gurgling, choking sounds.

  • Not breathing, or very shallow, slow breathing.

  • Blue or grey lips, fingertips.

  • Unconscious.

  1. Call 911 if overdose suspected.

  2. Administer first dose of Naloxone (in nostril if nasal, in thigh/buttock/arm if injectable).

  3. Give rescue breaths- at least one every 5 seconds.

  4. If not breathing and conscious within 2-3 minutes, administer second dose of Naloxone.

  5. Continue rescue breaths until help arrives.

  6. Urge individual to transport to hospital or stay with individual for 3 hours.

*No documented cases of overdose of first responders due to routine duties, such as touching individuals during overdose or administering rescue breaths.

Syringe Exchange

  • Reduces Hepatitis C by 50%, HIV by 80%

  • Individuals who use needle exchange 5 times more likely to enter treatment.

  • Can facilitate referral to health care and social services.

  • Education.

  • Reducing communicable disease.

  • IV drug use and Infectious disease: 900% rise in Hep C 2007-2016, 84% of those indicated injection drug use.

Connecting People to Care through Syringe Exchange

  • Recovery resources:

    • Social determinants of health

    • Peer support

    • Faith groups

    • Education

    • Counseling: cognitive processing therapy/somatic therapies

  • Medical

    • Buprenorphine

    • Methadone

    • Naltrexone

    • Treat sexual dysfunction

    • Treat hep C/HIV

*Cost savingsL 1 needle costs .04 cents, Hep C treatment $$$

Regional Success

  • Syringe exchange and services- WNCAP, Health Department, Steady Collective, Holler.

  • Post overdose response team - EMS.

  • Linkage to care re-entry program - Sunrise.

  • Social Determinants of Health Scholarships - Eleanor Health Foundation.

  • Medication Assisted Treatment- MAHEC, AMCHC, WNCCHS, Eleanor Health.

Housing First

A philosophy and practice which believes that:

  • Housing is first and foremost a housing problem.

  • Housing is a right to which all are entitled.

  • The issues that contributed to one’s homelessness can best be addressed once housed.

Are we housing first?

  • Are the applicants allowed to enter the program without income?

  • Are applicants allowed to enter the program even if they are not ‘clean and sober’ or ‘treatment compliant’?

  • Are applicants allowed to enter the program even if they have criminal justice system involvement?

  • Are service and treatment plans voluntary such that tenants cannot be evicted for not following them?

The Myth of Enabling

1. Reduces use of emergency services:

  • 2009 Seattle study found a 76% decrease in medical and crisis care costs.

  • Moore Place in Charlotte saw an 81% reduction in the use of emergency rooms in 2 years following housing.

  • 2017 Mission Hospital research found a 54%decrease in hospital use for Homeward Bound’s Permanent Supported Housing residents.

2. Promotes recovery:

  • Lowers rates of stimulant and opioid use at 1 year follow up (Davidson).

  • Better outcomes when individuals served have input into the program (Davidson).

  • Research shows incorporating peer support specialists can lower alcohol usage.

  • A 2 year longitudinal study of those with Alcohol Use Disorder placed in a housing first program found a 43% decrease in suicidology (Collins).

Harm Reduction in Mental Health

  • Harm Reduction as it applies to prescribed mood-altering medications means not being “pro” or “anti” medication, but “supporting people where they are at to make their own decisions, balancing the risks and benefits involved” (Freedom Center, Icarus Project).

  • Harm Reduction for users/survivors/ex-patients can also include:

    1. Elimination of seclusion and restraint (NARPA).

    2. Elimination of forced electroshock (NARPA).

    3. Full informed consent of side effects of medications (including long-term consequences) (Mad in America, Psych Rights).

    4. Challenging involuntary psychiatric detention (Bazelon Center for Mental Health Law).

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