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

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

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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 &

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SLIDE 1

SAN FRANCISCO SAFE INJECTION SERVICES TASK FORCE

MEETING 2

  • JULY 21ST, 2017 • 9AM-11AM • 25 VAN NESS AVE RM 610

SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH

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SLIDE 2

AGENDA

  • WELCOME & AGENDA REVIEW
  • MEETING 1 FINDINGS & THEMES
  • COMMUNITY SURVEY FINDINGS
  • SIS MODELS AROUND THE WORLD
  • DISCUSSION
  • PUBLIC COMMENT
  • CLOSING & NEXT STEPS

SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 2 JULY 21, 2017

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SLIDE 3

TASK FORCE KEY DATES 2017

3 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

JUNE JULY AUGUST SEPTEMBER

JUNE 15

MEETING 1

JULY 21

MEETING 2

SEPTEMBER 2017

RELEASE FINAL REPORT

■ DISCUSSION

  • Injection Drug Use & Harm

Reduction in San Francisco

  • About Safe Injection Services
  • Benefits and Risks

ACTIVITIES TOPICS

■ DEVELOP POLICY

RECOMMENDATIONS

  • PWID Survey Results
  • Safe Injection Service Models
  • Operations & Service

Considerations

■ DEVELOP & FINALIZE POLICY

RECOMMENDATIONS

  • Business & Neighborhood

Focus Group Results

  • HR360 Survey Results
  • Location and Siting

Considerations

AUGUST 10

MEETING 3

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SLIDE 4

MEETING 1 FINDINGS &THEMES

SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 4 JULY 21, 2017

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SLIDE 5

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

SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 5 JULY 21, 2017

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SLIDE 6

MEETING 1 FINDINGS & THEMES: TASK FORCE DISCUSSION

BENEFITS (CONTINUED)

  • Increasing collective healing, commitment, and impact, including
  • pportunities 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,
  • utreach, and integration of services.

SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 6 JULY 21, 2017

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SLIDE 7

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

SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 7 JULY 21, 2017

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SLIDE 8

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

SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 8 JULY 21, 2017

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SLIDE 9

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

  • pioid epidemic.
  • Training and support of safe injection services staff is crucial to its

success.

SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 9 JULY 21, 2017

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SLIDE 10

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
  • ppressed and marginalized communities.

SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 10 JULY 21, 2017

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SLIDE 11

COMMUNITY SURVEY FINDINGS

SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 11 JULY 21, 2017

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SLIDE 12

COMMUNITY SURVEY FINDINGS

RTI

NATIONAL PUBLIC DRUG USE SURVEY SFDPH COMMUNITY HEALTH RESPONSE TEAM

JULY 21, 2017 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 12

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SLIDE 13

OVERVIEW

  • Targeted sample of PWID (n=602)
  • Jan-Oct 2008
  • Interviews from 3 main SF neighborhoods
  • 20min Computer Assisted Personal Interviewing

KEY FINDINGS Drug Use: In the 30 days prior to the survey, participants reported if they had injected:

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

24% 41% 35% <39 40-49 50+

AGE

73% 26% 1% Male Female Intersex

GENDER

44% 37% 10% 4% 5% 1%

White Black Latino Native American Other API

RACE / ETHNICITY

DEMOGRAPHICS

14% 14% 16% 38% 38% 78%

heroin methamphetamine Speedball cocaine crack Goofball

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SLIDE 14

OVERVIEW

  • Cross-sectional observational study design (n=747)
  • November 2016 to March 2017
  • Convenience sample of participants enrolled in harm

reduction programs across 10 cities (12 unique sites)

  • Cities include San Francisco, Oakland, Los Angeles,

Denver, Minneapolis, Washington D.C., Atlantic City, New York City, Paterson, and Boston KEY FINDINGS FROM SF SAMPLE (n=198) Drug Use: In the 3 months prior to the survey, participants reported if they had ever used:

