Harm Reduction Handbook

OHIO HARM
REDUCTION
HANDBOOK
HARM REDUCTION VOCABULARY
• Naloxone: a medication that can reverse an overdose caused by an opioid drug (heroin or
HARM REDUCTION IS A SET OF
PRACTICAL STRATEGIES AND
IDEAS AIMED AT REDUCING
NEGATIVE CONSEQUENCES
ASSOCIATED WITH DRUG USE.
HARM REDUCTION IS ALSO
A MOVEMENT FOR SOCIAL
JUSTICE BUILT ON A BELIEF IN,
AND RESPECT FOR, THE RIGHTS
OF PEOPLE WHO USE DRUGS.
–HARM REDUCTION COALITION
prescription pain medications). When administered during an overdose, naloxone blocks the
effects of opioids on the brain and quickly restores breathing
o Narcan®: Opioid Antagonist
• It is a prescription medicine that reverses an opioid overdose. It cannot be used to get high and is not addictive. (stopoverdose.org)
• Methadone:
Methadone is a synthetic drug used to reduce the harm caused by opiate
addiction (usually heroin)
• Project DAWN: Deaths Avoided With Naloxone.
Project DAWN is a community-based
overdose education and naloxone distribution program.
• Overdose: When a drug is eaten, inhaled, injected, or absorbed through the skin in excessive
amounts and injures the body. Overdoses are either intentional or unintentional. If the person
taking or giving a substance did not mean to cause harm, then it is unintentional
• Syringe Exchange: Syringe exchange programs (SEPs) provide free sterile syringes and
collect used syringes from injection-drug users (IDUs) to reduce transmission of bloodborne
pathogens, and refer PWIDs to treatment
• IDU: Injection Drug Use(r)
• PWID: People who Inject Drugs
• Opioid: Opioids are medications that relieve pain. They reduce the intensity of pain signals
reaching the brain and affect those brain areas controlling emotion, which diminishes the effects
of a painful stimulus. (Drugabuse.gov)
• Hepatitis C: Hepatitis C is a contagious liver disease that ranges in severity from a mild
illness lasting a few weeks to a serious, lifelong illness that attacks the liver. It results from
infection with the Hepatitis C virus (HCV), which is spread primarily through contact with the
blood of an infected person. HCV can lead to needing a liver transplant
• HIV: Human Immunodeficiency Virus
• Good Samaritan Law: policies to provide limited immunity from arrest or prosecution for
minor drug law violations for people who summon help at the scene of an overdose
366% 366%
INCREASE IN
36 36
COUNTIES COUNTIES
IN OHIO
IN OHIO
EXPERIENCED
HEPATITISEXPERIENCED
C
HEPATITIS C
RATES INCREASE
RATES INCREASE
OVER 100%
OVER 100%
DRUG
OVERDOSE
DEATHS FROM
INCREASE IN
DRUG
OVERDOSE
DEATHS FROM
2000 2000
TO
2012 2012
5 DEATHS
74,000 74,000
NALOXONE
NALOXONE
ADMINISTRATIONS
ADMINISTRATIONS
FROM 2003 TO 2012
TO
5 DEATHS
29
PER DAY
EVERY DAY IN
OHIO ARE CAUSED BY
UNINTENTIONAL
DRUG OVERDOSES,
ONE PERSON EVERY
5 HOURS
FROM 2003 TO 2012
EVERY DAY IN
OHIO ARE CAUSED BY
UNINTENTIONAL
DRUG OVERDOSES,
ONE PERSON EVERY
5 HOURS
882
PER MONTH
IN
2012
29
PER DAY
882
PER MONTH
IN
2012
Sources : American Civil Liberties Union, Ohio Department of Health, Ohio Department of Mental Heath & Addiction Services, and Project DAWN
Sources : American Civil Liberties Union, Ohio Department of Health, Ohio Department of Mental Heath & Addiction
CURRENT LAWS AROUND NALOXONE
1. Prescribing Guidelines for Naloxone
•
Naloxone can be prescribed to a friend, family member or other individual who is in a position to provide assistance to an
individual who there is reason to believe is at risk of experiencing an opioid-related overdose.
