RECOMMENDATIONS AND NEEDS ASSESSMENT

FROM LOS ANGELES OVERDOSE PREVENTION SUMMIT PARTICIPANTS

MARCH 15, 2006

Drug Treatment: Residential (Heather Edney)

Do you think overdose prevention is needed within your area of expertise and service?

Yes, especially downtown with heroin users. Also in Lincoln Heights. Especially post-treatment.

Do you think overdose prevention is feasible within your area of expertise and service?

Yes.

If you were to do overdose prevention in your work or at your agency, what would it look like?

Trainings and education for people before they leave the program.

What kind of support do you need to implement overdose prevention within your organization?

We need a group room and a space for one-on-one counseling.

What kinds of recommendations would you offer to someone designing and/or implementing an overdose program or intervention?

Work with the police. Create ID cards for people carrying naloxone.

Drug Treatment: Outpatient (Terry Grand)

Do you think overdose prevention is needed within your area of expertise and service?

Yes – especially within methadone programs.

Do you think overdose prevention is feasible within your area of expertise and service?

Yes, but the barrier is liability for licensed providers.

If you were to do overdose prevention in your work or at your agency, what would it look like?

Train the staff to educate the patients. Be realistic that patients will still use heroin. Train patients also to help others in their environment.

What kind of support do you need to implement overdose prevention within your organization?

We need the support of the health department, politicians and police department. We also need educational materials.

What kinds of recommendations would you offer to someone designing and/or implementing an overdose program or intervention?

Dealers are a good way to get information to users. Tailor the messages to the population served. Medical providers can play a role in championing overdose prevention within their organizations.

Needle Exchange (Shoshanna Scholar)

Do you think overdose prevention is needed within your area of expertise and service?

Yes.

Do you think overdose prevention is feasible within your area of expertise and service?

Yes.

If you were to do overdose prevention in your work or at your agency, what would it look like?

1) Work on advocacy to make it safe to call 911 2) Rescue breathing training 3) Provision of naloxone to our clients with appropriate training.

What kind of support do you need to implement overdose prevention within your organization?

We need the support of EMS and law enforcement as well as drug treatment organizations. We need legal support for those who will prescribe and administer naloxone. We need policy/law protection to make this feasible. We also need staffing support and funding.

What kinds of recommendations would you offer to someone designing and/or implementing an overdose program or intervention?

Do whatever we can immediately. This is a crisis. Our clients and our friends are dying.

Correctional Services and Law Enforcement (Rachel McLean)

Do you think overdose prevention is needed within your area of expertise and service?

Yes.

Do you think overdose prevention is feasible within your area of expertise and service?

Yes, to a degree.

If you were to do overdose prevention in your work or at your agency, what would it look like?

Put posters in cubicles. Do one-on-one counseling. Court order people to participate in CPR training. Make prevention training a condition of probation. CPR training in jails (though challenging to implement).

What kind of support do you need to implement overdose prevention within your organization?

Mandate from management to implement (has to be top-down). Utilize CPR training through Hacienda La Puente and IRC (intake and reception centers). Have to make the trainings a part of treatment because using or being in the company of people who use can be a violation of probation.

What kinds of recommendations would you offer to someone designing and/or implementing an overdose program or intervention?

· Cover the entire spectrum of drug overdose – educate about all drugs.

· Overdose prevention training for probation, patrol police officers and IRC deputies, CA’s, medical service professionals.

· Make overdose prevention training a condition of probation for people with history of drug use.

· Conduct training at large law-enforcement conferences (i.e. California Sheriff’s Assoc. Meetings, California Police Assoc. Meetings, California Probation, Parole & Correctional Association Meetings)

· Use the “Worth Saving” documentary as an educational tool

· Frame issue as the intersection of public health and public safety

Homeless Services, Housing Agencies and SRO’s (Mark Casanova)

Do you think overdose prevention is needed within your area of expertise and service?

Yes.

Do you think overdose prevention is feasible within your area of expertise and service?

Yes.

If you were to do overdose prevention in your work or at your agency, what would it look like?

OD training – and training of trainers including peer training as well as one-on-one training. Naloxone prescriptions, rescue breathing training, peer-driven prevention materials.

What kind of support do you need to implement overdose prevention within your organization?

Financial. Physicians. Law enforcement support. Law change.

What kinds of recommendations would you offer to someone designing and/or implementing an overdose program or intervention?

Start doing it!

