2011 Harm Reduction Coalition Annual Report

2011 Annual Report

East Coast: 22 West 27th Street, 5th Floor New York, NY 10001 tel. 212-213-6376 fax. 212-213-6582 hrc@harmreduction.org

West Coast: 1440 Broadway, Suite 510 Oakland, CA 94612 tel. 510-444-6969 fax. 510-444-6977 hrcwest@harmreduction.org

www.harmreduction.org

Executive Summary: After nearly 20 years of dedicated leadership in advocating for harm reduction policy reforms, 2011/2012 was a landmark year on multiple key fronts of our mission. Daily access to policy makers in Washington, D.C., refining our mature role in public health through agency rebranding, and strengthening our communications and web presence through technological upgrades have expanded our capacity to be recognized as a central resource in advancing drug user rights nationally and globally.

Our accomplishments have included: •

Organizing a concerted effort of medical, legal and advocacy experts to prepare and pass a United Nations (UN) resolution asserting drug users rights and overdose prevention globally.

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Elevating drug user health issues to a national priority to improve hepatitis C testing and treatment funding.

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Increasing the number of traditional treatment and community-based providers registered as overdose prevention programs.

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Advocating for state and regional policies that enhance drug user involvement in providing peer-to-peer syringe exchange services.

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Increasing the number of providers and drug users who have been trained and have access to harm reduction best practices, and online, print and workshop resources.

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Fortifying program sustainability and organizational development through national capacity building training and technical assistance.

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Expanding our global reach with 35,000 monthly visits to Harm Reduction Coalition’s website, 3,900 Twitter and 6,000 Tumblr followers, and 80,000 hits on our podcast page last year.

In anticipation of the 9th National Harm Reduction Conference, “From Public Health to Social Justice,” to be held in November 2012, we will ensure the representation of current issues facing our community, feature new programs, and include interactive workshop strategies. Harm Reduction Coalition has been involved in protesting U.S. policies that will hamper drug user involvement in the 2012 International AIDS Conference.

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Although we experienced a setback with the reinstatement of the federal funding ban on syringe access, it has impassioned our efforts. The mainstream acceptance of community-based naloxone, hepatitis C treatment and funding advances, and the United Nation’s first drug overdose resolution have demonstrated that change is possible. Harm Reduction Coalition will continue to be a leading voice upholding every individual’s right to health and well-being and their competence to participate in the public policy dialogue.

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Overdose Harm Reduction Coalition has been at the forefront of advocating for national and global policies to improve opioid overdose prevention services for over 13 years and 2011 marked significant progress in this critical campaign. These advances could not come at a more vital time as Centers for Disease Control (CDC) data now shows that drug overdose is the leading cause of accidental death in the United States, and opioids account for a substantial portion of these poisonings. Remarkable gains were made to mainstream overdose prevention education and naloxone prescription and elevate public awareness of drug overdose issues. Harm Reduction Coalition has deservedly positioned itself as a vital partner with federal entities as the CDC, Federal Drug Administration (FDA) and Substance Abuse and Mental Health Services Administration (SAMHSA) to help guide policies towards systemic change.

Federal Overdose Strategy Harm Reduction Coalition’s strategic plan at the federal level focuses on guiding and assisting federal policy makers to design and implement a national overdose prevention strategy and ensuring that this strategy includes increasing access to naloxone to prevent and reduce opioid overdose deaths. With a daily presence in Washington D.C., we have rapidly elevated our profile as a national leader in overdose prevention and deepened our relationships with elected officials and federal agency staff.

Harm Reduction Coalition conducted targeted research on existing overdose programs, policies, laws and regulations regarding medical interventions performed by non-health or medical professionals, including naloxone injection. The agency reached out to members of Congress and Congressional staff to educate them on the issue and secure support for increased access to naloxone and for the April 2012 FDA “Role of Naloxone in Opioid Fatality Prevention” meeting. Harm Reduction Coalition also built relationships with traditional and non-traditional stakeholders from recovery, medical and faithbased communities to secure support for expanding accessibility to naloxone. As a result of our advocacy and educational efforts, critical discussions on harm reduction-based overdose prevention strategies emphasizing naloxone prescription are happening on the national and federal levels for the first time. This year, Harm Reduction Coalition elevated the issue of opioid overdose prevention with: •

Publication of Harm Reduction Coalition’s survey in the CDC’s “CommunityBased Opioid Overdose Prevention Programs Providing Naloxone—United States 2010” report in Morbidity and Mortality Weekly.

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Influenced two FDA meetings on expanding naloxone availability for drug users and their loved ones, including the opportunity for overdose activists and their family members to be heard on a national stage for the first time.