•
The prescription must be issued by a physician or other health care professional who is authorized to prescribe drugs. Under
this law, a physician (including a podiatrist) or an advanced practice registered nurse or physician assistant who is authorized
to prescribe drugs may prescribe or personally furnish naloxone for administration to an individual at risk or overdosing on
opioids. In other words, the naloxone prescription no longer has to be only for the person who is believed to be at risk of an
overdose.
•
The health care professional must instruct the individual to whom the drug is prescribed or furnished to summon emergency
services immediately before or immediately after administering the naloxone. This means the training provided must include
instructions to call 911 as part of the response to an overdose in addition to administering the naloxone.
CURRENT LAWS AROUND ESTABLISHING A
SYRINGE EXCHANGE PROGRAM (SEP)
1. What is blocking the creation of a Syringe Exchange Program?
•
2. Ohio’s Loophole in creation of a Syringe Exchange Program
•
2. Immunity to Criminal and Civil Liability
Prescribers of Naloxone
• Physicians, advanced practice registered nurses, or physician assistants who furnish or issue a prescription for naloxone in
good faith in accordance with the Ohio law are granted immunity from criminal or civil liability or professional disciplinary
actions for any action or omission of the individual to whom the drug is furnished or prescription is issued.
Peace Officers
• Immunity from administrative action and criminal prosecution for the unauthorized practice of medicine and certain drug
offenses is granted to a peace officer who does all of the following:
1.
2.
3.
Acts in good faith;
Obtains naloxone from a law enforcement agency licensed as a terminal distributor of dangerous drugs that employs the peace
officer;
(Administers naloxone to an individual who is apparently experiencing an opioid-related overdose.
Other Individuals
• Immunity from criminal prosecution for the unauthorized practice of medicine and certain drug offenses is granted to a family
member, friend, or other individual who is in a position to assist an individual who is apparently experiencing or at risk of
experiencing an opioid-related overdose if all of the following apply:
1.
2.
3.
The individual acts in good faith;
The individual obtains naloxone or a prescription for naloxone from a licensed health professional;
The individual summons emergency services either immediately before or after administering the naloxone to the
individual who is apparently experiencing an opioid-related overdose.
Ohio’s Drug Paraphernalia Law - Section 3719.17.12 of Ohio Revised Code;
“No person shall sell a syringe when there is reasonable cause to believe it is not authorized for a medical purpose”
This law considers syringes to be a drug abuse instrument and blocks the distribution of them in Ohio. Syringes can only be
given out for medical purposes, hence blocking the creation of SEPs in Ohio.
Emergency Health Order - Section 3718.09 of Ohio Revised Code
“The health commissioner or the commissioner’s designated representative, without prior notice or hearing and in
accordance with rules adopted by the director of health , may issue an emergency order requiring any action necessary to
meet a public health emergency”
This section of Ohio law gives a Health Commissioner the power to make exceptions to laws to address public health issues.
In Cleveland, Portsmouth, and Cincinnati; Health Orders have been issued to address rates of Hepatitis C and HIV among
Intravenous Drug Users and allowed each city to establish a SEP.
3. Barriers to Ohio’s Loophole
•
Required Support of Elected Officials
For an emergency public health order to work the support of elected officials in the community is needed, because without
their support the health order will not be recognized by law enforcement and the community. This has been a barrier
because elected officials in communities throughout Ohio will not support the creation of SEPs because of worries of losing
future elections.
Data to support the issuing of an Emergency Health Order
Ohio just recently started gathering data on rates of Hepatitis C around the state. Currently, there is a lack of data to show
epidemics of Hepatitis C in areas that are having high rates of positivity according to local agencies and doctors
House Bill 92
Legislation that would have removed barriers to Syringe Exchange Program implementation.
1. What was House Bill 92?
First Responders and Emergency Medical Technicians-Basic
• First responders and emergency medical technicians–basic (EMTs-basic) can administer naloxone to individuals suspected
of opioid overdose. First responders and EMTs-basic are authorized to administer naloxone only intranasally and by an auto
injector in manufactured dosage form.5 In addition, a first responder or EMT-basic may administer naloxone only under
1.
