Harm Reduction… Beyond Narcan…(Part 3)
Ashley Shukait, MPH, CHES®
• Overview of harm reduction services including syringe service programs and overdose prevention centers (Part 1)
• Current drug supply and drug checking capabilities (Part 2)
• Struggles, Barriers, Solutions for harm reduction in Michigan (Part 2)
• Provide strategies to strengthen and build more positive relationships between patients who use drugs & their healthcare providers (Part 3)
Agenda
Provide strategies to strengthen and build more positive relationships between patients who use drugs & their healthcare providers
Trust-Building w/in Systems
AQS
“Move at the speed of trust, but operate under the realization you are part of a system that can never be fully trusted & causes harm.”
Lead with Openness
If you have a “peer” or someone that has living experience in your clinicincorporate them as much as possible.
• ”I want to ensure you are supported and safe; however, that feels right for you.”
• Be upfront if there are limits you must discuss/report
• Provide a word if they are starting to approach that limitation and have a resource that understands these limitations and is not bound by reporting guidelines. • Assess your own beliefs and actions on how you treat PWUD, work through those moral failing beliefs engrained in society and medical practices
Is it relevant?
• Does their visit relate to their substance use in any way?
• Does honesty come with punishment? Ask permission to give feedback.
• Trauma-informed and healing are critical to providing care, but understanding structural and social impacts related to intersectionality to help address issues outside of the office visit
• Do you ask about the risks (drug), set, and setting involved in their usage?
• Understanding the complexity around someone’s drug use practices— their drug, set, and setting—is key to developing relationships and providing relevant, helpful support ( Zinberg, 1984)
Risk, Set, & Setting
*These are tips and suggestions, please do not ask these questions all at once.
Risk refers to…
• The drug use or sex work-specific issue that you’re discussing, i.e. Chief Complaint
• What issue is the patient concerned about?
• Drug(s) being used? Route? Frequency?
• What about the cuts? Acute/Chronic health problems from it?
• Consistency of Supply & Source? Potency?
Risk (Drug Specific) Questions
Context Setting: “Is it okay to discuss your drug use, to make sure I can provide you the best possible care that works for your health goals.”
“Can you tell me what substances you use and how you use them? Legal and non legal, Alcohol counts.”
“It is common for many people to mix drugs, do you mix or use in a specific order?”
“How often do you have to use “x” to stay well?”
“What does your ideal usage look like to be functional & happy?”
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Risk (Supply) Questions
Context Setting: “The drug supply is really unpredictable, I want to make sure I don’t overlook any reasons for short and long term health issues.” • “Do you have a consistent supplier that you trust?”
“Do you or your supplier have access to any drug-checking like Fentanyl test strips or other tech?”
*Refer to hr drug checking programs, provide FTS/Naloxone
“Some cuts like Levamisole in cocaine cause kidney problems or xylazine in dope that can cause wounds or anemia, have you noticed any problems related to your health and your supply?”
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SSTI Risk Questions
Context Setting: Explaining what it looks like when they use can tell you what infectious risks they encounter and find ways to offer safer use suggestions.
• People may not always be able to use every single safer use practice or supplies, but providing information and resources for safer usage and addressing their specific harms or alternatives can help reinforce safer use practices.
• “Have you tried alternatives to injecting to give your veins a rest?” “Snorting, smoking for example.” *Getting off right & resources to watch/look at later
“Do you have alcohol pads to use before you inject? Do you have syringes and supplies you need to use without having to share with others? What about reusing?”
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Risk Questions Continued…
• “Do you have wipes to clean your area before you use?”
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“You mentioned you use alcohol pads after you inject, that is great you want to keep that area clean. Using a new or clean gauze or tissue that is dry can be more helpful as alcohol can increase bleeding and keep blood from clotting.” “I can provide gauze to help.” • “Do you have access to sterile or clean water?”
Do they lick their needle before injecting? ASK in a non-judgmental way or as an example for safer use strategies
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Set refers to…
• The “mindset” that someone brings to the situation, including thoughts, mood, and expectations
• Beliefs/ideas: Do they have internal hatred for using/returning to use?
• What about their Physical Health: Self-care, including rest, food, and hydration help prevent overdose. Do your patients have access to that?
• Do they have other co-morbidities?
nder Spectrum Collective
Set Questions
“What does a safer pleasant drug using experience look like for you?” “What resources do you need to get there?”
“Do you feel anxious, rushed or have to sneak?”
“How is your sleeping and eating going?” “Can we help with food?”
“Do you have a stable support person/ppl you trust?” *Offer connect to peers/warm-lines/support groups for PWUD like Harm Reduction Works
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Setting refers to…
• Physical environment: Where potential harm occurs?
• Who is around them: Police, strangers, friends and family?
• Perceptions: Positive and Negative?
• Structural inequities exist outside of healthcare services that must be addressed.
Credit: AS
Setting Questions
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Do you have a secure spot to use in?” “You said you feel safer using alone, is there a way you can use in a place that you can be found if you nod off too long or are overdosing?”
“Do you know about safer use lines like “Never Use Alone, Brave and others”
*Provide those numbers/apps
“Do you face police harassment?”
*Document it/Rx for syringes
“Do you have a safe stable place you are staying at that you can use in?”
*Housing resources critically helpful
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Thank you for attending this presentation!
Resources
For detailed access to references email Ashley
Shukait (ashleyshukaitconsulting@gmail.com) to be added to her Zotero account with an extensive list of publications and resources.
