SAFE INJECTION SERVICES TASK FORCE MEETING 2 JULY 21 ST , 2017 - PowerPoint PPT Presentation

SAN FRANCISCO SAFE INJECTION SERVICES TASK FORCE MEETING 2 • JULY 21 ST , 2017 • 9AM - 11AM • 25 VAN NESS AVE RM 610 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH

AGENDA  WELCOME & AGENDA REVIEW  MEETING 1 FINDINGS & THEMES  COMMUNITY SURVEY FINDINGS  SIS MODELS AROUND THE WORLD  DISCUSSION  PUBLIC COMMENT  CLOSING & NEXT STEPS JULY 21, 2017 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 2

TASK FORCE KEY DATES 2017 ACTIVITIES TOPICS JUNE 15 AUGUST 10 SEPTEMBER 2017 JULY 21 MEETING 1 MEETING 2 MEETING 3 RELEASE FINAL REPORT JUNE JULY AUGUST SEPTEMBER ■ DEVELOP & FINALIZE POLICY ■ DISCUSSION ■ DEVELOP POLICY RECOMMENDATIONS RECOMMENDATIONS • Injection Drug Use & Harm • Business & Neighborhood • PWID Survey Results Reduction in San Francisco Focus Group Results • Safe Injection Service Models • About Safe Injection Services • HR360 Survey Results • Operations & Service • Benefits and Risks • Location and Siting Considerations Considerations JUNE 15, 2017 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 3

MEETING 1 FINDINGS &THEMES JULY 21, 2017 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 4

MEETING 1 FINDINGS & THEMES: TASK FORCE DISCUSSION BENEFITS  Increasing access to compassionate and quality health care services and substance use treatment for people who inject drugs (PWID)  Improving health outcomes for people who inject drugs by providing a safe, clean, and welcoming space  Reducing stigma towards people who inject drugs and injection drug use behaviors, and develop a more informed public community JULY 21, 2017 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 5

MEETING 1 FINDINGS & THEMES: TASK FORCE DISCUSSION BENEFITS (CONTINUED)  Increasing collective healing, commitment, and impact , including opportunities for people who inject drugs to reach sobriety and regain productive lives  Disseminating safer injection drug use practices in drug user community  Improve, expand, and sustain the system of care ’s operations, outreach, and integration of services. JULY 21, 2017 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 6

MEETING 1 FINDINGS & THEMES: TASK FORCE DISCUSSION OBSTACLES  Federal and state legal environment and the enforcement of those laws  Limited funding and resources for sustainable and robust safe injection services  People who inject drugs fearful of government, law enforcement, and system of care JULY 21, 2017 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 7

MEETING 1 FINDINGS & THEMES: TASK FORCE DISCUSSION OBSTACLES (CONTINUED)  Negative public perceptions and misinformation about safe injection services that reinforce stigma and opposition  Varying needs and viewpoints among those in early recovery JULY 21, 2017 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 8

MEETING 1 FINDINGS & THEMES: TASK FORCE DISCUSSION OTHER CONSIDERATIONS  It is important that SF adapt safe injection services models to fit the diverse needs and cultures of people who inject drugs , including peer-based models.  SF must continue being a national leader in harm reduction by demonstrating safe injection services as a way to address the opioid epidemic .  Training and support of safe injection services staff is crucial to its success. JULY 21, 2017 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 9

MEETING 1 FINDINGS & THEMES: PUBLIC COMMENT & FORMS  Largely in support of SF implementing safe injection services as a way to improve health outcomes and community benefits.  SF should consider expanding the conversation to include other drug consumption behaviors .  Safe injection services is an effective way to reduce criminality and link PWID to a network of health and social services .  The current conversation needs to be more inclusive of additional oppressed and marginalized communities . JULY 21, 2017 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 10

COMMUNITY SURVEY FINDINGS JULY 21, 2017 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 11

COMMUNITY SURVEY FINDINGS RTI NATIONAL PUBLIC DRUG SFDPH COMMUNITY USE SURVEY HEALTH RESPONSE TEAM JULY 21, 2017 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 12

ACCEPTABILITY OF A SAFER CONSUMPTION SITE AMONG PEOPLE WHO INJECT DRUGS IN SAN FRANCISCO Alex H. Kral, Lynn Wenger, Lisa Carpenter, Evan Wood, Thomas Kerr, & Philippe Bourgois OVERVIEW DEMOGRAPHICS  Targeted sample of PWID (n=602)  Jan-Oct 2008 AGE GENDER  Interviews from 3 main SF neighborhoods  20min Computer Assisted Personal Interviewing 41% 73% 35% 24% 26% 1% KEY FINDINGS Drug Use: In the 30 days prior to the survey, participants <39 40-49 50+ Male Female Intersex reported if they had injected: heroin 78% RACE / ETHNICITY methamphetamine 38% 44% Speedball 37% 38% cocaine 16% 5% 4% 1% crack 10% 14% Goofball White Black Latino Native American Other API 14%