2.
The written or verbal authorization of a physician or the cooperating physician advisory board of the emergency medical service
organization or
an authorization transmitted through a direct communication device by a physician, a physician assistant designated by a physician,
or a registered nurse designated by a physician. These authorization requirements, however, do not apply if communications fail.
o Criminal immunity applies to first responders, but not to emergency medical technicians.
See Ohio Revised Code 2925.61 (C).
CURRENT LAWS AROUND NALOXONE
1.
House Bill 4 (Naloxone-furnish or dispense with regard to a person at risk of opioid overdose)
•
This bill would allow a physician to authorize naloxone to a patient who is at risk of overdosing or to a person who might be
able to assist that patient during an opioid-induced overdose.
•
House Bill 4 would require a physician to have in writing certain protocol for furnishing naloxone.
•
Would allow pharmacists ability to dispense the medication without prescription
•
The legislation requires the Ohio Department of Health to create a model protocol for naloxone and gives it permission to
sell the medication wholesale to law enforcement officials.
•
Health departments will also have the ability to issue naloxone protocols through their medical director or health
commissioner.
House Bill 92 was legislation that would explicitly allow SEPs in Ohio.
This was legislation sponsored by State Representatives Nickie Antonio and Barbara Sears. This legislation was the first time that a
piece of legislation was introduced in Ohio that would explicitly allow SEPs in Ohio.
2. What would House Bill 92 have done if it passed?
• Change how SEPs get implemented in Ohio
House Bill 92 would have removed the need for an Emergency Health Order to implement a SEP. Instead it would give every
Board of Health in Ohio the power to decide on if a SEP should be implemented with input from the community and law
enforcement.
• Protect participants and workers from drug paraphernalia prosecution
All workers and participants of SEPs would be given a 1,000 foot radius of protection for the possession and distribution
of syringes. Participants of these programs would be identified by having a card that would have an anonymous unique
identifier that would show their participation in the program.
• Create guidelines for the operation of a SEP.
SEPs that would have been implemented by this law would have to be a 1 for 1 exchange, meaning participants must give
a syringe to get one. Also, all programs would have to have information on bloodborne pathogens (HIV and Hepatitis C) on
site and information on available drug treatment programs.
• What happened with House Bill 92?
House Bill 92 passed out of the Ohio House of Representatives in Fall 2013. It was then assigned to the Ohio Senate
Medicaid, Health and Human Services Committee. Once in the Senate the language in the legislation was considered to be
to controversial and the legislation did not achieve anymore movement in the 130th general assembly.
• What is being done legislatively in 2015?
House Bill 92 from the previous session is being redrafted to make the language less controversial so more support can be
gained on it. It is also being considered to be a part of a comprehensive piece of legislation that would address Ohio’s opiate
problem.
