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O F F I C E O F T H E A S S I S T A N T S E C R E T A R Y F O R H E A L T H Agenda – Syringe Service Programs: The Essential Roles of Non-Governmental and Community-Based Organizations Webinar Introduction: Sharon Ricks, OASH Region 4 Presentations: Daniel Raymond, Harm Reduction Coalition Chuck Wexler, Police Executive Research Forum Grace Keller, Howard Center Safe Recovery Webinar Q & A: Corinna Dan, OASH Office of Infectious Disease & HIV/AIDS Policy

The opinions, findings and conclusions expressed by speakers during this webinar are strictly their own and do not necessarily represent the opinion, views or policies of the Office of the Assistant Secretary for Health (OASH) and the Department of Health and Human Services (HHS); nor does mention of trade names, commercial practices, or organizations imply endorsement. References to publications, news sources, and non-Federal Websites are provided solely for informational purposes and do not imply endorsement by OASH or HHS. OASH and HHS assume no responsibility for the factual accuracy of the content of the individual organization found at non-Federal links. O F F I C E O F T H E 2 A S S I S T A N T S E C R E T A R Y F O R H E A L T H 2

COMPREHENSIVE SYRINGE SERVICES PROGRAMS: AN ESSENTIAL PART OF THE SYNDEMICS SOLUTION SSP participants are 5X more likely to enter drug treatment and 3.5X more likely to cease injecting compared to those who don’t use SSP programs O F F I C E O F T H E 3 https://www.cdc.gov/drugoverdose/pdf/pubs/2018-evidence-based-strategies.pdf A S S I S T A N T S E C R E T A R Y F O R H E A L T H 3

46 states, DC, and Puerto Rico have documented they have areas experiencing or at risk for increases of HCV/HIV O F F I C E O F T H E 4 A S S I S T A N T S E C R E T A R Y F O R H E A L T H 4 https://www.cdc.gov/pwid/vulnerable-counties-data.html

O F F I C E O F T H E https://www.hhs.gov/opioids/ 5 A S S I S T A N T S E C R E T A R Y F O R H E A L T H 5

HHS Blog – Substance Misuse, Infectious Disease, and the Powerful Potential of Syringe Service Programs “Comprehensive syringe services programs (SSPs) have the proven ability to help combat the opioid crisis and prevent the spread of infectious disease linked to ADM Brett P. Giroir, M.D. injection drug use.” Assistant Secretary for Health https://www.hhs.gov/blog/2019/11/06/substance- misuse-infectious-disease-powerful-potential-syringe- service-programs.html O F F I C E O F T H E 6 A S S I S T A N T S E C R E T A R Y F O R H E A L T H 6

HHS Resources Available to Support SSPs • Suite of materials available at www.cdc.gov/ssp • National Harm Reduction Technical Assistance and Syringe Services Program Monitoring and Evaluation recently awarded from CDC:  National Alliance of State and Territorial AIDS Directors (NASTAD) will develop a national network that provides harm reduction technical assistance responsive to the needs of states and local jurisdictions. • Support through Ryan White HIV/AIDS Program and the Substance Abuse Prevention and Treatment Block Grant O F F I C E O F T H E 7 A S S I S T A N T S E C R E T A R Y F O R H E A L T H 7

OASH Regional Office SSP Efforts Underway O F F I C E O F T H E 8 A S S I S T A N T S E C R E T A R Y F O R H E A L T H 8

Comprehensive Syringe Services Programs: Making Harm Reduction Work Daniel Raymond Deputy Director, Planning & Policy Harm Reduction Coalition raymond@harmreduction.org www.harmreduction.org @HarmReduction

CONTEXT: MORE THAN HIV PREVENTION • Outreach & engagement platforms • Sentinel sites & rapid response • Innovators on overdose response • Hub for comprehensive services 10

STATUS: ACTIVE POLICY SPACE AND RAPID DIFFUSION • Roughly 400 programs across the United States • Legal frameworks in roughly 3/4 of states • 80% of young people who inject drugs live at least 10 miles from nearest SSP 11

50-STATE STRATEGY Optimal Robust Implementation Policies Sustainable Supportive Financing Communities 12

ADVOCACY FOR OPTIMAL POLICIES • State legislation • Guidance and regulation • Building advocacy capacity • Leadership development 13

CAPACITY BUILDING FOR ROBUST IMPLEMENTATION • Training & technical assistance for new programs • Guidance on operational issues • Identification & dissemination of best practices and promising models 14

RESOURCE MOBILIZATION FOR SUSTAINABLE FINANCING • Innovative financing & funding streams (e.g. Medicaid, SAMHSA) • Analyzing resource & capacity gaps, impact • Advocacy for federal investments 15

ENSURING COMMUNITY SUPPORT • Messaging and communications to build a harm reduction constituency • Facilitating partnerships, coalitions • Meaningful involvement of people who use drugs, people in recovery, family members 16