NATIONAL PUBLIC DRUG USE SURVEY: A STUDY ON PUBLIC DRUG USE, RISK BEHAVIOR, AND SAFER DRUG USE SPACES OVERVIEW DEMOGRAPHICS  Cross-sectional observational study design (n=747) GENDER AGE  November 2016 to March 2017  Convenience sample of participants enrolled in harm reduction programs across 10 cities (12 unique sites) 36% 68%  Cities include San Francisco, Oakland, Los Angeles, 31% 25% Denver, Minneapolis, Washington D.C., Atlantic City, New York City, Paterson, and Boston 30% 8% 2% KEY FINDINGS FROM SF SAMPLE (n=198) <30 30-39 40-49 50+ Male Female Trans Drug Use: In the 3 months prior to the survey, participants reported if they had ever used: Ever Daily RACE/ETHNICITY methamphetamine 75% 49% heroin 74% 63% 48% crack 53% 47% opioid analgesics 41% 26% 32% methadone 36% 75% 11% 35% 29% 8% cocaine benzodiazepines 31% 13% White Black Latinx Other

CHEP SAFE INJECTION SERVICES SURVEY RESULTS OVERVIEW DEMOGRAPHICS  In-person interviews with PWID in SF (n=40)  Gender May 23 to June 7, 2017 AGE  10-20 min surveys in the field 5% <20  3 neighborhoods 30% 21-30 35% Female • Tenderloin (13 interviews) 40% 31-40 • Civic Center (12 interviews) 41-50 12.5% Male 57% • South of Market (15 interviews) 7.5% 51-60 2.5% 61-70 KEY FINDINGS 8% Transgender 2.5% 71-80 Drug Use: Participants reported they had injected: heroin 65% more than 1 65% Race/Ethnicity methamphetamine 58% crack 25% 36% 34% Speedball 28% cocaine 25% 15% Dilaudid 5% 4% 2% 8.5% alcohol 3% Ketamine White African Latinx API Native Other 3% Amercian American

WHERE PEOPLE REPORT INJECTING PUBLIC LOCATIONS PRIVATE LOCATIONS   STREETS OR ALLEYS OTHER’S APARTMENT, HOTEL ROOM, OR TENT   PARKS OWN APARTMENT, HOTEL ROOM, OR TENT   PUBLIC BATHROOMS ABANDONED BUILDINGS   PUBLIC TRANSPORTATION VEHICLES  STAIRWELLS OR HALLWAYS JULY 21, 2017 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 16

WILLINGNESS TO USE SAFE INJECTION SERVICES  AT LEAST 85% OF PEOPLE WHO INJECT DRUGS REPORT THEY WOULD USE SAFE INJECTION SERVICES RTI 85% 15% NPDUS 90% 10% CHEP 98% 2% WOULD USE WOULD NOT USE JULY 21, 2017 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 17

WILLINGNESS TO USE SAFE INJECTION SERVICES  AT LEAST 3 OUT OF 4 PEOPLE WHO INJECT DRUGS REPORT THEY WOULD USE SAFE INJECTION SERVICES MULTIPLE TIMES A WEEK RTI 63% 18% 10% 8% CHEP 50% 26% 13% 11% DAILY 3-6 TIMES/WK 1-2 TIMES/WK LESS THAN WEEKLY JULY 21, 2017 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 18

PREFERRED HOURS OF OPERATION RTI PREFERRED HOURS BY PERCENT OF RESPONSES NBDUS CHEP 55% 62% 35% 30% 35% 33% 23% 20% 16% 22% 20% 18% 16% 15% 5% 8am 9am 10am 11am 12pm 1pm 2pm 3pm 4pm 5pm 6pm 7pm 8pm 9pm 10pm 11pm 12am 1am 2am 3am 4am 5am 6am 7am 24 hrs

OTHER SERVICES “WHAT OTHER SERVICES WOULD MAKE IT MORE INVITING FOR COMMUNITY MEMBERS TO USE THE SPACE?” FOOD 45% SHOWER 45% MENTAL HEALTH COUNSELORS 43% MEDICAL CARE 30% INJECTION SUPPLIES 28% PLACE TO HANG OUT 25% CASE MANAGEMENT 20% HOUSING 13% ACCESS TO DRUG TREATMENT 13% BATHROOMS 10% CLOTHING 10% VOCATIONAL 10% HIV/HEP C TESTING 10% 20 JULY 21, 2017 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH

STAFFING & ENVIRONMENT “WHAT WOULD MAKE YOU FEEL SAFE AND TRUST A PLACE THAT OFFERS THIS SERVICE? GENERAL THEMES  positive staff attributes: friendly, non-judgmental, trustworthy, down to earth, understanding, can relate  ex-addicts, peers, and community members as staff  general safety (for vulnerable populations, OD prevention, safety from stealing and rules to ensure safety)  a comfortable and inviting environment  services that provide comfort  harm reduction and links to treatment 21 JULY 21, 2017 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH

COMMON THEMES ACROSS 3 SURVEYS THE MAJORITY OF SURVEY RESPONDENTS:  indicated willingness to use SIS if available  who reported injecting in public locations , reported injecting in streets, parks, alleys  expressed interest in other on-site services  desired linkages to other services  emphasized the importance that SIS include a peer component  preferred that SIS be open 24 hours a day or during regular business hours JULY 21, 2017 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 22

SAFE INJECTION SERVICE MODELS AROUND THE WORLD JULY 21, 2017 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 23