Delaware Needle Exchange Pilot Program and Needle Stick Prevention

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DelawareNeedle Exchange Pilot Program and Needle
Stick Prevention

• Overview

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Why Needle Exchange?

• Needle Exchange allows regular contact with
  active drug users and increases the opportunities
  to provide risk reduction counseling and connect
  addicts with drug abuse and/or HIV treatment
  services.
• Providing someone with safe injection equipment
  and preventing an HIV infection is far more cost
  effective (approximately 2,500 per person over
  his/her lifetime) than treating the same person
  for HIV over his or her lifetime (approximately
  119,000 per person over his/her lifetime).
• An increased rate of HIV among injection drug
  users means an increased risk for everyone their
  sexual partners (and their sexual partners),
  police officers encountering needles on the job,
  etc it is much easier to stop an infection chain
  before it starts than after.
• It is not just about HIV. Needle exchange lowers
  risk for transmission of Hepatitis B C.

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The specifics of the law

• The program must operate within Wilmington.
• To residents of Wilmington
• 1 for 1 exchange
• Prevent non-injectors from participation
• Include referral service, counseling, education,
  HIV testing.
• No redistribution of syringes (i.e. satellite
  distribution)

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The specifics of the law

• Secure inventory
• Trained staff expertise with IDU
• Clear identification of staff, van, materials,
  etc.
• Oversight Committee

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How We Do It

• Maximize existing resources
• HIV prevention provider expertise in population
• Mobile rapid HIV testing services
• HIV/AIDS evaluation protocols / systems
• CBO / DPH partnerships
• Law enforcement relations

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HIV Provider Expertise

• Brandywine Counseling, Inc.
• Has been a long-time and consistent HIV
  prevention provider to the IDU population of
  Wilmington.
• Only agency running a methadone program in
  Wilmington
• Already has mobile HIV testing service with their
  own van

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HIV Provider Expertise

• Already collects client level data on all
  services provided and is very experienced in
  evaluation data collection.
• Already has strict inventory control process in
  place.
• Already participates in quality assurance checks
  with DPH lab.
• Has a strong network of referral resources.

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How we are deciding where

• Comprehensive HIV Prevention Plan, 2005-2009.
• Statewide Coordinated Statement of Need
• DSAMH / Drug treatment provider data on
  population locations, etc.
• Wilmington Police data on drug related crime.
• not occur within 1000 feet of a school or known
  program primarily serving children.

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Clients

• Homeless? Use point of service as address.
• Risk Assessment intake and periodically after.
• Offer an HIV Test at intake and every 6 months
  thereafter.
• I.D. Issued
• Referrals will be made for other needed services
  and tracked to completion (Drug Tx, HIV Tx, etc.)

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Law Enforcement Coordination

• Held a special sub-committee meeting between DPH,
  BCI, and Wilmington PD. An MOU has been drafted
  to define relationships and responsibilities.
• Face-to-Face between patrol officers and NEP
  staff.
• Regular updates sent from NEP staff to law
  enforcement detailing schedule and activities.

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Syringe Law Changes to Policy

• Lawful to possess syringes if individual
  possesses a DE NEP membership ID card.
• No need to hide or discard, low chance for NSI
• Inform suspect of law before search
• Cannot confiscate syringe without additional
  charges
• If must confiscate, use gloves and container

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Officer Safety

• A high risk of transmission of infectious disease
  can exist when personnel have contact with the
  following groups
• Injection drug users
• Prostitutes
• Persons infected with Hepatitis B or C, or HIV

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Needle Stick Diseases

• Hepatitis
• Diphtheria
• Typhus
• Herpes
• HIV
• Tuberculosis
• Spotted Fever
• Syphilis

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At Risk Situations

• Car searches
• BODY SEARCHES
• Cell block and inventory searches
• Crime Scenes
• Searching personal effects (purses, bags,
  backpacks, etc.)
• Extrication at auto accidents
• Other?

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Risk of HIV from Needle Stick

• HIVhuman immuno-difficiency syndrome
• Usual health consequences
• Weakened immunity, long-term disability, death
• NOT likely to contract HIV from NSI
• Good news low probability
• Bad news 3 out of every 1,000 needle sticks with
  a infected needle will lead to HIV infection

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Risk of Hep B or Hep C from NSI

• Hepatitis B Virus is CURABLE
• Hepatitis C Virus is NOT CURABLE (most cases)
• Usual health consequences
• Hep B weakened liver, long-term disability
• Hep C a major cause of chronic liver
  diseaseleading cause for liver transplants
• VERY HIGH 30 chance of contracting HBV from NSI
• HIGH 10 chance of contracting HCV from NSI
• Serious effects on quality of life

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Safety Precautions

• Follow your department POLICY
• Your health is top priority
• Wear protection to reduce risk of a sharps stick
  during searches and situations of enhanced risk
• Use provided receptacles for sharps or use the
  syringe exchange program for proper disposal
• Do not throw down the storm drain or any other
  trash receptacle.
• REDUCE YOUR EXPOSURE DO NOT HANDLE

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Safety Precautions Cont'd

• Communication reduces risk of being stuck!
• Always ask if sharps are present
• Explain that possession of needles (and a
  membership ID card) does not violate the law