Transcript Presentation - Allegheny County Overdose Prevention Coalition

ACOPC Summer Conference 2016
“Anatomy of Recovery: Peaks and Valleys”
July 28, 2016
We have a large number of participants today so please be courteous
and fill in seats from the middle and from the front first.
#ACOPC2016
@OverdoseFreePA
A Harm Reduction Perspective:
Preventing Overdose Death for People Actively Using Drugs
Alice Bell, LCSW, Overdose Prevention
Project Coordinator, Prevention Point Pittsburgh
#ACOPC2016
@OverdoseFreePA
Prevention
Point Pittsburgh
Alice Bell, L.C.S.W.
Overdose Prevention Project
[email protected]
412-247-3404
Rio Arriba County, New Mexico, population 40,000:
Santa Fe Mountain Center gave out over 3,300 doses
of naloxone with 752 reversals reported in FY16 !!!
“We had 234 reported (fentanyl overdose)
reversals by drug users between JuneAugust and only a couple of
unfortunate deaths, about which we still
have little information. There were two
uses of naloxone by law enforcement in
the same period and no noticeable
uptick in EMS responses to overdoses.
Essentially, this was handled expertly
by the syringe exchanges and drug
users and many, many possible deaths
were averted.”
-Eliza Wheeler, the DOPE
Project, San Francisco
Allegheny County Trends in Accidental Drug Overdose Deaths
2000-2015*
*Data from Allegheny County Medical Examiners Annual Reports. Includes all overdose deaths
where these drugs were present at time of death, alone or in combination with other substances.
• Safer Injection Facilities – reduce the spread of infectious diseases like
HIV, AIDS and hepatitis C.
• Wherever there is street drug use, an SIF makes the area safer by
diminishing open drug use and curtailing litter, such as used needles.
• Finally, they’ve been shown to reduce overdose deaths.
• There has not been a single overdose death in an SIF ever!
Illicit drug overdose deaths in Vancouver's Downtown
Eastside dropped by 35 per cent after the establishment of
Insite, North America's first supervised injection facility,
according a new study by researchers at the University of
British Columbia and the British Columbia Centre for
Excellence in HIV/AIDS.
Harm Reduction Services
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Providing Sterile Injection Equipment
for over 20 years!
Testing for HIV and Hepatitis C
Education on disease prevention,
safer injection, how to avoid abscesses
Case Management, assistance to treatment
Crisis Intervention & Counseling
Overdose Prevention & Response Training
Naloxone Prescription for over 10 years!
Wound Consultation Clinic
All Services Free of Charge
Anonymous/Confidential
Low Threshold
Prevention Point Pittsburgh Naloxone
CUMULATIVE DATA - July 2005- June 2016
Third Party
Naloxone Law
Implemented
2005 - 2014 100% of rescues were by individuals who use opioids themselves,
In 2015 95% of rescues were by individuals who use opioids themselves.
“the definition of addiction is continuing to
do something despite negative
consequences, so inherently negative
consequences - i.e. punishment – is not
going to be effective.” – Maia Szalavitz
Neither jail nor treatment programs that
employ harsh or punitive techniques, offer
effective strategies to help people get
control over dangerous, compulsive
problematic patterns of drug use.
Employing negative consequences is an
illogical strategy for people who continue to
use drugs despite negative consequencesthe definition of addiction! If negative
consequences worked, they would not be
addicted in the first place.
• Supply reduced by drug take-backs, prescription
drug monitoring programs and changes in
prescribing practices in recent years.
• In 2012, for first time, Prescription Opioid Overdose
deaths down 5%; Heroin deaths up 35%
• In 2013, heroin deaths up 39% over 2012.
• 2010-2014 heroin deaths increased by more than 300%
• Hepatitis C infections have increased 150% since 2010; primarily
among adolescents/ young adults, white, living in non-urban areas.
Rural states have seen Hep C increase of 364%.
