[HARMRED] 1:1 Syringe exchange versus distribution

[Nabarun Dasgupta]

Dan is absolutely right. Naloxone has been used for more than a decade to prevent deaths, with minimal training. It's easy to use, and there are few side effects beyond withdrawal. True, better formulations are greatly needed, but that shouldn't stop it's use now. Naloxone is currently being used in plenty of different cultural settings in east and central Asia (China, Afghanistan, Cambodia, etc.), eastern Europe (Ukraine, Poland, etc.), western Europe (UK, Germany), and North America.

In ADDITION to being an antidote, naloxone gets people in the door for overdose prevention education; it's a pharmacologic outreach tool. There are also instances where people who have been empowered through naloxone have done rescue breathing when naloxone wasn't at hand.

There is mainstream support for naloxone distribution. The "jury" isn't out; health bureaucrats appear content to have debate for the sake of debate while people die. Luckily, some health authorities are endorsing naloxone distribution, including PEPFAR and UNODC. The North Carolina Medical Board sent a notice to every licensed physician, nurse and PA in the state:
"The prevention of drug overdoses is consistent with the Board’s statutory mission to protect the people of North Carolina.  The Board therefore encourages its licensees to cooperate with programs like Project Lazarus in their efforts to make naloxone available to persons at risk of suffering opioid drug overdose. "
http://www.ncmedboard.org/position_statements/detail/drug_overdose_prevention/
See also: http://www.projectlazarus.org

Wilkesboro, North Carolina and HCMC, Viet Nam may be as different as two places can be, but there are already verified reports of overdose reversals in Viet Nam with naloxone. Any indication whether CDC in Viet Nam going to support or stand in the way of naloxone distribution?

Best,
Nab
UNC/Project Lazarus


On Oct 15, 2010, at 9:41 AM, Dan Bigg wrote:

> Chris -
> 
> CRA does need-based -- what need?  The need for the person we see and everyone they will see to have enough syringes for one shot-one sterile syringe (in fact, some need more than 1 for each shot and this is OK too).
> 
> The essential way you get there is NEGOTIATE UP..."How many do you need for yourself and those around you to have a new one each shot?"  (Answer -- they say for instance 100)... you say "How about 200?...They say OK..you say "How about 300?...They say, "No, 200 is fine!"  This is the number you give them.
> 
> Please keep in mind that changing to a need based system -- where I feel the best science of safer injection, improved health, clean streets, etc lay -- may take a long time and such strict negotiating up will take time to sink in as the new standard!
> 
> Be ready for a few to leave with a bunch, maybe in the thousands, and you need to be OK with this as people test you and pass the word!  Without such a clear and present change more generous syringe usage and providing AND Collecting may never develop!
> 
> I saw the Vancouver Program DEYAS switch from a strict 1 - 4 - 1, with a limit of 4, to no limit (after they saw a massive spread of HCV) and three years later almost everyone who came in only took four -- even in discussions with participants people felt that taking more than 4 somehow 'violated' the program and evaded the shame/control/condemnation all 'good' drug users should always feel towards themselves and others...
> 
> It is somewhat counter intuitive but in a three year study with Yale/Robert Heimer we saw that such a respectful system results in MORE of what I would call community altruism -- kinda the "you catch more flies with honey than vinegar" approach.  We saw an 88% return rate at our program -- much less circulation time critical to lessening disease spread -- versus three 1 - 4 -1's around the country who averaged in the 50%'s .
> 
> Meeting with your participants, paying them for their expertise, having a nice meal and asking these questions would also help - we have had such meetings, we call Community Advisory Groups for years and our participants have been great with suggesting and navigating all such positive changes...
> 
> Call me to clarify if needed.
> 
> Peace, Dan
> 
> At 9:16 AM -0400 10/15/10, Serio-Chapman, Chris wrote:
>> Content-class: urn:content-classes:message
>> Content-Type: multipart/alternative;
>>   boundary="----_=_NextPart_001_01CB6C6B.29FB8A5E"
>>  
>> Hello from Baltimore! 
>>  
>> Currently we are exploring the possibility that our syringe exchange services may go the way of distribution-finally.  Just curious how many SEPs actually still do 1:1 and how many do distribution.  Is there someplace I can find this information?  If not, if individuals from SEPs could respond to let me know what they are doing I would be grateful.
>>  
>> Chris
>>  
>>  
>> Chris Serio-Chapman    
>> Baltimore City health Department
>> 
>> _______________________________________________
>> HARMRED mailing list
>> HARMRED at drcnet.org
>> http://drcnet.org/mailman/listinfo/harmred
> 
> 
> -- 
> 
> Dan Bigg, Director                      cra at attglobal.net
> Chicago Recovery Alliance              (312) 953-3797
> 
> 3110 West Taylor                  fax (773) 489-7448
> Chicago IL  60612-3944                http://www.anypositivechange.org
> "A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it." -- Max Planck 1858 - 1947
> _______________________________________________
> HARMRED mailing list
> HARMRED at drcnet.org
> http://drcnet.org/mailman/listinfo/harmred