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Organized a Legislative Hill Day focused on overdose prevention. Activists and advocates from across the country traveled to D.C. for the FDA meeting and Harm Reduction Coalition capitalized on their presence by organizing an advocacy day during which they met with their states’ Congressional delegations to discuss overdose prevention.

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Harm Reduction Coalition organized two significant meetings/briefings with Office of National Drug Control Policy (ONDCP) and its senior staff, including Director Gil Kerlikowske. In preparation for the 55th Commission on Narcotic Drugs (CND) Harm Reduction Coalition arranged for a pre-meeting exchange of information between the official U.S. delegation and drug policy reform allies including Open Society Foundation (OSF), Washington on Latin America, and the International Drug Policy Consortium. The second meeting was a briefing on the efficacy of community based naloxone by Harm Reduction Coalition’s Sharon Stancliff and Eliza Wheeler. The organization has had a significant impact on the thinking of ONDCP around overdose response. The cordial relationship and trust that now exists between ONDCP and Harm Reduction Coalition has been built with patience and deliberation over the last four years and has been greatly helped by having an increased presence in Washington, D.C.

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Broadened Harm Reduction Coalition’s strategic partnerships with nontraditional allies to address the rising prescription drug overdose crisis. Our Washington office strengthened relationships with non-traditional partners focused on prescription drugs, including the American Medical Association, the American Cancer Society, the Pain Care Forum, pharmaceutical companies, and conservative Congressional offices and staffers, and worked with them to integrate overdose prevention into their messaging.

Publication of “Community Based Opioid Overdose Prevention Programs Providing Naloxone—United States 2010” “To address the substantial increases in opioid-related drug overdose deaths, public health agencies could consider comprehensive measures that include teaching 5

laypersons how to respond to overdoses and administer naloxone to those in need.” — CDC’s Morbidity and Mortality Weekly Report Owing to the efforts of Harm Reduction Coalition and allied organizations, increasing numbers of community-based programs are providing naloxone and overdose prevention services to drug users, their friends and family and service providers, contributing to 10,171 reported overdose reversals since the mid-1990’s. These programs ensure that persons most likely to witness an overdose are empowered and equipped to successfully recognize and respond in the event of an opioid overdose.

In October 2010, Harm Reduction Coalition conducted the first comprehensive national survey to examine naloxone distribution program operations and their impact on the overdose epidemic. The final report includes data collected from over 155 sites, including syringe exchanges in 16 states, demonstrating the remarkable efficacy of these programs in reducing overdose deaths. The final report and findings, “Community-Based Opioid Overdose Prevention Programs Providing Naloxone—United States 2010” was published in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly on February 17, 2012, lending tremendous legitimacy to these programs and to our advocacy efforts to advance community-based naloxone distribution.

FDA Meetings on “Role of Naloxone in Opioid Overdose Fatality Prevention” and “Utilizing Innovative Technologies and Other Conditions of Safe Use to Expand Access to Nonprescription Drugs” Harm Reduction Coalition advocates for policies and programs that increase access to and utilization of naloxone and urges policy makers at the state, local and federal level to support initiatives that ensure broad access to naloxone as an essential strategy to prevent and eliminate opioid overdose deaths. In April 2012, in response to our advocacy efforts, the FDA hosted a public workshop to explore expanding access to naloxone. Presenters discussed the value of expanding naloxone availability beyond conventional medical settings, the acute shortage of naloxone in the U.S. and the process for making naloxone available over the counter (OTC). There was unusually broad attendance by representatives from government agencies interested in learning more about naloxone, including ONDCP, CDC, National Institute on Drug Abuse (NIDA) and SAMHSA, marking the significant gains made by Harm Reduction Coalition and advocacy partners to elevate opioid overdose and access to naloxone as issues of national import Compelling testimony was given by Harm Reduction Coalition staff and 6

24 other harm reduction providers and activists and, most powerfully, by parents of children who have suffered a fatal overdose.

Preceding the April 2012 meeting, the FDA convened industry experts to discuss Utilizing Innovative Technologies and Other Conditions of Safe Use to Expand Access to Nonprescription Drugs. Whitney Englander, Government Relations Manager, addressed the convention to illustrate the benefit of increased naloxone availability on the overdose epidemic in the U.S. should it be made available over the counter. Ms. Englander detailed the landscape of overdose fatality in the U.S. and the impact of naloxone distribution programs in decreasing overdose fatality rates, including accessibility and availability concerns and presented program models that would increase awareness, access and utilization of naloxone.