$10,488$10,488
70-90% 70-90%
OF HEROIN USERSOF HEROIN USERS
INJECT THE DRUG
INJECT THE DRUG
AGES
AGES
to
to
18
34
18
34
REPORT THE LARGEST
REPORT THE LARGEST
INCREASES
INCREASES
AVERAGEAVERAGE
IN-PATIENT TREATMENT
IN-PATIENT TREATMENT
CHARGE FOR A
CHARGE FOR A
DRUG OVERDOSE
DRUG OVERDOSE
ONE
IN
ONE
FOUR
IN
FOUR
IDUs (26.2%) SOUGHT
IDUs (26.2%)
DRUG TREATMENT
SOUGHT DRUG
WITHIN
TREATMENT WITHIN
30 DAYS AFTER 30
THEIR
DAYS
LAST
AFTER
OVERDOSE
THEIR LAST OVERDOSE
40.7% OF IDUs REPORTED
40.7% OF IDUs
THATREPORTED THAT
SOMEONE TALKED
SOMEONE
TO THEM
TALKED
ABOUT
TODRUG
THEMTREATMENT
ABOUT DRUG TREATM
FOLLOWING THEIR
FOLLOWING
MOST RECENT
THEIROVERDOSE
MOST RECENT
ANDOVERDOSE
MANY OF AND MAN
THESE INDIVIDUALS
THESE
(45.0%)
INDIVIDUALS
SUBSEQUENTLY
(45.0%) SUBSEQUENTLY
SOUGHT
SOUGH
TREATMENT
TREATMENT
IN HEROININ
ASHEROIN AS
PRIMARY DRUG OF CHOICE
PRIMARY DRUG OF CHOICE
SYRINGE EXCHANGE
SYRINGE
PARTICIPANTS
EXCHANGEHAVE
PARTICIPANTS
BEEN FOUND
HAVE BEEN FOU
FIVE
TIMES
FIVE
MORE
TIMES
LIKELY
MORE
LIKELY
TO ENTER A DRUG
TO TREATMENT
ENTER A DRUG
PROGRAM
TREATMENT PROGRAM
2007 TO 2012
2007 TO 2012
LEADING CAUSE
LEADING CAUSE
UNINTENTIONAL DRUG OVERDOSE
UNINTENTIONAL
IS THE
DRUG OVERDOSE IS THE
OF INJURY-RELATED
OF INJURY-RELATED
DEATH IN OHIO
DEATH IN OHIO
COST OF AN
COST OF AN
OVERDOSE
OVERDOSE
REVERSAL KIT
REVERSAL KIT
$40$40
1
6
4
3 3
5
OHIO NALOXONE DISTRIBUTION AND TRAINING SITES
10
18
1
11
2
16 17
12
2
Athens County
Athens City/County Health Department
278 W. Union Street
Athens, OH 45701
Phone: (740) 592-4431, ext. 230
8
Crawford County
9
Crawford-Marion ADAMH Board
(Partnering with Maryhaven)
Crawford /Bucyrus Phone: 419-562-7288
Cuyahoga County
3
4
13
7
2 17
8
8 5 9
3
4
14
1
19
5
15
2
6
The Free Medical Clinic of Greater
Cleveland
12201 Euclid Ave., Cleveland, OH 44106 –
(Friday 1p-5p)
Phone: (216) 721-4010
The Cuyahoga County Board of Health
5550 Venture Dr., Parma OH 44130
(Friday 9a-12p)
Phone: (216) 201-2000
MetroHealth Project DAWN
2500 Metrohealth Dr., Cleveland Ohio
44109
Phone: (216) 778-5677
http://www.metrohealth.org/projectdawn
Email: emetz@metrohealth.org
1
Brown, Clinton and Warren
Counties
4
Mental Health and Recovery Services
Board of Warren And Clinton Counties*
212 Cook Road
Lebanon, OH 45036
Phone: (513) 695-1692
2
3
Butler County
Atrium Medical Center*
Emergency Department
1 Medical Center Drive
Middletown, OH 45005
Cuyahoga County
Metrohealth Medical Center*
Emergency Department
2500 Metrohealth Drive
Cleveland, OH 44109
Franklin County
Nationwide Children’s Hospital
7
(Services only provided to pediatric patients younger than 21.)
Project HOPE (Home Overdose Prevention Effort)
700 Children’s Drive
Columbus OH 43205
Phone: (614) 355-8614
5
Hamilton County
Veterans Administration Hospital/
Cincinnati**
8
6
Warren County
Solutions community Counseling and
Recovery Services**
Talbert House**
Lebanon, OH
Atrium Medical Center*
Emergency Department
Atrium Health Center - Mason
7450 Mason - Montgomery Road
Mason, OH 45040
Narcan/Naloxone Clinic on Wednesdays
Phone: (740) 441-2018; (740) 441-2950
7
Phone: (440) 350-5891
Lorain County
Elyria City Health District/Lorain County
11 General Health District
202 Chestnut St.
Elyria, OH 44035
Phone: (440) 323-7595
http://www.elyriahealth.com or
www.loraincountyhealth.com
Crawford-Marion ADAMH Board
Marion Area Counseling Center, Inc.
