Photo by Jair Lazario/UNSPLASH
There’s a needle exchange program in Richmond to help people struggling with injectable drug use, but there’s much more to it.
It’s called Comprehensive Harm Reduction, and it’s designed to provide guidance and tools for safer use of the drugs. Its goals include reducing overdose deaths, heading off blood-borne infections that can result from needle drug use, including HIV and hepatitis C, and providing initial contacts and building trust that can lead to less frequent drug use or eventual entry into treatment programs. Health Brigade, which operates the pilot program, says research shows that participants in harm reduction programs are five times more likely to seek treatment than other drug users.
It’s an intersection point where someone struggling with addiction talks with counselors, and that may increase the odds “that someone is willing to start the journey to rehabilitation,” says Danny Avula, director of the Richmond and Henrico County Health Districts.
CHR is offered at the nonprofit Health Brigade, 1010 N. Thompson St., from 5 to 8 p.m. on Mondays and 1 to 4 p.m. on Fridays. The program began in October and has seen an uptick in use since Christmas, says Emily Westerholm, program coordinator. Health Brigade has been spreading information about the program’s availability through a number of outreach efforts, including distribution of about 8,000 cards. “This is a very new idea, here,” says Westerholm. They hope to reach 1,500 people this year.
Education and one-on-one contact without judgement or preaching come with each interaction. A CHR brochure details services and offers tips on safe usage, such as avoiding using alone, and tips on how to clean a syringe with bleach. Kits are available that include syringes, cookers and filters. Naloxone, a drug that can reverse an overdose, is available for free in a nasally administered package along with training on its use. The program also makes available testing for hepatitis, AIDS and sexually transmitted diseases; safe-sex items; wound care; toiletries; snacks; and water. Users are provided access or referrals to services including counseling, medical services, insurance enrollment substance treatment, HIV-preventive medication, substance use treatment and medication-assisted treatment.
Those seeking help can remain anonymous. Services are provided in a welcoming atmosphere, maybe over a cup of cocoa and a snack. “We try to make it as warm as possible,” says Westerholm. “They feel like they’re getting something valuable.”
It’s an evidence-based approach, but one that has met with resistance, as some contend that a needle exchange encourages and abets illegal drug use. “Some people get stuck swallowing the harm reduction pill,” says Westerholm.
"It’s about helping a person struggling with drug use to take charge of their life in any way possible and to be who they want to be. We like to empower them, to give them a voice,” says Westerholm. “This sort of gives people a prescription to figure it out on their own terms.”
The Health Brigade program is the second in the state. A program in Wise County in southwest Virginia operates out of a health department and offers one-for-one needle exchange, says Westerholm. The nonprofit has also applied for a grant to operate a mobile program that will bring its initiative to the streets. Westerholm says she hopes to have the mobile clinic in operation in March. The program is considered a pilot program, with funding currently running through 2020.
“We’re really hoping it stops being a pilot program and it’s just the norm,” says Westerholm.
Avula describes the Comprehensive Harm Reduction program as a big win for metro Richmond. “My hope is that the program will expand,” he says.
The program is one of several initiatives to combat the opioid epidemic in the metro region and the state. Overdoses have become the leading cause of unintended death in the state since 2013, surpassing vehicle wrecks and gun-related deaths.
Through the third quarter of 2018, Richmond and Henrico County were on track to have fewer drug overdose deaths compared with the same period in 2017. There were 69 opioid deaths in the city through the third quarter in 2018, down from 75 in a similar period the previous year. That’s notable, as a spike occurred statewide in the third quarter, negating a projected decline in overdose deaths that had been based on what was seen statewide through the first six months of the year.
“The opioid epidemic is still alive and well,” Avula says. “We’re still doing a full-court press.”
Statewide, heroin and fentanyl overdoses are driving the numbers. There has been a slight decline in prescription-related opioid overdose deaths, which Avula describes as a trend that’s “pretty real and significant.”
A number of initiatives undertaken by the state and by several local entities may be helping, such as a program to monitor prescriptions. He notes a 10 percent drop in opioid painkiller prescriptions and a 25 percent decline in the number of patients getting the prescriptions.
The state has also encouraged and expanded access to Narcan, a drug that can reverse an overdose. Locally, 2,852 doses of the medication have been made available to people in the community since July 2017, says Avula. Richmond Ambulance Authority, which provides emergency services in the city, reports it administered Narcan 894 times in 2018, a slight drop from 908 times in 2017. Narcan has been administered 31 times so far in 2019.
Medicaid expansion, which went into effect earlier in the month in Virginia, provides greater access to medical care, including addiction treatment, to state residents in need. There has also been a boost in funding to addiction therapy providers, which has boosted their numbers.
One factor affecting the numbers of overdose deaths is the strength of the drugs that are coming into a community. Much of the heroin is mixed with fentanyl, usually fentanyl that has been made in illicit laboratories. There can be great variations in the potency of the drug, and that can kill.
There have been numerous efforts to spread the word on the street about this problem. And some fentanyl testing strips are available so that users can at least test the drugs before consuming. Strips available through the Comprehensive Harm Reduction program show if there’s more than 200 nanograms of fentanyl present, or more than just a trace amount.
“It’s really empowering to have this tool,” says Westerholm.
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