I am the Evidence Naloxone Works” Video Campaign “We need to mobilize the community of drug users, we need to mobilize harm reduction activists, we need to mobilize the UN bodies to make an effort and make naloxone available in the community of drug users, and I am absolutely sure with this campaign, with these efforts we will be able to minimize the rate of overdose deaths” – Dacha Ocheret, at Harm Reduction Coalition NY discussing the I am the Evidence campaign.

Harm Reduction Coalition partnered with the Eurasian Harm Reduction Network to launch a dynamic online campaign featuring video testimonials from drug users and other naloxone administrators that showcases first-hand stories of overdose survival attributed to the use of naloxone. Since its launch, over 31 videos from the U.S., China, Russia, Scotland and Central and Southeast Asia have been viewed by over 20,000 people on the campaign’s Facebook page. Harm Reduction Coalition showed a compilation video of the testimonies in a meeting with the UN, The Global Fund and the Red Cross in Geneva in fall 2011, to promote increased naloxone distribution and the development of international guidelines for the global implementation of overdose prevention programs.

National Overdose Programs Drug Overdose Prevention Education (DOPE) and Skills and Knowledge for Opioid Overdose Prevention (SKOOP) Harm Reduction Coalition’s DOPE and SKOOP projects made substantial progress in expanding naloxone distribution to new venues and reaching new populations of at-risk 7

drug users, including prescription opioid users and people on methadone. Significant headway was made to build the capacity of collaborating organizations in our home base cities of San Francisco and New York to provide overdose prevention services autonomously.

In San Francisco, the DOPE project doubled its monthly naloxone distribution sites, enabling Harm Reduction Coalition to greatly expand the number of neighborhoods and sub-populations with access to naloxone. Overdose prevention training and naloxone distribution were provided at 230 sites and 279 one-to-one narcan trainings were held at syringe exchange programs. As a result of these trainings, 155 participants have reported that they used naloxone to reverse a potentially fatal overdose in the past year.

SKOOP promotes the integration of overdose prevention education, including naloxone distribution into various agencies, including syringe access programs, shelters, methadone clinics, detox centers and HIV programs. In the past year, SKOOP provided overdose prevention training and technical assistance to 33 agencies and performed 165 prescribing sessions at syringe exchange programs. In addition, overdose prevention trainings were provided in a variety of innovative venues, including at the Occupy Wall Street encampment at Zuccotti Park and at New School, the first academic institution to consider overdose prevention. In addition, the Institute for Family Health and Samaritan Village have both registered as Overdose Prevention Program providers, and are respectively the first primary care corporation and large therapeutic community in New York to do so.

Overdose Manual Harm Reduction Coalition’s capacity building and advocacy initiatives have influenced the expansion of overdose prevention programs across the United States. As more naloxone distribution programs continue to open in New York, San Francisco and across the country, we have established a lead role in providing technical assistance for these start-up programs. Responding to the needs of organizations seeking to establish overdose prevention programming, Harm Reduction Coalition developed a “Guide to Developing and Managing Overdose Prevention and Take Home Naloxone Projects� manual, which outlines the process of developing and managing an overdose prevention and education program, both for those with and without a take-home naloxone component, and provides strategies for integrating overdose prevention education into existing programs.

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The manual includes a comprehensive Overdose 101, which defines overdose and its causes and co-factors and outlines the basics for recognizing overdose and providing an effective response. The appendices include FAQs, annotated citations of existing research studies and examples of data tracking forms, sound policies and procedures and Power Point presentations to use when providing overdose prevention trainings, in addition to other helpful support materials.

International Overdose Work Over the last 4 years, the Harm Reduction Coalition has invested time and resources in building a relationship with the Office of National Drug Control Policy (ONDCP) with the belief that it is critical for harm reduction advocates and drug users to have input into national and international drug policy, in addition to public health policy. Following persistent and consistent efforts, accelerated by our newly established Government Relations Manager, we have seen a remarkable shift in the responsiveness of once reserved ONDCP. This year Harm Reduction Coalition’s work, publicly and behind the scenes, led to several tremendous international achievements on this front: •

Harm Reduction Coalition drafted the first UN resolution about overdose and successfully advocated for its passage at the 55th UN Commission on Narcotic Drugs (CND) in Vienna in March 2012.

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Harm Reduction Coalition was invited by the U.S. State Department to take part in a side event at the World Health Assembly (WHA) in Geneva in May 2012, titled “Opioid Overdose Prevention: Best Practices and Lessons Learned.” We were the only non-governmental organization sponsoring the event; co-sponsors included the United States, Estonia, Zanzibar and UNAIDS.

