Sharon Stancliff, MDCaroline Rath, PA-CHarm Reduction CoalitionNew York, NYUSA

Overdoses are rarely instant There are often bystanders Naloxone is a safe and effective antidote

Many overdoses are preventable with prompt recognition and treatment

Sporer 2006

Overdose prevention: Makes drug user health a priority in diverse

settings Endorses idea of drug users as capable and

concerned with their community Expands benefits from harm reduction intervention

to other medical populations

Prevention: understanding the role of:◦ mixing drugs ◦ reduced tolerance◦ using alone

Overdose recognition Actions

◦ Call emergency services◦ Rescue breathing- using dummy◦ Naloxone administration

Syringe exchange/syringe access sites Homeless Shelters Hospitals

◦ Inpatient◦ Public Clinics

Drug Treatment◦ Methadone/Buprenorphine◦ Detoxification programs

HIV programs Jails/ Prisons and with the formerly incarcerated

SEPs serve a high risk population SEPs have trusting relationships with drug users

and have expertise in working with drug users including peer educators

Competition with existing programs for staff and resources Syringe exchange programs funding and staff is stretched and has a lot of turnover◦ Peer educators can be excellent trainers◦ Reinforcement of message often possible

SEPs usually do not have medical personnel able to prescribe medications on staff◦ Sharing paid medical staff, use of volunteer clinicians

14 syringe distribution programs offering overdose prevention

Over over 2,600 syringe exchange participants, trained at 14 syringe access sites

Reports of overdose reversals using naloxone: over 260

SKOOP 5/08

New York City Department of Health is promoting naloxone training and distribution in:

Detoxification units Methadone programs Buprenorphine programs

Recently detoxified patients are at high risk of overdose

Methadone & buprenorphine patients go in and out of treatment

These patients are in contact with other drug users

Use of other sedatives associated with death of opioid maintained patients

Wines 2007, Sporer 2006

May be interpreted as condoning/expecting drug use◦ Address it as a community issue- points of contact

Staff may not see drug users as capable of such an intervention

Staff often invested in abstinence model

6 programs including detoxification units, methadone and buprenorphine programs have registered. All City Hospitals and several more are preparing to register

1 methadone program has distributed over 200 kits

Being homeless is associated with risk of OD In NYC, leading cause of death among homeless

2005-2006 was OD (23%) Associated factors may be:

◦ Social and economic stress◦ Lack of safe, familiar place to inject

Using alone and rushing injection◦ Less access to opioid maintenance treatment

Driscoll 2001,NYCDOHMH

Creation of policies and procedures for large agency with wide diversity in settings

Medical providers not present in all facilities to dispense naloxone

Needles are not allowed in all shelters Fear of repercussions/ stigma around disclosing

drug use

NYC plan for homeless shelters: One staff member on every shift trained in

overdose response. Initial training of medical staff completed Training of staff as overdose responders imminent

Medical providers will offer training and intranasal naloxone to all interested clients in city funded shelters

1 shelter implemented training of staff immediately after legislation passed

42% of cumulative AIDS cases in NYS have injection drug use or sex with an IDU as a risk factor

People with advanced disease are at higher risk of overdose death

In impoverished areas of NYC, OD is leading cause of non-HIV death in persons with AIDS.

NYSDOH, Wang 2005, Sackoff 2006

Clients may be reluctant to disclose drug use◦ May be a bridge to further discussion of drug use

Serving DU needs may still be “controversial” Staff lack of experience and knowledge about

harm reduction and drug use issues Lack of medical personnel on staff for naloxone

6 programs in NYS have registered 4 have initiated services

Post incarceration is major risk factor for death from OD (10)

◦ Study of deaths in first 2 weeks post incarceration among 30,237 released inmates

◦ 129 times greater likelihood of dying of OD vs. other WA state residents

◦ Bingswaner 2007

Gaining entrée to system Inability to give naloxone, must arrange for follow

up after release Institutional discomfort with the harm reduction

model Persons on parole are forbidden to access harm

reduction services

NYC Department of Health:◦ Plan to include OD prevention education with all intakes

for opioid maintenance or detoxification at the city jail◦ Some OD training done of NYCDOH counselors working

jail settings Outreach :

◦ Harm Reduction Coalition working with 3 service organizations working with the formerly incarcerated

Hospitals see patients admitted with drug related illnesses

Overdose prevention training not only addresses overdose risk but can build patient-provider relationship

Program is new with low volume but very acceptable to medical residents

Implementation of overdose prevention programs appears to be more acceptable to many agencies than provision of syringes

Core elements of the training can be adapted to many settings

Discussion of overdose prevention can contribute to patient/provider relationship & lead to discussions of drug treatment

Injection Drug Users Health Alliance New York City Department of Health and Mental

Hygiene New York State Department of Health