142 S. Prospect Street
Marion, Ohio 43302
Phone: (740) 387-8531
Montgomery County
Care
13 Crisis
ADAMHS Board for Montgomery County
Greene County
Chillicothe, Ohio 45601
Phone: (740) 775-1146, ext. 2225
Scioto County
Portsmouth City Health Department
15 Nursing Division
605 Washington St.
Portsmouth, OH 45662
Phone: (740) 353-8863
Stark County
16 Mental Health and Recovery Services
Board of Stark County Crisis Center
2421 – 13th Street, NW
Canton, OH 44708
Phone: (330) 452-6000
Quest Recovery & Prevention Services
17 1341 Market Avenue, North
Canton, Ohio 44714
Phone: (330) 453-8252
Trumbull County
Marion County
12
County Health District
14 Ross
150 E. Second Street
Trumbull County Health Department
18 176 Chestnut Ave. N.E.
Warren, Ohio 44483
Phone: (330) 675-2590, Ext. #3
Vinton County
County Health Department
19 Vinton
31927 Ohio 93
McArthur, OH 45651
Phone: (740) 596-5233 x234
601 S. Edwin C. Moses Blvd.
Dayton, OH 45417
Phone: (937) 224-4646
TCN Behavioral Health Services
452 West Market Street
Xenia, OH 45385
Phone: (937) 376-8700
Lorain County
6
Alcohol & Drug Addiction Services
Board of Lorain County**
4950 Oberlin Ave
Lorain, OH 44053
Phone: (440) 282-4777
SYRINGE EXCHANGE SITES
1
Free Clinic of Greater Cleveland
http://www.thefreeclinic.org
Phone: (216) 721-4010
2
Prevention Not Permission
Portsmouth City Health Department
Address: 605 Washington St
Portsmouth, OH 45662
Contact: Bobbi Bratchett
Phone: (740) 353-8863 x250
Email: bobbi.bratchett@odh.ohio
Website: http://www.portsmouthhealthdept.org/
Six State Psychiatric Hospitals: Administered by the Ohio Department of Mental Health and Addiction Services (OhioMHAS):
(A naloxone prescription is provided upon discharge to those who had a diagnosis of opioid/opiate addiction when admitted for treatment.)
-Northcoast Behavioral Healthcare (Northfield)
-Northwest Ohio Psychiatric Hospital (Toledo)
-Twin Valley Behavioral Healthcare (Columbus)
-Appalachian Behavioral Healthcare (Athens)
-Heartland Behavioral Healthcare (Massillon)
-Summit Behavioral Healthcare (Cincinnati)
Center for Chemical Addictions and
Treatment (CCAT)
830 Ezzard Charles Dr.
Cincinnati, OH 45214
Phone: (513) 381-6672
County General Health District
10 Lake
Painesville, OH 44077
Gallia County
Gallia County Health Department
499 Jackson Pike
Gallipolis, OH 45631
Ross County
University of Cincinnati
Cincinnati Exchange Project – Project
DAWN
Phone: (513) 377-7114
Lake County
(No appointment necessary for Cuyahoga County programs.)
TREATMENT AND HOSPITAL BASED PROGRAMS
Hamilton County
(AS OF MARCH 2015)
*Services provided to hospital emergency department patients only.
** Services provided to clients/patients only.
(as of March 2015)
3
Cincy Exchange Project
Phone: (513) 377-7114
Email: cep.libby@gmail.com
Locations Monday Cooper St. between Cherry St. and Colerain St.
Wednesday 65 E Hollister, Cincinnati, OH 45219
TO LEARN MORE CONTACT ANY ONE OF THE
PARTNERED ORGANIZATIONS LISTED BELOW
Harm Reduction Coalition
harmreduction.org
Project Dawn
healthy.ohio.gov
Ohio’s Community Opiate Task Forces
http://www.oacbha.org/opiate_task_force.php
(614) 224-1111
Ohio AIDS Coalition
(A Division of AIDS Resource Center Ohio)
ohioaidscoalition.org
info@ohioaidscoalition.org
(614) 340-6707
This handbook was compiled by the Ohio AIDS Coalition in conjunction with the
2015 Ohio Harm Reduction Summit.