8% 25% 31% 36%

<30 30-39 40-49 50+

AGE

68% 30% 2%

Male Female Trans

GENDER

48% 32% 11% 8%

White Black Latinx Other

RACE/ETHNICITY

NATIONAL PUBLIC DRUG USE SURVEY: A STUDY ON PUBLIC DRUG USE, RISK BEHAVIOR, AND SAFER DRUG USE SPACES

methamphetamine heroin crack

  • pioid analgesics

methadone cocaine benzodiazepines

31% 35% 36% 41% 53% 74% 75% 13% 29% 75% 26% 47% 63% 49%

Ever Daily

DEMOGRAPHICS

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SLIDE 15

36% 34% 15% 8.5% 4% 2% White African Amercian Latinx API Native American Other

Race/Ethnicity DEMOGRAPHICS

CHEP SAFE INJECTION SERVICES SURVEY RESULTS

2.5% 2.5% 7.5% 12.5% 40% 30% 5%

71-80 61-70 51-60 41-50 31-40 21-30 <20

AGE

KEY FINDINGS

Drug Use: Participants reported they had injected:

8% 57% 35%

Transgender Male Female

Gender

OVERVIEW

  • In-person interviews with PWID in SF (n=40)
  • May 23 to June 7, 2017
  • 10-20 min surveys in the field
  • 3 neighborhoods
  • Tenderloin (13 interviews)
  • Civic Center (12 interviews)
  • South of Market (15 interviews)

heroin more than 1 methamphetamine crack Speedball cocaine Dilaudid alcohol Ketamine

3% 3% 5% 25% 28% 25% 58% 65% 65%

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SLIDE 16

WHERE PEOPLE REPORT INJECTING

PUBLIC LOCATIONS PRIVATE LOCATIONS

  • STREETS OR ALLEYS
  • PARKS
  • PUBLIC BATHROOMS
  • PUBLIC TRANSPORTATION
  • OTHER’S APARTMENT, HOTEL ROOM, OR TENT
  • OWN APARTMENT, HOTEL ROOM, OR TENT
  • ABANDONED BUILDINGS
  • VEHICLES
  • STAIRWELLS OR HALLWAYS

JULY 21, 2017 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 16

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SLIDE 17

WILLINGNESS TO USE SAFE INJECTION SERVICES

  • AT LEAST 85% OF PEOPLE WHO INJECT DRUGS REPORT THEY

WOULD USE SAFE INJECTION SERVICES

98% 90% 85% 2% 10% 15% CHEP NPDUS RTI

WOULD USE WOULD NOT USE

JULY 21, 2017 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 17

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SLIDE 18

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

50% 63% 26% 18% 13% 10% 11% 8% CHEP RTI

DAILY 3-6 TIMES/WK 1-2 TIMES/WK LESS THAN WEEKLY

JULY 21, 2017 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 18

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SLIDE 19

PREFERRED HOURS OF OPERATION

62% 22% 16% 16% 20% 33% 35% 18% 23% 15% 5% 20% 35% 30% 55%

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

PREFERRED HOURS BY PERCENT OF RESPONSES

RTI NBDUS CHEP

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SLIDE 20

OTHER SERVICES

20

FOOD SHOWER MENTAL HEALTH COUNSELORS MEDICAL CARE INJECTION SUPPLIES PLACE TO HANG OUT CASE MANAGEMENT HOUSING ACCESS TO DRUG TREATMENT BATHROOMS CLOTHING VOCATIONAL HIV/HEP C TESTING

JULY 21, 2017 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH

“WHAT OTHER SERVICES WOULD MAKE IT MORE INVITING FOR COMMUNITY MEMBERS TO USE THE SPACE?”

10% 10% 10% 10% 13% 13% 20% 25% 28% 30% 43% 45% 45%

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SLIDE 21

STAFFING & ENVIRONMENT

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

“WHAT WOULD MAKE YOU FEEL SAFE AND TRUST A PLACE THAT OFFERS THIS SERVICE?