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At a private meeting in Washington D.C., Harm Reduction Coalition staff presented a national overdose update to senior staff of ONDCP.

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In November 2011, Harm Reduction Coalition, Eurasian Harm Reduction Network and Harm Reduction International met with representatives from UNODC, World Health Organization (WHO), Global Fund, and UNAIDS to present facts on overdose and promote the creation of a unified drug overdose position.

United Nations Commission on Narcotic Drugs Overdose Resolution

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“We took a different tactic this year. Instead of waiting for a country to develop a resolution and then working to try and fix it, Harm Reduction Coalition decided to write our own.”—Allan Clear, Harm Reduction Coalition Executive Director After determining to draft its own UN overdose prevention resolution, titled “Promoting measures to prevent drug overdose, in particular opioid overdose,” Harm Reduction Coalition met with ONDCP to determine the limits of the resolution content. The power of the U.S. within CND means that a resolution will not pass without its support. Based on this background work, we drafted a resolution that called for the development of member state strategies to address drug overdose, the collection of best practices by UNODC and the provision of technical assistance from the UN and WHO for nations that request it, including information on naloxone distribution. The Czech Republic and Israel agreed to introduce the resolution. Harm Reduction Coalition provided expertise and new language for the Czech government as it began meetings and negotiations with multiple UN member nations to advocate for the resolution. The prep work was so thorough that this groundbreaking passed in 15 minutes of debate which is rare at a CND meeting. The resounding success caused Estonia, the overdose capital of Europe, to introduce a pilot naloxone programs immediately. ONDCP’s staffers congratulated Harm Reduction Coalition after the passage.

Co-Sponsor of “Opioid Overdose Prevention: Best Practices and Lessons Learned” Following the success of the CND resolution, representatives from the U.S. State Department approached Harm Reduction Coalition to co-sponsor a side session panel with the U.S. and the government of Estonia. The session marked one of the first high profile appearances of drug use on the WHA agenda. The event was moderated by WHO’s Vladimir Poznyak, Department of Mental Health and Substance Abuse. Pamela Hyde, the head of SAMSHA presented on prescription drug overdose and Dr. Sharon Stancliff, Medical Director at Harm Reduction Coalition, presented “Community-based Overdose Prevention Programs Distributing Naloxone.” The event received a highly favorable response by attendees from Poland to China, and Harm Reduction Coalition is advocating for a resolution at next year’s WHA, similar to the one passed at the CND. Syringe Access Drug users were dealt another devastating blow by Congress with the reinstatement of the ban on federal funding for syringe exchange in December 2011. Despite an 80% decrease in the incidence of HIV among injection drug users over the past 20 years attributed in substantial part to syringe exchange programs, eight federally funded 10

studies supporting the efficacy of syringe exchange for preventing HIV among injection drug users (IDUs) without increasing drug use and endorsements by all the major medical associations, conservative opposition in Congress prevailed, again, at least for this year.

Despite this setback, Harm Reduction Coalition made significant progress in advancing syringe access through grassroots community organizing, creative technical assistance to syringe exchange providers and advocacy efforts in the beltway and beyond. Our regional capacity building programs expanded syringe access in Colorado, Nevada and New Jersey and laid the foundation for similar progress in the South. Our D.C. office has continued to build upon open and back door relationships with federal entities and public officials and expanded our base of support among non-traditional harm reduction allies, which will be essential to the future removal of the ban.

Federal Work Throughout 2011, Harm Reduction Coalition’s syringe access policy advocacy centered on building relationships and momentum to further align federal policies and programs with drug user health priorities. Our work with federal officials built upon successful partnerships with key advocacy coalitions and policy allies, as well as on support from key Congressional offices which have been cultivated over the course of our campaigning to lift the federal funding ban on syringe exchange. In addition to advocacy efforts, Harm Reduction Coalition continued to advance syringe exchange on the federal level through monitoring and tracking Congressional activity that would undermine policy on use of federal funds for syringe exchange. Throughout the year, we monitored progress by the CDC and SAMHSA in implementing federal funding and releasing long awaited program guidance. SAMSHA released its guidance on the use of the federal Substance Abuse Prevention and Treatment Block Grant funds for syringe exchanges which incorporated our suggestions, in mid-September.

Harm Reduction Coalition, partners and advocates mobilized efforts to block proposed ban language and focused on building support for syringe exchange in the Senate in response to the Labor, Health And Human Services Education Appropriations Bill for FY 2012, released by the House of Representatives in September 2011, which would reinstate a complete ban on use of federal funds for syringe exchange domestically. We met with House and Senate offices to argue against the funding ban language and campaigned to mobilize our networks and constituents to register their dissent with Congressional offices. After the Senate agreed to adopt the House’s language, we stepped up advocacy to secure support for removal of the ban in the 2013 budget, as 11

well as to minimize the damage done by the ban’s reinstatement and keep federal officials engaged and active in promoting syringe exchanges, even without federal funding.

