Transcript Syringe Access and Syringe Type Issues in Durham, NC

THE NEED FOR HARM REDUCTION
IN NORTH CAROLINA
North Carolina Harm Reduction Coalition
NORTH CAROLINA HARM
REDUCTION COALITION
North Carolina Harm Reduction Coalition (NCHRC) is North
Carolina’s only comprehensive harm reduction program. NCHRC
engages in grassroots advocacy, resource development, coalition
building and direct services for law enforcement and those made
vulnerable by drug use, sex work, overdose, immigration status,
gender, STIs, HIV and hepatitis.
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NORTH CAROLINA HARM REDUCTION COALITION
OVERVIEW
• Harm Reduction
• Syringe Access and Injection Drug Use (IDU)
• Crack Use
• Overdose Prevention
• Ethics
• 4 Pillars
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NORTH CAROLINA HARM REDUCTION COALITION
HARM REDUCTION
• Harm reduction is a way of preventing disease
and promoting health that “meets people where
they are” rather than making judgments about
where they should be in terms of their
personal health and lifestyle.
• This is based of the behavioral health theory
“stages of change.”
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NORTH CAROLINA HARM REDUCTION COALITION
HARM REDUCTION
Accepting that not everyone is ready or able to stop
risky or illegal behavior, harm reduction focuses on
promoting scientifically proven ways of mitigating
health risks associated with drug use and other high risk
behaviors, including condom distribution, access to
sterile syringes, medications for opioid dependence such
as methadone and buprenorphine, and overdose
prevention.
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NORTH CAROLINA HARM REDUCTION COALITION
ISSUE SPOTLIGHT:
WHO NEEDS/USES SYRINGES
• Diabetics (680,000-820,000)
• HIV+ (35,000)
• HBV/HCV+ (+/-750,000, of which 120,000 know their status)
• Cancer Patients
• People taking hormone replacement therapy
• Multiple Axis 3 Issues
• IDUs +/- 50,000 IDUs
•
IDUs are injecting: Pills, hormones, vitamins + street drugs
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NORTH CAROLINA HARM REDUCTION COALITION
WHERE DO PEOPLE GET THEIR
SYRINGES IN NORTH CAROLINA
Doctor (Get a prescription)
Friends/Associates
The Underground Syringe Exchange
Legal Syringe Exchange in Another State/District (DC/NYC)
Pharmacies (Pharmacists have right in NC to decide who gets one)
Drug Dealer
Discarded syringe at a known IDU site
Acquire them from health care sites (sympathetic staff or steal them)
Biohazard Containers
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NORTH CAROLINA HARM REDUCTION COALITION
WHAT ELSE ARE WE WORRIED
ABOUT WITH IDUS?
• Cookers
• Cottons
• Tourniquets,
shoelaces, belts
• Water
• Crack/meth pipes
• Choy
• Other drug use
equipment
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NORTH CAROLINA HARM REDUCTION COALITION
PROBLEM WITH A LACK OF
SYRINGE ACCESS
HIV/AIDS - ($340,000-$620,000 per infection)
35,000 people have HIV/AIDS in NC
HBV/HCV ($80,000-500,000 per infection)
Up to 750,000 people have HBV or HCV in NC
Law Enforcement Needlesticks (33% get a needlestick, 28% get multiple)
Health Care Provider Needlesticks every 30 seconds someone gets a stick,
some require PEP, which costs >$4,500
Overdose (#4 cause of death in NC), which cost >$6,000 per case
When people reuse syringes they get abscesses that cost >$2,000 per case
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NORTH CAROLINA HARM REDUCTION COALITION
WHAT ELSE ARE WE WORRIED
ABOUT WITH IDUS?
Access to Treatment
Access to Methadone/Bupe
Access to Overdose Prevention Education
Access to Narcan
Access to HIV/Hep B +C Services
Access to housing, medical services, food, jobs, etc.
Stigma
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NORTH CAROLINA HARM REDUCTION COALITION
SYRINGE ACCESS ISSUES IN THE
TRIANGLE
2009 STUDY FROM RTI:
Racial differences in acquisition of syringes from pharmacies under conditions of legal but
restricted sales
Elizabeth C. Costenbadera,∗, William A. Zule, Curtis C. Coomes
Result: In our study sample, African-American IDUs were one-fifth as likely as white
IDUs to report pharmacies as their primary source of syringes in NC.
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NORTH CAROLINA HARM REDUCTION COALITION
THE PROBLEM WITH SHARING
SYRINGES
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NORTH CAROLINA HARM REDUCTION COALITION
CRACK USE
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According to the DEA Crack is used by 2% of NC
A lot of crack users get exposed to HCV by sharing their
crack pipes
Difficult to work with population
Operate “after hours”
High risk for STIs
Harm reduction programs prevent crack users from getting
HIV, HCV and STIs
HCV can be prevented by providing rubber tips (or spark
plug covers) on pipes or by promoting rubber band use
Harm Reduction Programs refer crack users to drug
treatment
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NORTH CAROLINA HARM REDUCTION COALITION
OVERDOSE
• #4 cause of death for 18-49 year olds in NC
• NC Doctors wrote 17million known scripts for NC’s 9 million residents in
2010
HARM REDUCTION
• Overdose can be prevented by providing overdose prevention training, as
well as community initiatives to anyone who use prescription or illegal
drugs or is likely to do so (people in drug tx, corrections, seniors, etc)
• Overdose can be prevented with the passing of Good Samaritan laws that
protect people who call 911
• Overdose can be prevented by having doctors use controlled substance
registry
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NORTH CAROLINA HARM REDUCTION COALITION
ETHICS
Does harm reduction promote drug use?
No, in fact in communities with harm reduction programs the following
occur:
• Drug use goes down
• Amount of people who access drug treatment goes up
• Crime goes down
• Average age of first drug use goes up
• Increase in HIV, HCV & STI testing
• HIV and Hepatitis incidence goes down
• Decrease in overdose rates
SOURCE: NIH & CDC
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NORTH CAROLINA HARM REDUCTION COALITION
4 PILLARS
• Drug use is not going to end and is a part of human culture whether we
agree with it or not.
• Thus a comprehensive approach is necessary to decrease the negative
health outcomes
The 4 Pillars Solution
• Drug Prevention, Harm Reduction, Drug Treatment and Law
Enforcement need to work together, not against each other to fight this
the negative impacts of drug use
• This has worked to much success in Vancouver, Switzerland and New
Mexico.
• NCHRC currently operates using this framework as its operating principle
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NORTH CAROLINA HARM REDUCTION COALITION
NORTH CAROLINA HARM
REDUCTION COALITION
Robert Childs, MPH
Executive Director
NCHRC, PO BOX 13761, Durham, NC, 27709
336-543-8050
[email protected]
http://www.nchrc.org
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NORTH CAROLINA HARM REDUCTION COALITION