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2023 Summit Nothing About Us Without Us Voices
Interviews with Hamilton County S.A.F.E Services (Syringe Service Program) Participants:
Observations from the Field Welcome and Overview Hamilton County Public Health Questions/Open Discussion 2 Agenda Learning Objectives
- Describe S.A.F.E. Services participant opinions on ways to increase the safety of illicit drug use.
- Demonstrate the need for continued education to promote the best outcomes with the use of naloxone.
- Examine the impact of stigma from the person using drugs perspective. Introductions Darci Smith, MA Senior Community Outreach Coordinator darci.smith@hamilton-co.org Shana Merrick, MSW, LSW, CDCA Director of Harm Reduction Division shana.merrick@hamilton-co.org Harm Reduction Sub-Committee & Survey Background
- Sites: Interviews were conducted at the Corryville, Northside, Over- the-Rhine, Western Hills, and Walnut Hills S.A.F.E. Services sites
- Approach: Hamilton County Public Health staff conducted the interviews and recorded responses in Qualtrics with laptops
- Dates: Interviews conducted between May 9 and June 8, 2022
- Length: Interviews were 17 minutes in length on average
- Incentive: participants received a grocery gift card in exchange for their time Survey Methodology
- Total participants: 148
- Gender: 77 participants identified as female, 69 as male, and 1 preferred not to say
- Race and ethnicity: 4 participants identified as Hispanic/Latino, 9 as Black, 133 as White, 1 as American Indian, 1 as Asian/Pacific Islander, and 4 as other / multi-racial Participant Overview Source: US Census Quick Facts, accessed on June 9 2022 Participant Location Participants by location Participants by zip code These six zip codes accounted for 41% of interviews; 55 other zip codes accounted for 59% of interviews but each had 4 or less people from each zip code This site is the newest and has lower foot traffic than the others, resulting in fewer surveys Tools To Use Drugs Safely Do you have the tools to use drugs safely? Tell us about your experiences and the tools you use. 97% of interviews indicated they had the tools needed to use drugs safely 79% of interviews expanded to name the SSP as the reason they are safe
Interviewees mentioned
Clean water (9 mentions)
Water is something HCPH is not funded to provide Alcohol pads (4 mentions)
Interviewees wanted more alcohol pads offered Cookers (3 mentions)
Interviewees mentioned these were not always available Short + long needles (2 mentions)
Interviewees wanted a mix of sizes for their needles Ways To Increase Safety What could be done to make using drugs safer for you?
- Stop using – 23 mentions
- Safe injection / supervision facility – 15 mentions
- Legalization – 13 mentions
- Not using alone – 13 mentions
- Fentanyl test strips (to test for strength, other drugs) – 12 mentions
- Narcan – 8 mentions
- Clean water – 6 mentions
- Vending machines – 5 mentions
- Closer SSP locations – 5 mentions
- Housing – 5 mentions
- Use small amounts – 4 mentions
- Health information + education – 3 mentions
- Police stigma – 2 mentions Ways To Increase Safety – Quotes Interviewees know quitting is the only real way to be safe Other ways to increase safety “More vending machines” “A certain place where people could go and have others monitor them” “More understanding from police. It is hard to get services if they follow us” “I use the smallest amount to stay well and not chase the high” “To be sure to not use alone” “It would be safer if I did not use” “Going to treatment and stopping altogether. Otherwise I have everything I need to be safe” “Outside of being abstinent, there is really no safe way” “Quitting would be first. I want to quit but it is really hard” “Stopping all together and using my coping skills” Ways To Improve Access To Services What would improve your access to services? (select all that apply) 3% 4% 16% 18% 20% 22% 27% 39% 0% 20% 40% 60% Different days Different services or supplies offered Other Knowledge of available services Different location Different hours Weekend availability Transportation
Other included
- Expanded hours
- Specific other locations
- Request for bus passes
- Home delivery % of respondents choosing n = 116 Feedback On How To Increase Access Participants expanded on access needs, mentioning the following categories (n = 132) TRANSPORTATION is the biggest barrier for S.A.F.E services clients and others they know ❖ 22 people wanted a location closer to their home, especially those in other counties or in Kentucky ❖ 10 people mentioned bus passes would help with transportation ❖ 4 people mentioned a shuttle would help with transportation WEEKEND HOURS requested by 15 people, especially those working MORNING HOURS requested by 8 people, especially those working second shift Many thanked the Exchange and said services work for them as is Ways To Address Overdose Deaths What do you think could be done to prevent overdose deaths? 39% of interviews mentioned the supply of naloxone 14% of interviews mentioned education about how to use naloxone 26% of interviews spoke of the importance of not using alone 16% of interviews spoke of using small amounts and going slow 11% of interviews mentioned criminal justice related topics – good Samaritan education, police stigma, arresting drug dealers, and legalization of drugs 9% of interviews spoke of fentanyl test strips 8% of interviews spoke of safe injection or supervised high locations for monitoring Carrying Naloxone Do you carry naloxone? 0% 20% 40% 60% 80% 100% Most of the time Some of the time Rarely Never Carry naloxone Reasons why people carried naloxone….
