Practice Title: Establishing and Expanding Harm Reduction Efforts in Marion County, Indiana
Department: Marion County Public Health Department
Size: Large (Population of 500,000+ people)
State: Indiana
Summary of Practice:
Marion County Public Health Department (MCPHD) serves a population of nearly 1 million, primarily in Indianapolis, Indiana, which distributes a high level of vulnerability across socioeconomic status, household characteristics, racial and ethnic minority status, and housing type/transportation by CDC/ATSDR Social Vulnerability Index measures. From 2012 to 2017, Marion County observed a ten-fold increase in acute hepatitis C cases with 95% tied to illicit substance use. While HIV rates in Marion County remained steady, the fate of fellow Hoosiers in Scott County prompted the creation of a novel harm reduction program within Indianapolis . The overarching goal of Safe Syringe Access and Support is to prevent infectious diseases related to injection drug use, period.
Due to tension between the legalization of syringe services in Indiana and continued criminalization of paraphernalia, MCPHD worked closely with Indianapolis Metropolitan Police Department to bridge best harm reduction practices with those that would be well-received by local law enforcement and elected officials. Safe Syringe is thus able to operate under a hybrid needs-based negotiation model, and staff contributes to IMPD’s Crisis Intervention Training promoting the use of harm reduction as a referral tool for police officers, probation and parole officers, emergency medical services (EMS), and more in Marion County. The results of a study on police office attitudes related to harm reduction at the launch of the program led to collaboration with Northeastern University to bring new training on “Safety and Health Integration in the Enforcement of Laws on Drugs” to Indiana Law Enforcement Academy and officers across the state.
Safe Syringe launched in April 2019 with two mobile locations identified by geographic information related to rates of HIV and hepatitis C, emergency medical response to overdose, and arrests for drug-related crimes. MCPHD offered epidemiologic data and education on the history and impact of harm reduction to local neighborhood associations and community partners prior to providing services in the area. These town hall sessions led to meaningful community partnerships, including faith-based institutions, re-entry and housing programs, and AIDS Services Organizations. While the COVID-19 pandemic slowed the rollout of additional locations, Safe Syringe was able to add service hours at two additional locations in 2021 at two district health offices, including a storefront location which allows syringe and wraparound services (point-of-care testing and immunizations) to be offered 36 hours per week. Once per week, Safe Syringe hosts a mobile health fair at Brookside Community Church including comprehensive STI testing through Bell Flower Clinic and primary care services through Gennesaret Free Clinic., Safe Syringe receives supplemental recovery systems support in partnership with Indiana Addiction Issues Coalition. Lastly, in collaboration with Shalom Community Health Center, Safe Syringe offers monthly non-syringe harm reduction services and point-of-care testing at Indianapolis Public Library.
Indiana law establishes limitations on the legalization of syringe services; organizations must go through their city or county legislative authority and demonstrate a need for services in response to increases in infectious disease rates related to substance use. This lengthy and cumbersome process is a challenge for many organizations, and currently only eight out of ninety-two counties host legalized programs. In recognition that institutional distrust of public health exists in many communities, MCPHD began efforts to extend services to other local nonprofits with existing relationships in marginalized communities. Safe Syringe subcontracted with an ASO in March 2022 to further the reach of harm reduction with PLWHIV and BIPOC; an additional partnership is planned for spring 2023 to expand services among LGBTQ+ communities. Safe Syringe exclusively hires people with lived experience with injection drug use that are dually trained as peer recovery coaches to assist clients with goal setting according to the client’s own motivation level.
MCPHD contracted an independent accounting firm to conduct a cost-effectiveness analysis specific to Safe Syringe between 2019-2023 to provide additional evidence to support harm reduction programs in Indiana. While analysis is ongoing and the pandemic confounded many variables, interim results demonstrated two primary impacts in Marion County: (1) a decrease in EMS runs related to overdoses, and (2) a decrease in inpatient costs related to injection drug use.
To date, Safe Syringe’s greatest outcome lies in its ability to deliver the overdose-reversing drug directly into the hands of those most likely to need and use it. With the limitations in community outreach during the peak of the pandemic in spring and summer 2020, Safe Syringe partnered with Overdose Lifeline and a local emergency department to deliver harm reduction kits to homes in which 911 was called for overdose; these kits contained ten doses of naloxone, as well as non-syringe harm reduction supplies, a resources pamphlet, and nonperishable food goods. In response to changes in the prevalence of fentanyl in illicit opioids, Safe Syringe doubled distribution of naloxone from 2019 to 2021 to new clients and continues to replace doses as they are used to reverse overdoses in the community. Safe Syringe provides client-provided syringe waste to the state public health laboratory to screen for drug compounds. In the first year of collection, 88% of tested syringes were found to contain fentanyl compared to just 33% containing heroin.
According to a qualitative survey conducted among Safe Syringe participants in 2021, the primary reason clients return to the Safe Syringe program (excluding syringes) is the nonjudgmental, welcoming atmosphere promoted by the staff. Since its introduction in 2019, Safe Syringe has served nearly 2,700 unique clients at approximately 13,000 visits. Nearly 1.3 million syringes and over 33,000 doses of naloxone have been distributed among people who inject drugs, and 1,899 lives have been saved with naloxone provided through this program. For more information on Safe Syringe Access and Support through Marion County Public Health Department, please visit www.marionhealth.org /safesyringe and follow the program on Facebook.
Establishing and Expanding Harm Reduction Efforts in Marion County, Indiana
Category
HIV, STI, and Viral Hepatitis
Description