Since the December 2011 reinstatement of the federal ban, Harm Reduction Coalition has worked with federal and state officials to define exactly what could and could not be funded under the ban and urged both to remain flexible and adapt programming to meet these definitions. We successfully advocated for the release of a statement to recipients of federal money in early 2012 that enumerated a more flexible and less circumscribed approach to what is fundable under the ban. Work is being done to generate renewed federal commitment and leadership for the implementation and resourcing of comprehensive drug user health services, including syringe access. Looking towards FY 2013, Harm Reduction Coalition is leading grassroots organizing efforts in key target states to mobilize Congressional support and coordinating with advocacy partners on outreach and education to Congressional offices to support removal of the federal ban once again.

National Day of Action “[The] protests were successful if they showed politicians that the public does care about access to clean needles. People who use drugs are our relatives; they are us…Drug users are a part of the fabric of our community. This affects so many people.” Allan Clear, Harm Reduction Coalition Executive Director in “Clean Needle Access is a Must, Activists Say” on Precarious.Com On March 21st, 2012, Harm Reduction Coalition and partners organized a National Day of Action to generate attention for lifting the reinstated federal funding ban on syringe exchange and to make the collective voice of activists and syringe advocates nationwide impossible to ignore. Regional Director, Hilary McQuie, was the lead organizer for the field component of the Day of Action, which included: •

Mobilizing and coordinating grassroots partners in the home districts of target U.S. Senators in 13 states (CA, CO, CT, IL, IN, MA, MN, NC, NM, NY, OH, PA, WA).

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A National Call-In Day to Senate offices and a mass letter writing campaign

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Launching a new petition against the federal ban via the Harm Reduction Coalition website to gather new contacts and reinvigorate old ones.

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Hosting conference calls with grass roots organizers to strategize and coordinate efforts.

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Creating a call to action e-blast and a Facebook event page.

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Participating in a civil disobedience sit-in with members of Housing Works at target Congressional Offices across Capital Hill that resulted in approximately 30 arrests and news coverage across the country, including in Hawaii News Daily, The Windy City Media Group, Missoula Independent, National Journal and The Huffington Post.

Regional Work Harm Reduction Coalition’s Policy and Capacity Building departments partnered to expand syringe access in regions across the country by advocating for the removal of prohibitive legislation and by providing capacity building and technical assistance to community-based organizations, advocates and syringe access programs in key states around the country, including California, Colorado, Nevada, Hawaii, Louisiana, Maine, New Jersey and New York. Significant accomplishments include: California •

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Advocacy and organizing efforts resulting in successful passage of two critical harm reduction bills, AB 604 and SB 41, in October 2011. As of January 1, 2012, these new laws will enable the expansion of syringe access in California by: 1) permitting the Office of AIDS (OA) to establish a process through which qualified CA agencies may apply directly to OA to provide syringe access services (AB 604); 2) easing Syringe Access Program (SAP)-related reporting requirements for local health officials; 3) amending syringe possession law, notably by specifying that syringe access program staff and volunteers will not be subjected to criminal prosecution for possession of syringes acquired from an authorized SAP (AB 604); and, 4) allowing pharmacists to sell syringes without requiring a prescription, as well as allowing any adult to possess up to 30 syringes for personal use if acquired from a pharmacist, physician, or authorized SEP (SB 41).

Initiated and launched the East Bay Drug User Health and Wellness Collaborative to facilitate information sharing, linkages, and cross-disciplinary strategizing to increase health and wellness of people who use illicit drugs in Alameda and southern Contra Costa counties. In addition, Harm Reduction Coalition provided technical assistance on messaging and communications, mission statement and 13

website development for the new Oakland based drug user organizing group, United for Drug Policy Reform Colorado • Technical assistance to community-based organizations in Fort Collins, Colorado Springs, and Denver to establish SAPs following the passage of SB 189, which legalized SAPs in the state.

• Community mobilization and technical assistance with the Harm Reduction Action Center in support of establishing syringe access services and amending the prohibitive SAP city ordinance restricting SAPs within 1000 feet of a school or 50 feet of a dwelling unit and demanding a 1:1 exchange model, which was favorably amended in spring 2011.

• Capacity building assistance for SAP in Boulder to establish overdose prevention programming following advocacy efforts which secured provisional approval for the SAP to begin offering these services.