MOST OF THE TIME
- To save lives – their own, someone they know, or someone in the community (90%)
RARELY OR NEVER
- They only use at home
- They only use alone
- They have legal concerns
- Heroin is not drug of choice / use
- It is not convenient
- Stigma What Impacts Your Decision To Carry Naloxone “Quotes”
ALWAYS CARRY NEVER OR RARELY CARRY
“Think about my mother getting a call that I have died”
“I want to save lives. I always have it on me”
“I’ve lost so many friends. Now that we have access it would be stupid not to carry it”
“I’ve had five siblings and my mom die from overdoses”
“My husband chases the high and does a lot. I worry about him overdosing”
“It is hard to explain if you have it and you get stopped – the cops know you do drugs”
“I only use at home so I don’t carry it with me”
“I am not sure if it is legal and I don’t want to get in trouble”
“I keep it in my house for people who come over and overdose”
Use Of Naloxone In what situations have you used naloxone? Did you call 911? What other steps did you take? Use of naloxone Use of 911 0% 20% 40% 60% 80% 100% Used for famil y, frien d, or stran ger Calls 911, 43% Does not call 911, 39% Sometimes calls 911,…
We also learned that
- One-third of interviewees specifically mentioned they had to use more than one dose of naloxone
- People do not call 911 because:
- The person was ok after naloxone
- The user of naloxone could monitor the person who overdosed
- The user of naloxone was afraid of legal implications
- The person asked for 911 not to be called once they came to Interviewees’ Knowledge Of Fentanyl Do you know what fentanyl is? 100% of interviews indicated they know what fentanyl is Tell me more about your understanding of fentanyl. 45% of interviews are seeking fentanyl as a drug of choice 30% of interviews try to avoid fentanyl or do not seek it 7% of interviews indicate they test for fentanyl
Interviews also shared
- Their understanding that fentanyl is now in many forms of drugs (e.g., cocaine, weed, pressed pills)
- Fentanyl is more readily available and cheaper compared to heroin
- Fentanyl is stronger and more dangerous Thoughts on Fentanyl Use I use fentanyl every day. In the beginning I did it did, thinking it was heroin. The dealers lied about it for the longest time.
Most things are not like the heroin that I first started using. Now I do seek out fentanyl. It is the only thing that produces a strong high for me. I was clean for 7 years and relapsed two years ago. the drugs have changed - what is being sold as heroin is not very good.
It is the only thing you can use after you start fentanyl. Fentanyl is stronger than heroin. It is what is out there now. I don’t think there is heroin around anymore.
Yes it is my drug of choice. It is 100x stronger than heroin and cheap Fentanyl is the devil and I use it.
I do seek it out. It’s hard to find heroin or any other substances not mixed with fentanyl The Impact Of Stigma Has stigma impacted you? Your ability to seek support?
70% of interviews explicitly mentioned stigma impacting them For those that say stigma impacted them, they mentioned the stigma comes from the following audiences:
38% 29% 17% 11% Family and friends Healthcare Employment Law enforcement % interviews impacted by stigma mention a specific audience Health Information and Visits If you have a health question, who do you ask? Where do you go?
In the past year, how often did you visit a doctor or medical facility?
2% 3% 5% 8% 9% 10% 22% 24% 34% 0% 20% 40% 60% Hotline Public Health / SSP No one Family in healthcare Treatment center Family (general)
ED / Urgent Care PCP or specialist doctor Internet 0% 20% 40% 60% 80% 100% More than 4 times 3-4 times 1-2 times Never % of respondents mentioning Health visits SSP Services Knowledge + Information How did you hear about our services?
Which three sources of information from the list below do you trust the most? Reasons why interviewees trust sources of information:
- Health care providers: they are educated and knowledgeable; trust is often broken due to stigma
- Word of mouth, family, and friends: they can provide help based on lived experience with addiction
- Social service providers: they are knowledgeable and compassionate; many people specifically mentioned lived experience and the SSP here
- Social and mass media: these outlets have accountability; there was mixed trust in social media Many individuals said they don’t trust anyone based on their experiences 5% 15 % 29 % 53 % 0% 50% Treatment center Internet Word of mouth Friend 2% 3% 7% 7% 8% 14% 17% 55% 56% 57% 62% 0% 20% 40% 60% Billboards Radio TV Faith leaders Newspapers Social media Other Social service providers Family / friends Word of mouth Health care providers % of respondents mentioning % of respondents choosing Other was “no one” or “internet”
- Now, bags of short + long syringes are offered at SAFE services locations
- Increased hours at Western Hills and Northside locations
- Continued education around use of naloxone
- Meeting with other naloxone distributors in the county to see how we can collaborate
- Healthcare services offered at Caracole on Thursdays (wound care + basic care)
Next Steps: What are we doing with this information?
Questions?
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