Innovative frameworks to expanding harm reduction:

Strategies to build relationships with law enforcement on HIV prevention

January 8, 2016

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@hivprevjustice #harmreduction

Webinar Instructions

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• During Q & A segment the moderators will read

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Raise your Hand, Use the Question Feature to Ask Questions, or

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Today’s Agenda • Agenda & Opening

– Mary Beth Levin, Associate Professor, Georgetown University School of Medicine

• North Carolina Perspective– Tessie Castillo, Advocacy and Policy Coordinator, North Carolina Harm Reduction Coalition

– Donnie Varnell, Special Agent In-Charge (retired), North Carolina Department of Justice

• Atlanta, Georgia Perspective– Mona Bennett, Associate Director, Atlanta Harm Reduction Coalition

• Maine Experience– Kenney Miller, Executive Director, Down East AIDS Network & the Health Equity Alliance

– Joel Merry, Sheriff of Sagadohoc County, co-leader of Law Enforcement Workgroup for Maine Anti-Opiod/Heroin Initiative

• Summary and Wrap-up– Mary Beth Levin, Associate Professor, Georgetown University School of Medicine

• Community and Additional Perspectives– Van Ingram, Executive Director, Kentucky Office of Drug Control Policy

– Philomena Kebec, former Staff Attorney/Child Welfare Prosecutor for the Bad River Band of Lake Superior Chippewa;

current volunteer with the Gwayakobimaadiziwin Bad River Needle Exchange

– Mark A. Spawn, Chief/Ret. Fulton Police, Director of Research and Training at New York State Association of Chiefs of

Police, Consultant for The Spawn Group, LLC

• Q&A and closing

North Carolina

Tessie Castillo, Advocacy and Policy Coordinator, North Carolina Harm Reduction Coalition

Donnie Varnell, Special Agent In-Charge (retired), North Carolina Department of Justice

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Atlanta, Georgia

Mona Bennett

Associate Director

Atlanta Harm Reduction Coalition

A Maine RevolutionLaw Enforcement and Harm

Reduction

Kenney MillerExecutive Director, Health Equity Alliance

Co-Founder, Maine Harm Reduction Alliance

Joel MerrySheriff, Sagadahoc County

President, Maine Sheriff’s Association

Advancing the health, wellbeing and rights of people who use drugs.

• Education

• Advocacy

• Action

Importance of Law Enforcement

• Crucial to programmatic success

– Syringe exchange

– Overdose prevention

• Naloxone administration

– Diversion projects

• Project Hope

• Bangor LEAD

Importance of Law Enforcement

• Crucial to achieving legislative/policy change

– Political environment in Maine

– Harm reduction at the intersection of criminal justice and public health

– Authority of law enforcement and appeal to conservatives

– Leading policy change

• Federal ban on funding for SES

• State Naloxone advances

Culture Shift

• Each office/agency has it’s own culture

• The great culture shift...

– Medical model of addiction

– Collaboration with harm reduction

– Charge to serve and protect – what this means

• Not universal…

Working Across the Culture Divide

• Know who you’re working with

– Find the right person – gatekeepers and hierarchy

– We’re all ideological creatures

– Research and listen

• Find common ground

– What brought them to law enforcement in the first place?

– Mandate of law enforcement

Working Across the Culture Divide

• Speak their language – frame your messages

– Recidivism

– Jail overcrowding

– Public safety

• The Thin Blue Line

– Find your champions

– Know your research

– Examples of where it’s worked

Mary Beth Levin

Associate Professor, Georgetown University School of Medicine

SSPs Protect Those who Protect Us

o Needle stick injuries to law enforcement are a common occurrence. In San Diego, nearly 30% of officers have been stuck by a needle.1

o Decriminalization of syringes (and SSPs) has been tied to reduced needle stick injuries. In South Carolina, where syringes are legal, officers have experienced needle stick injuries at half the rate of their counterparts in North Carolina, where syringes are illegal.2

o In Connecticut, police officer needle stick injuries were reduced by two-thirds after the establishment of SSPs.3

o “In the cities that have adopted needle services programs, there is a dramatic reduction in needle sticks to firefighters who crawl on their hands and knees through smoke-filled rooms in search of victims.” - Charles Aughenbaugh, Jr., President, New Jersey Deputy Fire Chiefs Association, Retired Deputy Fire Chief, March 2011

SSPs Make Communities Safer for Everyone

o SSPs distribute free sterile syringes to injection drug users (IDUs), which reduces the likelihood that users will share injecting equipment.1

o SSPs safely dispose of used needles, a service not typically provided by distributors such as pharmacies.

o SSPs make neighborhoods safer by reducing needle-stick injuries.1

o In New York City, the growth of SSPs from 1990 to 2001 was associated with a 78% decrease in HIV prevalence among IDUs. 1

o During this time period, the same population saw a decrease in the prevalence of hepatitis C from 90% to 63% 2

o One study showed that within 6 months of using federally-funded SSPs, clients saw a 45% increase in employment.

