Shooting Up Safely D Harm Reduction and Syringe Exchange D D D - - PowerPoint PPT Presentation

Shooting Up Safely

Harm Reduction and Syringe Exchange

Thaddeus Pham Hawaii Department of Health November 2014

D D D D D d

Meet your liver!

What can hepatitis lead to?

Usually no symptoms for 20-30 years Without treatment, hepatitis can lead to liver cancer

C Is for…Cooker!

 Transmission routes  direct BLOOD-to-BLOOD  mostly, sharing needles/works  other possible risks?  Highly infectious  stable in environment for 4 days to 6 weeks  stable in syringes for up to 63 days!  NO VACCINE!

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Beyond C is for Cooker...

Sharing Injection Equipment



Not only NEEDLES



cookers



cottons



water



• ther paraphernalia



Not only DRUG USERS



transgender (hormones)



bodybuilders (steroids, vitamins)



diabetics (insulin)



Bleach may kill HCV but only if properly used

What is happening?

 Hawai`i = highest rate of liver cancer in US  The leading causes of liver cancer in HI

hepatitis B hepatitis C

Harm Reduction…

Harm reduction is a philosophy and set of strategies for working with individuals engaged in potentially harmful behaviors. The main objective is to reduce the potential dangers and health risks associated with such behaviors, even for those who are not willing

• r able to completely stop. Harm reduction

uses a non-judgmental, holistic and individualized approach to support incremental change and increase the health and well-being of individuals and communities.

Reducing the Harm

Harm reduction is a philosophy and set of strategies for working with individuals engaged in potentially harmful behaviors. The main objective is to reduce the potential dangers and health risks associated with such behaviors, even for those who are not willing

• r able to completely stop. Harm reduction

uses a non-judgmental, holistic and individualized approach to support incremental change and increase the health and well-being of individuals and communities.

History of Harm Reduction

 Merseyside, England (1980s)



Response to HIV, Hepatitis B



Syringe exchange

 Netherlands (1980s)



Public health, law enforcement, community

 United States (1988)



1st syringe exchange

 Hawaii (1989)



1st Statewide syringe exchange

What is Syringe Exchange?

 Reduce Bloodborne Risks



Collect used syringes



Replace with sterile ones

 Drug User Health



HIV/Hep Testing



Drug treatment



Other services!

 Healthier communities



Protect families of drug users



Less syringes in communities In 2011, at least 211 SEPs in U.S.

Hawaii and Harm Reduction

 Street Outreach (1980s)



Bleach for needles

 Pilot SEP (1989)



Gov Committee on AIDS



Pam Lichty, Nancy Kern, Nancy Partika

 RCUH Research (1990)  Act 152 (1993)



DOH to oversee SEP



CHOW only recipient

 CHOW 501c3 (1999)  Hep Free Hawaii (2011)

[325-111] Sterile Needle and Syringe Exchange Established

 Establishes SEP through Department of Health (may be

contracted out)

 Requires one-for-one exchange  Extensive data collection and annual evaluation to

demonstrate effectiveness

 Syringe Exchange Oversight Committee  Comprised of law enforcement, policy makers,

Attorney General’s office, DOH

[325-111] Criminal Liability

“Exchanges under the sterile needle and syringe exchange program shall not constitute an offense under section 329-43.5 for the participant or for the employees of the department or its designees”

[325-21] Sale of Sterile Syringes

for the Prevention of Disease

 Allows the sale of sterile syringes by:



Pharmacist



Physician



Healthcare provider



Authorized agent of pharmacy  Must provide education about diseases, drug

treatment and disposal

 “Sale or purchase of sterile hypodermic syringes

under subsection (a) shall not constitute an

• ffense under section 329-43.5”

Syringes Exchanged 1993-2012

• 100,000

200,000 300,000 400,000 500,000 600,000 700,000 800,000 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

7.7 million syringes exchanged

Evidence of Effectiveness

World Health Organization



Over 200 studies



Reduce HIV



Reduce used syringes



No increase in drug use

Hawaii Data



AIDS among PWID: 14.7% HI vs. 32.3% nationally



Low HIV rates among women and children



CHOW Project: <3% HIV



No new HIV+ for 6 years

Harm Reduction in Hawaii

The Community Health Outreach Work (CHOW) Project is dedicated to serving individuals, families and communities adversely affected by drug use, especially people who inject drugs, through a participant-centered harm reduction approach. CHOW works to reduce drug-related harms such as but not limited to HIV, hepatitis B/C and overdose. CHOW supports the optimal health and well-being of people affected by drug use throughout the State of Hawaii.

What does CHOW do?

 Statewide  Syringe Exchange

 Mobile vans  Individuals

 HIV/Hep Testing

 Care Coordination

 Hygiene kits, supplies  Referrals

 Drug treatment  Mental Health

What does CHOW do?

 Outreach

 Drug Users  Homeless  Sex Workers

 Housing Linkage  Advocacy

 Good Samaritan  Overdose Prevention

River Street and Vineyard 9 am – 2 pm (M – F)

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CHOW Is a Community

Young Injection Drug Users



Massachussets (MMWR 2011)



Age distribution of newly reported HCV 2002-2009



Hawaii (CHOW report 2013)



HCV antibody positive rate 18.4 (2011) to 28.6% (2012)

Syringe Exchange in Hawaii

 Evidence-based

 Increase HIV and hepatitis prevention  Decrease “dirty” needles in circulation  No increase in drug use

 Increase community health

 Keep families healthy  Overdose prevention  Housing and social services

Former CHOW Participant Now in Recovery

“CHOW saved my life. When I was

• ut there, I lost everything and
• everyone. CHOW’s outreach workers

respected me when I couldn’t respect

• myself. They helped me stay alive

until I was ready to help myself.”

How can I help?

www.hepfreehawaii.org www.chowproject.org

Mahalo!

Reach out! Thaddeus Pham

thaddeus.pham@doh.hawaii.gov