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Harm Reduction february 2013 Nursing Education Saskatchewan

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Here is a basic presentation on Harm Reduction, for Nursing Students, that can easily be adapted for health care providers in various fields of practice.

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Harm Reduction february 2013 Nursing Education Saskatchewan

  1. 1. Harm Reduction NEPS 325February 2013
  2. 2. Outline • Define Harm Reduction • Examples • Role of Nurse – Break • Special Populations • Current Scenario Discussion
  3. 3. How do you define Harm Reduction?
  4. 4. How they define it…A neutral, non judgmental, lowthreshold approach, geared towardsindividual attributes and context as wellas social factors of behavior andpotential risk for harm Keane, 2003; Hathaway, 2002; Erikson, 2001
  5. 5. How they define it…• HR is not a moralistic concept• HR is a pragmatic solution to the very serious issues of HIV infection.• HR is intended to be a value neutral approach & makes no assumptions• The intention of HR is to help people make informed decisions & empower them to reduce the risk of HIV infection. Canadian Aboriginal AIDS Network http://www.aidslaw.ca/publications/interfaces/downloadFile.php?ref=1954 “The lived experience of HIV-positive Aboriginal persons sits at the intersection of several systemic issues, including discrimination, poorer access to health services (including delayed uptake of HIV treatment), and addiction.”
  6. 6. ETHICS?The values of harm reduction are consistent with the valuesof professional nursing presented in the code of ethics: • the provision of safe, ethical, competent and compassionate care; •the promotion of health and well‐ being; •the promotion of and respect for informed decision‐ making; •the preservation of dignity, in which care is provided on the basis of need; and •the promotion of justice. Canadian Nurses Association March 2011
  7. 7. Harm Reduction & Substance UsePolicies and programs directed at reducing theharmful consequences of drug use while theperson continues to use ……compatible withabstinence. Riley et al, Substance Use & Misuse, 1999 & CCSA PP
  8. 8. Did You Know?• ~2000 people are using injectable drugs in RQHR• RQHR provides ~2 million needle/year• Injected drugs of choice in RQHR: cocaine, morphine,dilaudid, oxycontin•RQHR distributes and collects more needles that SHR and haslower HIV and HCV rates!
  9. 9. Guiding Principles• Pragmatism • Flexibility/Maximization• Humane of Intervention Options Values/Rights • Evaluation• Focus on Harms • Education• Prioritization of Goals • Informed Decision making CAMH, CCSA, Fisher 2006
  10. 10. Concerns• HR enables drug use and entrenches addictive behaviour• HR encourages drug use among non-users• HR drains resources from treatment services• HR is a Trojan Horse for decriminalization & legalization• HR increases disorder & threatens public safety & health Harm Reduction: A BC Community GuideShould we care what the public thinks, when the evidenceclearly supports HR as best practice?
  11. 11. Benefits• It saves lives through:• Reducing harm to those at high risk, and to their family, friends and society• Reduces the spread of HCV/HIV• Empowers people to choose what is best for them and when they are ready to take the next step,• Offers opportunity to stabilize their lives• Decreases crime (Harm Reduction in SK, A Resource Guide )
  12. 12. Culture• HR new to First Nations• Concepts need to be culturally appropriate• Leaders hold the power to help.• The problematic use of drugs is not the “problem”, it is a symptom of much broader social problems that face First Nations, Inuit and Métis in Canada
  13. 13. 4 PillarsPrevention Treatment• Prevent or delay • Improve physical, emotional, and onset. psychological healthHarm Reduction Enforcement• Reduce harms for • Strengthen community individuals, families, and safety by responding to communities. crimes and community disorder issues.
  14. 14. Programs & Policies• Seatbelts, car seats, helmet programs• Safer Sex Programs• Methadone Maintenance Treatment• Needle Exchange Programs• Insite, Safer Injection Facility• Moderation Management• Safer Tattooing & Body Art
  15. 15. What Can YOU Do?• HIV and HCV are PREVENTABLE• Consider harm reduction within framework ofproviding medical care – Goal is to minimize harm with a patient-first approach – Maximize intervention options – Knowledge ≠ behaviour
  16. 16. https://www.facebook.com/injectingadvice
  17. 17. Substitution Therapy• Methadone Reduces – Illicit opiate use – Overdose deaths – Frequency of injecting – Needle sharing – HIV/HCV/HBV transmission – Criminal activity, recidivism T Kerr, R Jürgens. Methadone Maintenance Therapy in Prisons:Reviewing the Evidence. Montreal: Canadian HIV/AIDS Legal Network, 2004.
  18. 18. Substitution Therapy21-year-old driver charged in fatal street racing accidentWhat could be substituted for street racing, that would allow the behaviour to continue, in a safer manner?
  19. 19. Role of Nurses • Code of Ethics • Developing therapeutic relationships • Involving current and former people who use drugs • Care planning • Referrals • Health promotion teaching and education • Overdose managementProfessional boundaries and self care
  20. 20. Key Components to BBI Testing Pilot• Increased awareness for staff and patients• Link to care• Offer routine HIV testing to ALL patients admitted to critical care – HCV and HBV offered at same time – Targeted testing = missed opportunities• Pilot will establish what works in practice in your unit