• 2015 – 188 injection-related HIV cases in rural, Scott County, Indiana
Concern that we are likely to see this in other rural areas soon.
“Across the country that day, 182 people
were arrested in a dozen cities in
Operation Tar Pit. Agents seized relatively
small quantities of drugs and cash: sixty
pounds of heroin and two hundred
thousand dollars. Yet Tar Pit remains the
largest case-geographically and in terms
of manpower used – the DEA and FBI
have ever mounted jointly.”
Despite massive arrests of all levels of
management in the Sante Fe area, one
heroin user there reported:
“After Tar Pit,” he remembered, “there was
no dope on Sante Fe streets for exactly
one day.”
Since the institution of physician prescribed buprenorphine
and methadone maintenance in 1996 in France, heroin
overdose dropped by 79%
600
French population in
1999 = 60,000,000
No. of deaths
500
400
300
Patients receiving buprenorphine
(1998): N= 55,000
200
Patients receiving methadone (1998): N=
5,360
100
0
1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999
Year
Medication assisted treatment also has resulted in reduced HIV
and hepaitis by reducing needle sharing
Auriacombe et al., 2001
Buprenorphine/
Suboxone
Given the black market for this medication,
what we have here is a Dallas Buyers Club
situation for substance use disorder.
Expanding legal access is the best way to
reduce diversion.
Even diverted medication is better than no
medication. 2008-2015 there were only 2
documented overdose deaths in Allegheny
County where toxicology report on person
who died indicated they had taken
buprenorphine.
Buprenorphine keeps people alive!
ANXIETY TREATMENT GOALS
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Develop strategies to
reduce symptoms, or
reduce anxiety and improve
coping skills
Increase understanding of
anxious feelings.
DRUG TREATMENT GOALS
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Be free of drug/alcohol
use/abuse
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Client will abstain from
using substances and will
manage withdrawal
symptoms without relapsing
Peaks and Valleys
Antidote for opiate
overdose.
Routinely used by EMS.
Very safe and effective.
No psychoactive effects
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Deaths from Opioid Overdose are almost entirely preventable
if oxygen is maintained through rescue breathing.
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In addition, we have a highly effective, very safe antidote.
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Paramedics use naloxone to immediately reverse the effects of
opiate overdose.
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Standardized 5–10 min education is sufficient.
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Online Trainings available at PrescribetoPrevent.org
Remember the guy who bought 80-proof vodka that turned out to be 190-proof
Everclear and died from alcohol poisoning? Probably not, because that sort of
thing almost never happens in a legal drug market, where merchants or
manufacturers who made such a substitution, whether deliberately or
accidentally, would face potentially ruinous economic and legal consequences.
In a black market, by contrast, customers frequently get something different from
what they thought they were buying: something weaker, something stronger, or
some other substance entirely. As The Washington Post notes in a story about
fentanyl-laced heroin, the results can be fatal.
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NUMBER ONE priority: Put naloxone in the hands of those most
likely to be on the scene and first to respond, individuals who use
opioids, themselves. Naloxone should be in every first aid kit.
 How best to reach this population? By making naloxone available, free
of charge in these settings:
▪ Syringe Exchange Programs
▪ Jails
▪ Methadone, Suboxone and Other Treatment Programs
▪ Hospital Emergency Departments
▪ Free Clinics
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Simultaneously make effective treatment available and accessible to
all who want and need it.
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Work on addressing systemic societal problems that result in people
seeking relief from pain.
Alice Bell, L.C.S.W.
Overdose Prevention Project
Prevention Point Pittsburgh
[email protected]
412-247-3404
Co-Sponsors
Pyramid Healthcare, Inc.
Greenbriar Treatment Center
White Deer Run Treatment Network
Summit BHC of PA
Community Care Behavioral Health Organization
University of Pittsburgh
Thank you!!!
#ACOPC2016
@OverdoseFreePA