COMMUNITY PLANNING & SYRINGE ACCESS ADAM REILLY PROJECT DIRECTOR

COMMUNITY SUPPORT FOR HARM REDUCTION

Identified key individuals to champion harm reduction in various sectors of the community People who take drugs Family members Law enforcement Judicial and corrections system Drug treatment and prevention Health care system City and county government Business community Private funders

ENGAGING THOSE WHO TAKE DRUGS IV

Conducting street outreach Outreach to those in treatment Conducted community assessment

189 surveys completed 67 participants in focus groups All individuals were currently using or had used

in the past year Community assessment was used as a way

to make national and international data on harm reduction have a real connection to what was going on at the time locally

GAINING LAW ENFORCEMENT SUPPORT

Have worked closely and continue to do so with CPD and Hamilton County Sheriff’s office

Outspoken support from city police Chief and county Sheriff

Engage community liaison officers, those for individual neighborhoods and those for specific groups

Maintain relationships with district commanders and liaison officers

Provide training to law enforcement on harm reduction and Naloxone use

Local law enforcement understands how harm reduction protects them and other first responders

BUSINESS AND FUNDING COMMUNITY SUPPORT

Support from major local foundation, Interact for Health, has been a catalyst for harm reduction in Cincinnati

Early support of such an approach has lead to more support in the wider funding community

Connections made with business leaders, prominent individuals and families

HAMILTON COUNTY ROE PLAN

Individuals from more than 30 organizations joined forces in 2013

During that time they were split into four main categories Treatment/recovery Harm Reduction Prevention Supply reduction

A more than 40 page detailed plan will be released to the public in the coming weeks

Plan has endorsement from key city and county officials

GETTING PEOPLETHE TREATMENTTHEY NEEDTreatment Outcomes:

More Hamilton County residents will achieve long-term recovery as a result of addiction treatment and related services.

Fewer Hamilton County residents will overdose on opioids

TREATMENT STRATEGIES

• Increase the capacity of all levels of addiction treatmentcare, particularly for indigent and underinsured HamiltonCounty residents.• Enhance addiction treatment services through thecontinued use of evidence-based counseling practicesand by making Medication Assisted Treatment (MAT)more available in conjunction with treatment services.• Increase the number of sober housing units available forHamilton County residents.• Strengthen treatment providers’ collaborations withmutual help groups such as Narcotics Anonymous,Alcoholics Anonymous, and SMART Recovery.• Make peer mentoring and support more available topeople in recovery and for providers of MedicationAssisted Treatment.

REDUCING HARMCAUSED BY THEOPIOID EPIDEMICHarm Reduction Outcomes:

- Decrease the number of new Hepatitis C,HIV, and other infections caused byintravenous drug use

- Decrease the number of unintentionaloverdoses due to opioid use

- Decrease the transmission of Hepatitis C,HIV, and other infections through accidental needle sticks.

HARM REDUCTION STRATEGIES

• Increase community based Naloxone distribution• Expand syringe exchange programs in Hamilton County• Increase community support and education efforts• Increase access to healthcare for intravenous drug users• Provide overdose education and prevention services throughout Hamilton County.

PREVENTINGOPIOID MISUSEPrevention Outcomes:

• Fewer people begin misusing prescription opiates

• Fewer people begin using heroin and other illegal opioids

PREVENTION STRATEGIES

• Provide information by educating the public and professionals about heroin and prescription drug issues.• Build skills, connected to trust and communication

• Improve the safety of the physical environment

• Advocate for policies that increase the availability of permanent drop boxes and education about SBIRT and pain management practices.

CUTTING THESUPPLY OFOPIOIDS INHAMILTON COUNTY Supply Reduction Outcomes:

• Reduce the supply of heroin in Hamilton County

• Less diversion of prescription opiates

SUPPLY REDUCTION STRATEGIES

• Enforce current laws and regulations• Collaborate with others to educate the public• Explore the feasibility of implementing harm reduction measures on alarger scale

PUTTING THE PLAN INTO ACTION

Funding collaborative has been established Comprised mostly of local private funders ROE admin team will pursue local, state, and

federal funds for portions of the plan as well Plan is a living document and will be updated

periodically Once fully implemented ROE will be able to

show the success of each strategy and how they work together

MISSION STATEMENT

The Cincinnati Exchange Project is a local advocacy organization that promotes education and the harm reduction model. We advocate for policy change that will enable local community based organizations to conduct outreach, testing and provide safe injection equipment to the injection drug use community. Upholding every individual’s right to health and well-being. These efforts will increase their competence to protect themselves, loved ones, and the community as a whole.