KEY TACTICS • Convening and building networks (CASEN, IDUHA, HepConnect) • Expanding the range of services (NYS health hubs) • Meaningful involvement of people who use drugs (employment, advocacy) 17

OPPORTUNITIES FOR ADVANCING PROGRESS • Training, technical assistance, resources guides (SSP implementation manual, rural SSPs) • 2020 National Harm Reduction Conference https://harmreduction.org/conference/ 18

L a w E nfo rc e me nt a nd Syring e Se rvic e s Pro g ra ms CHUCK WE XL E R E XE CUT I VE DI RE CT OR, POL I CE E XE CUT I VE RE SE ARCH F ORUM

Pre vio us PE RF wo rk o n the 20 o pio id e pide mic  Ne w Cha lle ng e s fo r Po lic e : A He ro in E pide mic a nd Cha ng ing Attitude s T o wa rd Ma rijua na (2014)  Building Suc c e ssful Pa rtne rships b e twe e n L a w E nfo rc e me nt a nd Pub lic He a lth Ag e nc ie s to Addre ss Opio id Use (2016)  T he Unpre c e de nte d Opio id E pide mic : As Ove rdo se s Be c o me a L e a ding Ca use o f De a th, Po lic e , She riffs, a nd He a lth Ag e nc ie s Must Ste p Up T he ir Re spo nse (2017)  T e n Sta nda rds o f Ca re : Po lic ing a nd the Opio id Crisis (2018)

T e n Sta nda rds o f Ca re : 21 Po lic ing a nd the Opio id Crisis 7. T o re duc e HI V a nd he pa titis o utb re a ks, pro te c t o ffic e r he a lth, a nd he lp individua ls re a c h tre a tme nt, the sta nda rd o f c a re sho uld b e fo r De pa rtme nts to c o lla b o ra te with pub lic he a lth a nd c o mmunity-b a se d a g e nc ie s to suppo rt we ll-ma na g e d syring e se rvic e pro g ra ms.

Building Suc c e ssful Partne rships be twe e n L aw E nforc e me nt 22 and Public He alth Age nc ie s to Addre ss Opioid Use Advic e fro m the re po rt:  E mpha size tha t syring e se rvic e s pro g ra ms a re no t just a “drive -thru” fo r syring e s. T he y c o nne c t pe o ple with tre a tme nt se rvic e s a nd o the r lo ng e r-te rm a ssista nc e .  Disc uss o ffic e r sa fe ty a nd ho w syring e se rvic e s pro g ra ms c a n re duc e o ffic e rs’ risk o f ne e dle stic ks.  T a ke a g ra dua l a ppro a c h to g e t pe o ple c o mfo rta b le with the ide a .

Ca se Study: 23 Hunting to n, We st Virg inia  Po pula tio n 50,000  474 o ve rdo se s, 34 o f tho se fa ta l, in the first six mo nths o f 2015  I mple me nte d a ha rm re duc tio n pro g ra m tha t inc lude d:  Syring e e xc ha ng e  Na lo xo ne de plo yme nt

Ca se Study: 24 Hunting to n, We st Virg inia T hre e -ste p pro c e ss to b uild c o mmunity suppo rt:  Raise awar e ne ss a mo ng lo c a l o ffic ia ls a nd o the r c o mmunity me mb e rs, a ddre ssing b o th the mo ra l impe ra tive a nd the c o st-e ffe c tive ne ss o f ha rm re duc tio n pro g ra ms.  Build a c oalition o f suppo rte rs, o ne pe rso n o r o ne g ro up a t a time .  Have str ship a nd suppo rt fro m to p o ffic ia ls, ong le ade r to de mo nstra te o wne rship o f the pro b le m fro m the to p do wn.

25 Chuc k We xle r Po lic e E xe c utive Re se a rc h F o rum c we xle r@ po lic e fo rum.o rg www.po lic e fo rum.o rg

Grace Keller Program Coordinator Howard Center Safe Recovery

Our Approach Client-centered & non-judgmental • • Meet people where they are Drop-in services • Consistent hours • Needs based distribution • High positive regard for the client • • Anonymous and low barrier Diverse menu of options all under one roof • 27

Safe Recovery Services: • Syringe exchange • Community case management • Narcan/Naloxone distribution and overdose prevention education • Fentanyl testing strips • HIV and Hepatitis C testing and linkage to medical care • Drug treatment options counseling and referral • Low-barrier Buprenorphine treatment on site • Transportation assistance • Hepatitis A/B vaccinations • Legal clinic 28

Safe Recovery by the Numbers • >5,000 Members • >25,092 doses of Narcan distributed • >1,466 overdose reversals reported Source: Safe Recovery Data 2019 29

The most important aspect of a syringe service program is the human connection. 30