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: [email protected] 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: [email protected] 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: [email protected] 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 [email protected] (614) 340-6707 This handbook was compiled by the Ohio AIDS Coalition in conjunction with the 2015 Ohio Harm Reduction Summit.
© Copyright 2024