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

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

7. 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

9. 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,

10. 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

15. Starting Point?
Making a Safer Shot

16. More Accurate
It‟s a HEP World!!

17. Candidates for Hepatitis A Vaccination
• High-risk populations
* Users of illegal drugs.
Candidates for Hepatitis B Vaccination
• High-risk populations
* Injection drug users.

18. 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

19. 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

20. H1N1 Flu
Pneumococcal
Seasonal Flu
Hep A and Hep B separately
Tetanus
Hep A/B Combined - Twinrix

21. 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

22. Enough Motivation to Address
OD? Program

23. 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

25. 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

26. CRA‟s Opiate Overdose Prevention/Intervention Work…
Results thru July 2010:
16,121 persons reached and
2,027 convenience reports of
peer reversal received

29. ALL TESTING POSSIBLE…
All Testing Possible…
Chlamydia/Gonorrh
ea
Rapid HIV ab – Syphilis + HCV
oral or finger ab
stick

30. 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

31. Bridge to Life Improvements
- 300 new methadone
treatment admissions
in 40 days - Spring „00

36. MOST
•Mobile
Opiate
Substitution

41. 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)!!!

42. 1
2 3
From July 1994 to present: 256,138 cases in
SPSS database, 60,055 unique participants,
plethora info

43. Why force such extensive
data collection for all
participants?
Why require programs to
RE-ENTER data by hand