HOW CEP GOT STARTED

Coalition of interested parties started work in 2007; reps from drug treatment, health care, law enforcement, and others (separate from ROE)

Ohio is a home rule state Cincinnati Health Department declared a

health emergency on 2/28/2012 Health emergency allows CEP to operate

within the city of Cincinnati only Gained support of CPD and Hamilton County

Sheriff’s office

TURBULENT START TO CEP

Operations started in Springdale in February 2014 with an emergency order

After 6 weeks of operations it was claimed that CEP decreased business at surrounding businesses by 20%

All levels of Springdale government withdrew support

No incidents occurred and police or first responders were never call for anything related to CEP

Next neighborhood we approach was Lower Price Hill which ended up being a media nightmare!

CEP OPERATIONS STABILIZE

Change over in city and county law enforcement leadership

Greater knowledge of issue in the general public

Partnership with Episcopal church in Mt. Auburn

Large scale support for harm reduction in Northside

COMMUNITY BUILDING FOR CEP

CEP operates in 2 Cincinnati neighborhoods Mt. Auburn and Northside 3rd site to start in late-April, this site will have a focus

on Transgender services To gain access and support CEP…

Canvassed neighborhoods, talking to community members and cleaning up trash and needles

Identified key neighborhood supporters/advocates Met with community councils and business

associations Conducted community education sessions Secured support from CPD and both district

commanders along with community liaison officers Continue to build and maintain relationships with

those in each community

WHO MANAGES AND RUNS CEP

Medical Director Dr. Judith Feinberg, MD

Project Director Adam Reilly

Project Manager Libby Harrison

Volunteers Much of the community work CEP does is

through the work of our amazing volunteers!www.cincyep.org or follow us on Facebook www.facebook.com/cincinnatiexchangeproject

WHAT SERVICES ARE OFFERED

1-for-1 syringe exchange FREE rapid HIV, HCV, syphilis and pregnancy

testing Safer sex & injection equipment/education Community based Naloxone distribution Active referrals to detox and drug treatment Active referrals to other social services ACA enrollment through Free Store Foodbank A conduit for entering drug treatment

WHAT’S THE CLIENT EXPERIENCE

Initial paper work (only done once) Agrees to participant’s rights and

responsibilities No Drug use, drug dealing, weapons, or other

illegal activity Given a participant code AREI5723 All services are offered, but not required Initial visit may be 20 minutes, subsequent

visits may only be 5 minutes.

WHAT CEP HAS SEEN AS OF 3/16/2014 240 total clients Exchanged 15,500 syringes Distributed 200 Narcan Kits through Project DAWN and

26 Evzio kits 27 lives saved 7 deaths, nearly doubled since running our of Project DAWN

supply 15% given to second party, 85% to first party 10 organizations trained and supplied with Narcan CBD unit trained and District 3 is in the process

Average age of client is 37, youngest 19, oldest is 67 Average length of use 8.4 years 10% of clients have been using less than 1 year 30% of clients have been using for more than 20 years

CEP RACIAL/ETHNIC BREAKDOWN

Sales

Asian Native American Hispanic Middle EasternWhite

CEP EMPLOYMENT STATUS

Sales

EmployedUnemployedStudentDisabledHomemaker

CEP GENERAL DATA

56% have overdosed in lifetime 71% report being HCV positive 4.3% report being HIV positive

NEXT STEPS AND EXPANSION

CEP is a data driven program, but can only operate in communities that are welcoming

We have plans to expand within the city and are in talks with other jurisdictions in the region

CEP needs communities to approach them, we have found that when approached by community members we have more success than the reverse

We hope that data collected by CEP and the successful operations for more than a year will help to open more community member’s minds, leading to greatly expanded services in the region

MOBILE UNIT