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SLIDE 22

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

22

COMMON THEMES ACROSS 3 SURVEYS

JULY 21, 2017 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH

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SLIDE 23

SAFE INJECTION SERVICE MODELS AROUND THE WORLD

SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 23 JULY 21, 2017

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SLIDE 24

SAFE INJECTION SERVICE MODELS AROUND THE WORLD

SAFE INJECTION SERVICES

Professionally supervised facilities where drug users can inject pre-obtained drugs in safer conditions

SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 24 JULY 21, 2017

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SAFE INJECTION SERVICE MODELS AROUND THE WORLD

  • TERMS USED TO DESCRIBE FACILITIES THAT PROVIDE SAFE

INJECTION SERVICES

  • Supervised Injection Facilities (SIFs)
  • Safe Consumption Facilities (SCFs)
  • Drug Consumption Rooms (DCRs)
  • Supervised Consumption Services (SCS)

SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 25 JULY 21, 2017

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SLIDE 26

SAFE INJECTION SERVICE MODELS AROUND THE WORLD

  • GOALS & PRIORITIES OF SAFE INJECTION SERVICES
  • attract hard-to-reach populations of drug users
  • reduce morbidity and mortality by providing a safe environment for

more hygienic drug use

  • provide education on safe injection practices
  • reduce public drug use
  • improve public areas surrounding urban drug markets
  • promote access to social, health, and drug treatment facilities

SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 26 JULY 21, 2017

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SLIDE 27

SAFE INJECTION SERVICE MODELS AROUND THE WORLD

SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 27 JULY 21, 2017

AUSTRALIA CANADA DENMARK FRANCE GERMANY LUXEMBOURG NETHERLANDS NORWAY SPAIN SWITZERLAND USA TOTAL

# OF SITES ONE √ √ 2 MULTIPLE √ √ √ √ √ √ √ √ 8 NONE & EXPLORING √ 1

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SLIDE 28

JULY 21, 2017 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 28

SAFE INJECTION ROOM - MONTREAL

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SLIDE 29

JULY 21, 2017 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 29

SAFE INJECTION ROOM - VANCOUVER

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SLIDE 30

JULY 21, 2017 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 30

SAFE INJECTION ROOM - FRANCE

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SLIDE 31

JULY 21, 2017 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 31

SAFE INJECTION ROOM - AUSTRALIA

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SLIDE 32

JULY 21, 2017 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 32

SIS FLOOR PLAN - AUSTRALIA

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SLIDE 33

JULY 21, 2017 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 33

SIS FLOOR PLAN - AUSTRALIA

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SLIDE 34

JULY 21, 2017 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 34

SIS FLOOR PLAN - AUSTRALIA

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SLIDE 35

SAFE INJECTION SERVICE MODELS AROUND THE WORLD

SAFE INJECTION SERVICE MODELS

  • INTEGRATED
  • SPECIALIZED
  • MOBILE

SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 35 JULY 21, 2017

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SLIDE 36

SAFE INJECTION SERVICE MODELS AROUND THE WORLD

MODEL DESCRIPTIONS KEY ADVANTAGES & DISADVANTAGES

INTEGRATED

  • most common type
  • part of a broader and interlinked network of

services housed in the same facility Examples of services offered

  • showers
  • laundry
  • counseling
  • testing for blood borne viral infections
  • needle and syringe exchange
  • psychosocial care
  • employment programs
  • medical services, wound care, medication-

assisted treatment (MAT)

Advantages

  • convenient access to other important health and

social services

  • consistent with current emphasis on offering

integrated and coordinated care for persons with complex medical conditions Disadvantages

  • integrating with medication-assisted treatment

places burden on individuals picking up their medication

  • individuals may be trying to stay away from

areas of active drug use

  • complexity
  • cost

Note: Adapted from Wright, N. M. (2004). Supervised injecting centres. British Medical Journal, 328(7431), 100-102. doi:10.1136/bmj.328.7431.100 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 36 JULY 21, 2017

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SLIDE 37

SAFE INJECTION SERVICE MODELS AROUND THE WORLD

MODEL DESCRIPTIONS KEY ADVANTAGES & DISADVANTAGES

SPECIALIZED

  • focus on providing a safe place for

hygienic consumption of drugs in a non- judgmental environment, while providing referrals to other services

