A Syringe Services Program in Chicago

The Power of Any Positive Change!

Chicago Recovery AllianceCDC SSP ConsultationAugust 30-31, 2010 Atlanta GE

Low Threshold – All Treatment Options - All are Welcome

Assisting Any Positive Changes As People Define Them for Themselves

Year Exchange Scheme % Reporting 1:1 for self and others’92-’93 1 1 43% after using SEP*‘93-’95 2 1, 1st 5-1 for 1 after 58% after using SEP*’96-now need-based (self +) 92% after using SEP*Now = “How many do you need for one shot-one syringe for yourself and others around you?” Negotiate up!

“100? 200? 300?... no, 200 is fine”!

Syringe Exchange Scheme Used

* Community Advisory Groups and Cross-Sectional Surveys

Insight: Cooperation up-front leads to cooperation in return…

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, Regarding Diffusion of Benefit Study

SYRINGE RETURN COOPERATION IS BUILT THROUGH RELATIONSHIPS, NOT

FORCED/COERCED!!

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Chicago Recovery AllianceSyringes Found in Humboldt Park

July 1993 - June 1996Note: Search method is 20 minute walking tour of consistent course

OutreachStarts

Date of Tour

Numberof

SyringesFound

Making a Safer ShotStarting Point?

More Accurate!

It’s a HEP World!!

Candidates for Hepatitis A Vaccination

• High-risk populations * Users of illegal drugs.

Candidates for Hepatitis B Vaccination

• High-risk populations * Injection drug users.

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

The Berkeley Free ClinicHealth Care for People Not Profit

http://www.berkeleyfreeclinic.org

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.

Pneumococcal

Seasonal Flu

H1N1 Flu

Hep A/B Combined - Twinrix

Hep A and Hep B separatelyTetanus

Vaccination Experience to Date…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 vaccine!

Enough Motivation to Address OD? Program

Opiate Overdose Prevention and Intervention

in Chicago

Use of a proven antidote to save lives where they are being lost

on the streets

CRA’s OD work dedicated to John Szyler as Any Positive Change

T I M E

Person's

Level of

Opiate

Activity

100% of Their OD Dose

One shot naloxone save...D E A T H

N O T B R E A T H I N GN O T R E S P O N S I V E

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CRA’s Opiate Overdose Prevention/Intervention Work…

Results thru July 2010: 16,121 persons reached and 2,027 convenience reports of peer reversal received

All Testing Possible…

Rapid HIV ab – oral or finger stick

Syphilis + HCV ab

ALL TESTING POSSIBLE…

Chlamydia/Gonorrhea

CRA Annual Report 200911,021 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

Bridge to Life Improvements

- 300 new methadone treatment admissions in 40 days - Spring ‘00

MOSTMOST•Mobile Opiate Substitution Therapies

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)!!!

- Resources needed to start but can be self-supporting

- IMPROVEMENT FOR ALL DISIPLINES!!!

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From July 1994 to present: 256,138 cases in SPSS database, 60,055 unique participants, plethora info

Why force such extensive data collection for all participants?

Why require programs to RE-ENTER data by hand if they have it electronically?