  21. 21. Cost Effectiveness?• Screening for HIV is cost-effective even where HIV prevalence is low (0.1-0.2%)• Routine testing every 5 years is as cost effective as yearly mammograms after age 50 (Ann Intern Med. 2009; 150:125-131)• ~25% of Canadians with HIV are unaware of their diagnosis
  22. 22. Substance Use and Acute Care• Assess patients fully and ask • Ask patients to tell you if they use about their use, how they • Don’t punish patients for using support their use, &if they are • Keep the door open –review your withdrawing AMA policy• It isn’t your life, so avoid • Be clear about what patients can judgment expect from you & what you• Manage withdrawal properly – expect from them withdrawal is a MEDICAL “They may have made some bad EMERGENCY choices but your job is to• Set realistic boundaries look after their needs” Remember• Understand the impact of Maslow???? trauma, pain and anxiety
  23. 23. Social Determinants of Health Maslow’s Hierarchy of Needs Where is your client at right now?Maslows hierarchy of needs and subpersonalitywork, Kenneth Sørensenhttp://two.not2.org/psychosynthesis/articles/maslow.htm
  24. 24. What are your experiences?
  25. 25. Break Time!
  26. 26. Special Populations • Concurrent Disorders (mental health & addictions) • Aboriginal • Remanded Populations • Women • Youth
  27. 27. “Insite saves lives. Its benefits have been proven.” With thatblunt statement, the Supreme Court of Canada cuts to theheart of the matter: by denying Vancouver’s safe-injectionfacility, Insite, a further exemption from laws prohibitingdrug possession, the federal government acts contrary tothe Charter of Rights and Freedoms.
  28. 28. Peer Support & CommunityMobilisation• Strengthens programs and policies• Involving current and former people who use drugs for: – Better program design – Better program implementation – Better effectiveness and coverage
  29. 29. Harm Reduction in Canada: Ambivalence, Denial, or Apathy?• Federally, in Canada, the window is either closed or very nearly• Coverage & capacity far too low (need 60%), implementation far too late.• Interventions with the lowest impact -supply reduction, legal constraints, detoxification & abstinence & awareness programs-are the most often practised.• Need to look at examples from around the world• Need to look at what works on the ground locally
  30. 30. Harm Reduction in the USA: Ambivalence, Denial, or Apathy?• US Surgeon General Gives Okay for Needle Exchange Funding• “Washington, DC has the highest rate of new AIDS cases in the country with an estimated 1 in 20 residents living with HIV.• HIV Travel Ban finally lifted, after 22 years• “The most widely implemented school-based prevention program, known as Drug Abuse Resistance Education (DARE), has also proven to be ineffective at reducing rates of illicit drug use.”
  31. 31. Current EventsThrone Speech 2009“Therefore, my government will introducechanges to limit the proliferation of needleshanded out by needle exchange programs.Ultimately, this program cannot be allowedto function as a source of unlimited freeneedles. ““My government will tightencontrols around both the numbers ofneedles exchanged and distributed. Wewill cap the number of needles given out atany one time, thus creating more frequentcontact with health professionals, which inturn means more frequent opportunity forintervention and treatment. “
  32. 32. http://www.facebook.com/pages/SK-HIV-Provincial-Leadership-Team/221186151258175
  33. 33. Legal issues or Health issues• December 2011 AIDSLAW &bill c-10 – “With injection drug use as the single greatest category of exposure to HIV for Aboriginal persons, they are thus disproportionately vulnerable to policies that punish people who use drugs, such as the “tough-on-crime” law enforcement measures that Bill C-10 will impose and barriers to harm reduction services, both inside and outside of prison.” http://www.aidslaw.ca/publications/interfaces/downloadFile.php?ref=1954• HIV disclosure ruling clarified by top court – People with low-level HIV and condoms neednt disclose infection – The court ruled Friday that the "realistic possibility of transmission of HIV is negated" provided the carrier of the virus has a low viral load and a condom is used during sexual intercourse. Otherwise… – HIV carriers have to disclose their status to their partners. http://www.cbc.ca/news/canada/story/2012/10/05/supreme-court-hiv-ruling.html
  34. 34. In Small Groups• Consider the ‘Ethical, Legal and Social’ Context• Consider how this may impact your practice across a variety of settings• Consider the RN as an Advocate, what is your role given the Code of Ethics?
  35. 35. Conclusions?• Evidence Informed Decision Making?• Morality vs best practice?• Interplay of Politics and Policy• Public Health vs Human Rights?
  36. 36. “Ultimately we know deeply that the other side of every fear is a freedom.” Marilyn Ferguson
  37. 37. Thank you for your time and attention. Please feel free to contact Sarah at:Sarah Liberman, RN, MN(306) 775-7987 sarah.liberman@siast.sk.caGreg Riehl RN, MA(306) 775-7383 greg.riehl@siast.sk.ca
  38. 38. SK HIV/HCV Nursing Education Organization• The mission for the Saskatchewan HIV/HCV Nursing Education Organization is achieved through: – Providing accessible and affordable education and learning opportunities – Creating a network of members by which support and mentorship can occur – Serving as a provincial voice for issues related to HIV and Hepatitis nursing care – Advocating for the rights and dignity of people who are living with HIV/AIDS and/or HCV, or who are vulnerable to these infections – Supporting a collaborative professional practice environment – Promoting professional growth – Improving patient/client/resident outcomes

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