HIV/AIDS Service Providers (Stephen Simon)

Do you think overdose prevention is needed within your area of expertise and service?

Yes. Overdose is applicable to many clients – HIV, homeless, etc.

Do you think overdose prevention is feasible within your area of expertise and service?

It is feasible as long as the County makes it accessible. It is necessary to remove the moral stigma. A team within each agency should be trained in naloxone use, just like emergency preparedness.

If you were to do overdose prevention in your work or at your agency, what would it look like?

Use the vehicle of secondary syringe programs. Make it part of regular CPR training – just one more technique to use before the paramedics arrive. This is a no-brainer.

What kind of support do you need to implement overdose prevention within your organization?

· Need help with trainings and addressing issues of morality.

· Might need contractual mandating.

· Support from individual agencies to provide naloxone.

· Need to hear from or have approval from the County Health Dept., those in power, those with funding.

What kinds of recommendations would you offer to someone designing and/or implementing an overdose program or intervention?

· Task Force should be integrated with County Health and higher levels of administration and also work at the grassroots level.

· There must be public understanding of the need for this type of program.

· Standardization important: Should be an “inter-agency collaboration” with across the board accountability.

· Possibly change the name to overdose “treatment” or “intervention” rather than “prevention”

· Purpose is to prevent death, not pass judgment. This is a medical intervention.

Policy Makers and Funders (Glenn Backes)

Do you think overdose prevention is needed within your area of expertise and service?

Yes.

Do you think overdose prevention is feasible within your area of expertise and service?

Yes.

If you were to do overdose prevention in your work or at your agency, what would it look like?

Help to run legislation. Help raise money. Talk to NY Office of AIDS to find out how they were able to justify putting overdose under their purview. Encourage California Office of Alcohol and Drug Programs to take it on.

What kind of support do you need to implement overdose prevention within your organization?

Physicians willing to prescribe naloxone.

What kinds of recommendations would you offer to someone designing and/or implementing an overdose program or intervention?

Get families and survivors involved from the start. Bring physicians in from other cities and send L.A. folks to observe other programs (i.e. in San Francisco, Humboldt County and New Mexico).

Clinicians and Emergency Medical Services (Kristen Ochoa)

Do you think overdose prevention is needed within your area of expertise and service?

A big yes. There is a general lack of awareness among medical professionals about overdose.

Do you think overdose prevention is feasible within your area of expertise and service?

Yes, but conservatism will be a barrier. California law will also be a barrier.

If you were to do overdose prevention in your work or at your agency, what would it look like?

Begin by starting research studies. Education with patients who have just overdosed and come to the ER. Put overdose education and harm reduction into pre-clinical and clinical training of medical students.

What kind of support do you need to implement overdose prevention within your organization?

Find faculty members willing to oversee or support research efforts.

What kinds of recommendations would you offer to someone designing and/or implementing an overdose program or intervention?

Address the lack of knowledge of medical providers around these issues.

Use models from other cities where overdose programs have been developed.

Researchers (Ricky Bluthenthal)

Do you think overdose prevention is needed within your area of expertise and service?

Yes.

Do you think overdose prevention is feasible within your area of expertise and service?

Yes.

If you were to do overdose prevention in your work or at your agency, what would it look like?

No comments.

What kind of support do you need to implement overdose prevention within your organization?

· Get police to not arrest people at the scene of overdoses. Also, provide exemptions for calling 911 for parolees and people on probation.

· Get needle exchange program staff to advocate for overdose patients and hospital staff in emergency rooms.

· Give naloxone to overdose patients upon hospital discharge.

· Have an emergency medical technician devoted solely to administering naloxone (might not be applicable in Los Angeles, but was used successfully in Syndey, Australia).

· Have physicians and nurses on staff at needle exchange programs and drug treatment sites.

What kinds of recommendations would you offer to someone designing and/or implementing an overdose program or intervention?

· Attempt to answer the following research questions: How does social isolation occur related to overdose and how might it be change?

· What are outcome variables for overdose prevention interventions? More knowledge, fewer nonfatal overdose, more 911 calls, more rescue breathing, etc…

· What are the barriers for drug users adopting overdose prevention strategies?

· How does price and purity of heroin impact trends in overdose?

· What is the spatial impact of Narcan distribution?

· What opportunities does the existing pattern of service utilization among IDUs offer for overdose prevention?

· What are the mental maps of drug users regarding service utilization, drug use, etc?

· Do overdose prevention media messages need to be tailored based on race/ethnicity and class among drug users?