Cdc ssp consultation 8 2010

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Dan Bigg's presentation at CDC's Syringe Service Program Consultation in Atlanta on August 30-31, 2010

Dan Bigg's presentation at CDC's Syringe Service Program Consultation in Atlanta on August 30-31, 2010

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  • 1. The Power of Any Positive Change! A Syringe Services Program in Chicago Chicago Recovery Alliance CDC SSP Consultation August 30-31, 2010 Atlanta G
  • 2. Assisting Any Positive Changes As People Define Them for Themselves Low Threshold – All Treatment Options - All are Welco
  • 3. S y Exchange Scheme Year % Reporting 1:1 for self r and others ‟92-‟93 1 1 43% after using SEP* i „93-‟95 2 1, 1 5-1 for 1 after 58% after using SEP* st ‟96-now need-based (self +) 92% after using SEP* n Now = “How many do you need for one shot-one syringe for yourself and others around you?” g Negotiate up! “100? 200? 300?... no, 200 is e Insight: Cooperation up-front leads to cooperation in fine”! return… * Community Advisory Groups and Cross-Sectional
  • 4. SYRINGE RETURN COOPERATION IS BUILT THROUGH RELATIONSHIPS, NOT FORCED/COERCED!! Among our more interesting findings is that the CRA SEP in Chicago has the highest return rate of any syringe exchange we have studied -- approximately 88% -- compared to return rates in the 55-70% range for exchanges in New Haven, Hartford, and Oakland. This is despite/because of the fact that the CRA SEP does not conduct a 1-for-1 exchange. Furthermore, CRA customers report using their syringes fewer times than customers of other exchanges we have investigated -- 1.6 in Chicago versus 3-4 in New Haven, San Francisco, Oakland, and Baltimore and 5-7 in Hartford. This suggests that the CRA policy allows injectors the best opportunity to achieve the stated U. S. Public Health Service goal of "one shot, one syringe". -- Robert Heimer, PhD, Personal Communication January 2002,
  • 5. Chicago Recovery Alliance Syringes Found in Humboldt Park July 1993 - June 1996 Note: Search method is 2 0 minute walk ing tour of co nsistent co urs e 160 140 120 Number of 100 Syr in ges Foun d 80 Outreach Starts 60 40 20 0 7/93-1 8/93-1 9/93-1 1/94-1 1/94-3 2/94-2 3/94-2 4/94-2 5/94-2 6/94-2 7/94-2 8/94-2 9/94-2 1/95-2 2/95-2 4/95-1 6/95-1 8/95-1 1/96-2 2/96-2 3/96-2 4/96-2 5/96-2 10/93-1 11/93-1 12/93-1 10/94-2 11/94-2 12/94-2 10/95-1 12/95-1 Date of Tour
  • 6. Starting Point? Making a Safer Shot
  • 7. More Accurate It‟s a HEP World!!
  • 8. Candidates for Hepatitis A Vaccination • High-risk populations * Users of illegal drugs. Candidates for Hepatitis B Vaccination • High-risk populations * Injection drug users.
  • 9. Despite the long-standing existence of unambiguous recommendations for risk group vaccination, hepatitis B vaccination coverage remains low in most risk groups in most high- income countries. This low coverage may be attributed to a lack of perceived risk of hepatitis B and the absence of appropriate health care programmes targeting hepatitis B monitoring and vaccination for certain risk groups, particularly sex workers, injecting drug users, and prisoners…The Viral Hepatitis Prevention Board also recognises that new strategies will have to be developed and implemented. Hepatitis B vaccination: how to reach risk groups. Francois G, Hallauer J, Van Damme P. Vaccine 2002 Nov 22;21(1-2):1-4
  • 10. The Berkeley Free Clinic Health Care for People Not Profit Hepatitis Testing, Education and Vaccination (Hep-TEV) Service is open only to people at risk for hepatitis. Hep-TEV provides anonymous or confidential testing and counseling for hepatitis A, B and C. The hepatitis clinic is open Saturdays between 3 and 5. Those interested should call between 1 and 2:30pm on Saturday for a same-day appointment at (800) 6-CLINIC. http://www.berkeleyfreeclinic.org
  • 11. H1N1 Flu Pneumococcal Seasonal Flu Hep A and Hep B separately Tetanus Hep A/B Combined - Twinrix
  • 12. Vaccination Experience to Date… 46,270 vaccinations completed over last decade (84% latest completion figures for HBV/Twinrix); Some staff take longer than others to get up to speed -- more hands on training and on-site support; Physician skilled in work with drug users critical to program success; Could not happen without CDPH
  • 13. Enough Motivation to Address OD? Program
  • 14. Opiate Overdose Prevention and Intervention in Chicago Use of a proven antidote to save lives where they are being lost CRA‟s OD work dedicated to Johnstreets Positive Chang on the Szyler as Any
  • 15. One shot naloxone save... DEATH NOT BREATHING 2 NOT RESPONSIV E 100% of Their OD Dose 4 Person's Level of 3 Opiate Activity 1 TIME
  • 16. CRA‟s Opiate Overdose Prevention/Intervention Work… Results thru July 2010: 16,121 persons reached and 2,027 convenience reports of peer reversal received
  • 17. ALL TESTING POSSIBLE… All Testing Possible… Chlamydia/Gonorrh ea Rapid HIV ab – Syphilis + HCV oral or finger ab stick
  • 18. CRA Annual Report 2009 11,021 visits 6,341 unique participants 3.06 million syringes exchanged 30.8% female, 1% trans 55% W, 31% AA, 9% PR, 4% Mex 32% 20-24, 25% 30-44, 23% 44+, 12% 25-29, 7% 13-19
  • 19. Bridge to Life Improvements - 300 new methadone treatment admissions in 40 days - Spring „00
  • 20. MOST •Mobile Opiate Substitution
  • 21. MOST Twenty Month Trial Ended July 2007. Lessons: -Successful engagement tool through any positive change - All risk reduction tools INCREASED engagement and did not prevent or reduce relationships!! -Regulations allow respectful engagement but current system can be challenged by practice of public health/harm reduction approach due to cost effectiveness vs. profit, etc. -- Physicians need to be trusted to prescribe methadone (cheap) not just buprenorphine (very expensive)!!!
  • 22. 1 2 3 From July 1994 to present: 256,138 cases in SPSS database, 60,055 unique participants, plethora info
  • 23. Why force such extensive data collection for all participants? Why require programs to RE-ENTER data by hand