  • usually located in close proximity to
  • ther services and where drug users

already congregate Advantages

  • requires less operational complexity
  • referrals to other services are available,

just not in house

  • less expensive to site and operate then

more comprehensive models Disadvantages

  • access to additional services less

convenient than integrated model

  • creates a potential barrier to accessing
  • ther services

Note: Adapted from Wright, N. M. (2004). Supervised injecting centres. British Medical Journal, 328(7431), 100-102. doi:10.1136/bmj.328.7431.100 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 37 JULY 21, 2017

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SLIDE 38

SAFE INJECTION SERVICE MODELS AROUND THE WORLD

MODEL DESCRIPTIONS KEY ADVANTAGES & DISADVANTAGES

MOBILE

  • specially outfitted vehicles that provide

space for 1-3 injection booths inside

  • offer a limited range of other services
  • able to provide referrals to other

services not available directly on the van Advantages

  • able to reach populations outside the

service range of stationary supervised consumption facilities Disadvantages

  • low capacity
  • limited services offered
  • access to additional services less

convenient than integrated model

  • creates a potential barrier to accessing
  • ther services

Note: Adapted from Wright, N. M. (2004). Supervised injecting centres. British Medical Journal, 328(7431), 100-102. doi:10.1136/bmj.328.7431.100 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 38 JULY 21, 2017

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SLIDE 39

SAFE INJECTION SERVICE MODELS AROUND THE WORLD

SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 39 JULY 21, 2017

AUSTRALIA CANADA DENMARK FRANCE GERMANY LUXEMBOURG NETHERLANDS NORWAY SPAIN SWITZERLAND USA TOTAL

MODEL TYPE INTEGRATED

√ √ √ √ √ √ √ √ √

9 SPECIALIZED

√

1 MOBILE

√ √ √ √

4

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SLIDE 40

SAFE INJECTION SERVICE MODELS AROUND THE WORLD

SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 40 JULY 21, 2017

NUMBER OF COUNTRIES WITH STAFF TYPE (OUT OF 10)

NURSE PHYSICIAN MENTAL HEALTH SOCIAL WORKERS OTHER NON-MEDICAL HEALTH EDUCATORS PEER WORKERS LAW ENFORCEMENT / SECURITY

2 3 6 7 7 7 8 10

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SLIDE 41

CONSIDERATIONS FOR SIS OPERATIONS & SERVICES

  • SUPPORT AN INTEGRATED MODEL THAT INCLUDES ON-SITE SERVICES
  • PROVIDE LINKAGES TO OTHER SERVICES
  • UTILIZE TRAINED & NON-LICENSED STAFF
  • INCLUDE PEER COMPONENT
  • DESIGN AS A SAFE, CLEAN, & WELCOMING SPACE
  • OPEN DURING REGULAR BUSINESS HOURS
  • DEVELOP CLEAR & MEASURABLE PROGRAM GOALS

SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 41 JULY 21, 2017

  • INFORMATION

SOURCES:

  • RESEARCH/

LITERATURE

  • COMMUNITY

SURVEYS

  • FOCUS

GROUPS

  • TASK

FORCE

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SLIDE 42

DISCUSSION QUESTION

SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 42 JULY 21, 2017

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SLIDE 43

DISCUSSION QUESTION

WHAT ARE YOUR THOUGHTS ON THESE CONSIDERATIONS FOR SIS IN SAN FRANCISCO?

SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 43 JULY 21, 2017

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SLIDE 44

PUBLIC COMMENT

2 MINUTES PER PERSON

SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 44 JULY 21, 2017

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SLIDE 45

CLOSING COMMENTS & NEXT STEPS

SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 45 JULY 21, 2017

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SLIDE 46

NEXT MEETING

THURSDAY • AUGUST 10TH • 2017 • 9AM-11AM 25 VAN NESS AVE • ROOM 610

  • BUSINESS & NEIGHBORHOOD FOCUS GROUPS
  • LOCATION & SITING

SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 46 JULY 21, 2017