Nevada • Public policy development assistance and community mobilization for Nevada partners working on syringe access legislation resulting in the creation of SB 335 which removes syringes from paraphernalia laws. While SB 335 did not make it out of the State Assembly Health Committee, we are working with NV advocates to plan for 2013 legislation.

• Worked to form the Nevada Public Health Alliance for Syringe Access (PHASA) as part of a strategy to organize public policy education and community mobilization towards removal of barriers to sterile syringe access with our NV partners.

New York • Technical assistance for the NYC Peer Delivered Syringe Exchange (PDSE) Network including planning for the 2012 PDSE conference, developing a PDSE Conference Fundraising Working Group, and consulting on the development of the NYC SAP PDSE toolkit to be published by Harm Reduction Coalition.

• Conducted formative evaluation with NYC PDSE Network to identify barriers to syringe access service utilization by drug users, including focus groups on law enforcement interactions, NYC syringe possession cards, and 2011 penal code changes.

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Southern Syringe Access Expansion “Damn, I had no idea there were so many people down with harm reduction in the South.”—Conference participant at Reducing Harm and Building Communities: Addressing Drug Use in the South.

Harm Reduction Coalition has focused specific advocacy and capacity building efforts in the South, which continues to experience a disproportionate burden of drug-related harm including HIV and hepatitis C among injection drug users. In order to shore up harm reduction services in these areas, and to direct public attention to crucial public health policies impacting these communities including the lack of adequate syringe access, we developed and co-hosted two regional drug user health events with community partners.

In September 2011, Harm Reduction Coalition partnered with the North Carolina Harm Reduction Coalition, Atlanta Harm Reduction Coalition and Women with a Vision to host a two-day Reducing Harm and Building Communities: Addressing Drug Use in the South conference in Durham, North Carolina. The conference was organized to disseminate information about harm reduction practices, build alliances and assess the needs of communities most impacted by drug use. Harm Reduction Coalition coordinated 16 workshops and panels for over 150 activists, drug users, harm reduction providers, and other community members. The discussions focused on syringe access needs, structural and legal barriers to HIV and hepatitis C prevention, and on developing on-going advocacy and community mobilization strategies to build alliances with law enforcement to reform dangerously prohibitive paraphernalia laws.

Preceding the Southern conference, we developed an Open House in partnership with the Atlanta Harm Reduction Coalition (AHRC) on August 7th to educate community stakeholders and policy makers about state specific issues related to drug user health, disparities in syringe access, and increase visibility and support for harm reduction programs in Georgia. The event was a successful forum for cross-disciplinary dialogue on barriers to expanding syringe access and harm reduction services for drug users and generated attention for the critical work being done by AHRC. Hepatitis C “Viral hepatitis represents a looming crisis for our health system. One in 50 Americans are chronically infected with hepatitis B or C, but the majority of the cases have never been diagnosed. The need for screening and early detection is more urgent now than 15

ever.”—Daniel Raymond, Chair of the National Viral Hepatitis Roundtable and Harm Reduction Coalition Policy Director Harm Reduction Coalition’s hepatitis C (HCV) policy and advocacy initiatives have had a remarkable impact on elevating drug user health issues to strengthen HCV prevention and intervention strategies. While diagnosis and treatment of HCV is critical, the stigma associated with HCV and HIV leaves many drug users unaware of infection and hesitant to seek care. A new rapid hepatitis C test and newly approved treatments that have doubled cure rates pose a real opportunity to end hepatitis C as a serious public health issue if they are coupled with anti-stigma and advocacy efforts which emphasize drug user health. This year Harm Reduction Coalition achieved several important advancements towards this goal on a state and national level, including: Hepatitis C Testing and Treatment Advocacy Harm Reduction Coalition worked with advocacy partners to organize and execute the New York State Hepatitis C Legislative Awareness Day on March 14, 2012. Hundreds of advocates were bused into Albany to educate state policy makers about how to improve the state’s response to Hepatitis C. Specifically, advocates pushed for the renewal of the $1.2 million already allotted to funding comprehensive hepatitis C support services at in New York City and pushed for an additional $2.1 million, which they won, along with a 2013 action plan to improve care access statewide.

On the national level, a $10 million increase in federal funding was obtained for viral hepatitis testing and for programs linking those in need to care; $1.6 million is specifically for injection drug users. This award was made possible as a result of advocacy efforts led by the Hepatitis Appropriations Partnership and the National Viral Hepatitis Roundtable, national coalitions that Harm Reduction Coalition participates in and holds a leadership role in.