o In addition, SSP clients were 25% more likely to have been successfully referred to mental health treatment and prescribed medication than other SAMHSA grantees.3

o In New Jersey, 22% of the state’s SSP clients have entered drug treatment.4

SSPs Bring Results

SSPs Do NOT lead to an increase in crime or drug use.

o Neighborhoods in Baltimore with SSPs experienced an 11% decrease in break-ins and burglaries, while areas without SSPs saw an 8% increase in such crimes during the same period.1

o In Seattle, IDUs who had used SSPs were more likely to report a significant decrease (>75%) in injection drug use, to stop using injection drugs, and to remain in treatment than IDUs who had never used SSPs.2

o The same study in Seattle found that new users of the SSP were five times more likely to enter drug treatment than individuals who never utilized the program.2

Local Examples:

National Black Police Association letter to President Clinton (March 1998)

:

“We are hopeful that Secretary Shalala will exercise her waiver authority immediately and allow federal resources to be used for needle exchange. Our members support the lifesaving effects that needle exchange promotes — including reduction of HIV disease in our communities and bridging the gap between those addicted to drugs and the medical care and drug treatment services they so desperately need.”

Ways law enforcement can help

• Provide helpful quotes

• Personal testimony at meetings

• Op-eds

• Organizational sign-ons

Messages and Messengers:

law enforcement, faith communities, and

families.

“By restoring the ban on federal funding for syringe exchange, members of Congress undoubtedly believed they were striking a blow against drug use. As extensive experience has shown, nothing could be further from the truth. By withholding funding for syringe exchange, Congress has made our communities less safe, made police officers and medical responders unsafe, undermined a vital bridge to drug treatment, and hindered national efforts to address public health problems such as HIV and hepatitis C.”

- Chief James Pugel, Seattle Police Department

What do Syringe Services Programs (SSPs) mean for Illinois?

“I’ve been stuck by needles and cut by broken crack pipes and razors while on duty. We had to search people so quickly, it was easy to touch something dangerous. If one of us got stuck, we might report it to a superior officer so he could write an exposure report, or we might not. I never sought treatment for

needle-sticks because we were supposed to be tough guys, you know. We’d get cut and move on.”

- Jen “Crash” Earls, former Chicago patrol officer and member of rapid response and special operations teams

Why Illinois? In Illinois, 24.3% of all AIDS cases have occurred among injecting drug users, compared to 25.2% nationally.1 Seven syringe services programs are active in Illinois: in Belleville, Champaign, Chicago, Kankakee, Springfield, and Urbana.2 African Americans account for a disproportionately large share. While representing 36.8% of the Chicago population, they represent 71% of new infections among IDUs in Chicago.3

Federal dollars went to SSPs in Illinois: Centers for Disease Control and Prevention:*(Chicago, FY 2010) $ 50,000 Substance Abuse and Mental Health Services Administration4 (FY2009): $ 14,541 Substance Abuse and Mental Health Services Administration (FY2010): $ 139,784 Substance Abuse and Mental Health Services Administration (FY2011): $ 172,009

*In addition, Chicago had planned to use an additional $50,000 of 2012 CDC funds.

Syringe Services Programs Work in Illinois

In 1995, 32% of AIDS cases in Illinois were attributable to IDU; by 2005, that number was 12%, signifying a decrease of 66%.

During the same timeframe the city of Chicago saw a decrease from 33% to 15%, or a 55% drop.5

This 66% reduction in IDU HIV infections state-wide has saved an estimated $200M due to averted medical expenses.6

Participants in a Chicago SSP were 49% more likely to use condoms with main partners.7

Syringe Services Programs are Cost-Effective Illinois’ relatively small investment in syringe services funding can have huge returns. Studies have shown that every $1 invested in syringe services programs results in $7 in savings.8 Thus, we can estimate that federal funding had already set into motion over $2.6M in savings, and that over time, a $50,000 FY12 CDC investment would have resulted up to $350,000 in additional savings.

1 Illinois: Estimated Numbers of AIDS Diagnoses Among Adults and Adolescents by Transmission Category, Cumulative through 2010. Available at: http://www.statehealthfacts.org/profileind.jsp?rgn=15&cat=11&ind=845 2 amfAR: Syringe Exchange Program Coverage in the United States 2014. http://www.amfar.org/uploadedFiles/_amfarorg/Articles/On_The_Hill/2013/2013%20SSP%20Map%20Final.pdf 3 AIDS Foundation of Chicago. HIV/AIDS in Chicago (2009. Available at: http://www.aidschicago.org/pdf/chicago_factsheet_2010.pdf 4 SAMHSA dollars went to DASA-IL El Rincon (FY 2010-11) and University of Illinois at Chicago (FY 2009-2011) 5 Substance Use Disorders and HIV/AIDS. Center for Health & Justice at TASC. Available at: http://www.centerforhealthandjustice.org/BOSUDsandHIV-AIDS.pdf 6 Federal cuts won’t hurt Chicago needle-exchange programs. AIDS Foundation of Chicago. Available at: http://news.medill.northwestern.edu/chicago/news.aspx?id=198568&print=1 7 CDC. Needle Exchange and Sexual Risk Behaviors Among a Cohort of Injection Drug Users in Chicago, Illinois. Available at: http://www.thebody.com/content/art50367.html 8 Nguyen TQ. et al. Syringe Exchange in the United States: A National Level Economic Evaluation of Hypothetical Increases in Investment,