HHS Viral Hepatitis Action Plan Release: Harm Reduction Coalition played a critical role in successful advocacy to incorporate robust strategies and actions to address the needs of drug users in the Department of Health and Human Services (HHS) Viral Hepatitis Action Plan released in May 2011. The Plan adopted several of our recommendations, including strong language on expanding syringe access as a cornerstone of hepatitis C prevention. The agency engaged federal officials at HHS, SAMHSA and CDC, including CDC Director Thomas Frieden, in building support for these recommendations 16

Federal Viral Hepatitis Testing Legislation Harm Reduction Coalition worked with coalition partners to draft the Viral Hepatitis Testing Act of 2011, which asks for $110 million for improved national surveillance and testing for hepatitis B and C. Since its introduction, the policy department has diligently educated policymakers on the bill and strategized with sponsors to successfully attract additional co-sponsors, increase bipartisan support, and engage groups such as the Congressional Doctor Caucus.

Building a Hepatitis C Collaborative—Albany Forum Harm Reduction Coalition is working to expand syringe access and hepatitis C testing, care and treatment in Community Health Centers (CHC) across New York State which play a vital role in providing primary health care to over 1.4 million insured and underinsured New Yorkers, the majority of whom are people of color and immigrants living below the poverty level. In July 2011, a groundbreaking forum was held for representatives from 15 of the state’s leading CHC’s in Albany, NY to share and develop models and strategies to integrate hepatitis C services into CHC’s and to expand the network of CHC’s that offer them.

The forum, which was organized by Harm Reduction Coalition in collaboration with New York’s Primary Care Association, the Community Health Care Association of New York State (CHCANYS) and the New York State Health Department, produced a plan to pilot a state-wide capacity building network to increase syringe access, hepatitis C testing and linkage to treatment in New York’s CHC’s. Under the Affordable Care Act, CHC’s are expected to double the number of patients they serve in the coming years and are a critical frontier in expanding access to care for people disproportionately affected by hepatitis C. Statewide Hepatitis C Pre-Conference Event On the eve of the New York State Viral Hepatitis Conference, held in New York City, Harm Reduction Coalition hosted a pre-conference reception for 60 people at the Museum of Sex on Fifth Avenue, featuring keynote speaker Dr. Gregory Dore, head of the Viral Hepatitis Clinical Research Program at the Kirby Institute Australia. The gathering was an opportunity for HIV and HCV advocates to network and connect beyond usual divisions. Many diverse HIV organizations were represented at the event, as well as a large number of people living with HIV and HCV and the evening fostered opportunities to increase communication and integration of joint advocacy efforts going forward.

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Increasing Meaningful Drug User Involvement in Harm Reduction Programs Recognizing that current and former drug users have a unique capacity to build trust and relationships with other users most at risk of overdose, HIV and hepatitis C infection and have a unique understanding of affected communities’ needs, Harm Reduction Coalition is committed to expanding the meaningful involvement of drug users in all aspects of its work. During 2011, the agency invested in building the personal and professional capacity of drug users and in foregrounding peer-delivered services and drug user led harm reduction and advocacy efforts through research, capacity building, training and conference planning.

Peer Delivered Syringe Exchange Report “I am citing your Peer-to-Peer Harm Reduction Coalition report. Many congratulations on a great overview and evidence for the approach.” – Paul Kobrek, PhD, New York City Department of Public Health In March 2011, Harm Reduction Coalition published and disseminated the “User-toUser: Peer-Delivered Syringe Exchange in New York City” report. The report is a comprehensive analysis and set of recommendations for expanding the Peer Delivered Syringe Exchange (PDSE) Model, includes a quantitative survey of NYC syringe exchange programs participating in PDSE, and was drawn from an extensive research process including literature review, focus group and interviews with PDSE workers, SAP supervisors and staff, and other stakeholders and experts. The report has been viewed and disseminated extensively online and was distributed to hundreds of our national contacts, including state health departments, the CDC, the National Association of State and Territorial AIDS Directors, Adult Viral Hepatitis Prevention Coordinators, New York State Advisory Council, PDSE Coordinators and major harm reduction funders. The findings and recommendations were presented to the National HIV Prevention Conference, the New York City PDSE Network, the American Public Health Association and the Brooklyn, Harlem and Bronx HCV Task Forces. The response has been overwhelmingly positive and the NYC Department of Health and Mental Hygiene is collaborating with Harm Reduction Coalition to publish a PDSE toolkit based on the recommendations in the report.