AIDS and Behavior, November 2014, Volume 18, Issue 11, pp 2144-2155. http://link.springer.com/article/10.1007/s10461-014-0789-9

Organizational Sign-On

Organizational sign on pt 2

Putting it into practice• Incident report: name*, badge number*,

squad car number*, physical description, date, time, location.

• Organizational buy-in.

• Community buy-in – harm reduction does not mean “anything goes” – being a good neighbor.

• LEO’s are people too.

• You are not alone!

Thank you!

Mary Beth Levin, MPHAssociate Professor

Department of Family MedicineGeorgetown University School of Medicine

levinmb@gmail.com

Community and Law Enforcement Perspectives

Van Ingram, Executive Director, Kentucky Office of Drug Control Policy

Philomena Kebec, former Staff Attorney/Child Welfare Prosecutor for the Bad River Band of Lake Superior Chippewa; current volunteer with

the Gwayakobimaadiziwin Bad River Needle Exchange

Mark A. Spawn, Chief/Ret. Fulton Police, Director of Research and Training at New York State Association of Chiefs of Police, Consultant for

The Spawn Group, LLC

Law Enforcement and Harm Reduction

• Logical interface (police and harm reduction institutions)

• Police routinely interacting with IDUs

• Police frustrations with criminal justice systems (substance abuse, mental illness, other social issues)

Law Enforcement and Harm Reduction

• Already part of mission (i.e. traffic/bike/pedsafety, alcohol and drugs, school-based programs, neighborhood initiatives, PI&E)

• “War on Drugs” paradigm shift

• Police carrying Naloxone

• Evolving laws – decriminalization (syringes, trace possession, Good Samaritan)

• Complicated laws – inconsistencies, ground-level implementation, variations, policy guidance

Law Enforcement and Harm Reduction

• Policy guidance (example)

– Working with CBOs and SEPs, etc.

– Stakeholder meetings

– Guidelines for police and SEP (i.e. surveillance of area and persons, points of contact, emergency protocols, etc.) “To establish guidelines for policing functions in and about SEP locations to ensure that clients are able to participate freely as designed and within the context of the law…”

Law Enforcement and Harm Reduction

• Designation of liaisons

– Policy level (executive)

– Operational level (managers)

Law Enforcement and Harm Reduction

• Meeting Challenges and Resistance

– Engage with data

– Engage with other community partners

– Engage prosecutor’s office

– Engage with municipality administration

– Leverage relationships

• Mark A. Spawn

– CEO, The Spawn Group, LLC

– Director of Research and Training, New York State Assn. of Chiefs of Police

– Chief of Police/Retired, Fulton, New York

– Producer of “APB: All Points Bulletin” audio and video productions

– Harm reduction productions and resources for law enforcement

– mark@spawngroup.com

AUDIO PODCAST: “Condoms Not Evidence” An amendment to the criminal procedure law prohibits

police from considering possession of condoms as cause to arrest for certain prostitution and loitering

offenses. Funded by a grant from the NYS Dept. of Health AIDS Institute.

http://www.nychiefs.org/podcast/APB154_Condoms_Not_Evidence.mp3

VIDEO: “Syringe Programs in New York State” Developed for New York law enforcement, this video

highlights relevant laws which authorize these programs while demonstrating how the service is

ultimately delivered in the community. We visit syringe programs in Ithaca, Bronx and Harlem.

Interviews from service programs and law enforcement officials make this a well-rounded and

informative production. Time 16m 11s. https://youtu.be/pjD6-HBcy8Q

DOCUMENT: “Syringe Programs – A Sample

Policy” http://www.nychiefs.org/media/SYRINGE_PROGRAMS_SAMPLE_POLICY.pdf

AUDIO PODCAST: “Syringe Programs” Frequently Asked

Questions” http://www.nychiefs.org/podcast/APB114_Syringe_Law-FAQs.mp3

AUDIO PODCAST: “Syringe Law and Harm Reduction Programs”

http://www.nychiefs.org/podcast/APB035_Syringe_Law_and_Harm_Reduction_Programs.mp3

DOCUMENT: “Syringe Programs Resource Sheet” Click here for a downloadable summary of syringe

programs in New York and relevant sections of the Penal Law relating to CPCS 7th and possession

of hypodermic instruments; This resource will also be included in our annual Law Enforcement

Handbook.

• You may also email your

questions to

smadoori@aidschicago.or

g

Questions?

Thank you!