User Community Training Series Harm Reduction Coalition created the User Community Training Series in partnership with Users United, a New York City union of drug users, to provide harm reduction education, advocacy skills and personal and professional development for people who 18

use drugs. The series, pioneered in 2011 and being offered again in 2012, consists of seven training sessions on topics including: Overview of Harm Reduction, Hepatitis C Treatment, Overdose Prevention, Quality Healthcare is Your Right, Communication Skills, Understanding Drug-Related Stigma, and Methadone and Buprenorphine. We have identified several participants interested in playing a greater role in providing peer harm reduction services through mentoring, a speakers bureau, and consulting opportunities at the organization.

Training Institutes in CA and NY and Online Harm Reduction Coalition’s training institutes in Oakland and New York City provided training and professional development offerings for 2,890 people, in addition to a full calendar of contract trainings. The 2011 Spring Training Institute calendar focused on “Health Care for Drug Users”, and was developed to challenge drug-related stigma and to increase understanding of drug users’ needs by building stronger relationships with people who use drugs. Specific course offerings included: • • • • • •

Understanding Drug-Related Stigma Improving Health Care with Drug Users Intersection of Domestic Violence/Intimate Partner Violence and Substance Use in the Lives of LGBT Individuals and Communities Outreach to Crack Cocaine Users Your Body on Drugs Pregnancy and Drugs: Harm Reduction Approach

The NY fall training calendar featured a specialized focus on hepatitis C, including a series of roundtable discussions on key hepatitis C issues facing people who use drugs.

The Training Institute in CA hosted its second week long, 35-hour Harm Reduction Training Intensive in core harm reduction competencies, which included the addition of two new core trainings, Street Drugs, Prescription Pills and Getting High; and Practical Strategies for Reducing Drug-Related Harm.

Online Training Institute Launched Harm Reduction Coalition developed and launched a comprehensive, credentialed Online Training Institute comprised of web-based training sessions and interactive webinars in a dynamic expansion of our harm reduction training offerings. The Online Training Institute enables us to extend our training services beyond the urban 19

catchment areas reached by our centers in New York City and Oakland in order to increase the understanding of harm reduction philosophy, strengthen harm reduction leadership, develop an awareness of attitudes that contribute to discrimination against drug users and other marginalized communities and offer professional development to people working in harm reduction nationwide.

From Public Health to Social Justice Harm Reduction Coalition’s 9th National Conference, “From Public Health to Social Justice,” will bring over 1,000 people from around the country and the world and representing the many facets of harm reduction to Portland, Oregon on November 1518, 2012. In past years, the conference has featured one pre-conference institute to explore a particular issue, but this year we are excited to hold two pre-conference institutes on November 14th, one on Drug User Organizing and the other on Hepatitis C: Meeting the Needs of Drug Users in a Rapidly Changing Treatment Landscape. Also this year, in addition to panels, workshops and round tables, the conference will feature new participatory break-out sessions in which conference participants can partake in an open dialogue concerned with the future of harm reduction and public health in the U.S., and devise strategies for keeping its true to its roots as a force for social change.

2012 International AIDS Conference in Washington D.C. As a result of the travel ban being lifted on HIV positive people traveling to the U.S., the International AIDS Conference (IAC) will be held here for the first time since 1990.

However, the U.S. still imposes travel restrictions on individuals with a history of drug use and sex work, meaning two of the three populations most affected by HIV (men who have sex with men being the other population) are legally prohibited from attending the conference. Harm Reduction Coalition and other harm reduction and sex worker advocates are vocally opposing the legitimacy of holding the conference in D.C. Despite its objections, we have been actively planning for the IAC and are on the AIDS 2012 Community Program Committee. Our accomplishments include: •

Advocating for the inclusion of a new provision in the IAC charter stating that the conference will not be held in a country until any immigration issues prohibiting populations affected by HIV are changed.

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Setting up a Harm Reduction & Drug Policy Zone. In addition to presenting information and creating opportunities for discussion and networking among participants from around the world, the zone will give attendees an opportunity 20

to discover harm reduction services critical to overcoming the HIV pandemic.

The zone will host: a session representing the views and contributions of people who use drugs; an educational tour of a mock safer injection site and needle exchange van; video presentations from around the world by people who use drugs; harm reduction resources and discussions on HIV-related drug policy.

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Hosting an opening night Reception. Harm Reduction Coalition has invited leading international doctors, scientists and officials dealing with drug policy, the head of the CDC, and others to attend its reception co-hosted by the International Centre for Science in Drug Policy and International Doctors for Healthy Drug Policies.

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Organizing presentations on sound drug policy and harm reduction methods throughout the six day conference.

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Advocating for an opening speaker slot for a U.S. based drug user. While unsuccessful in securing a slot at the opening, Harm Reduction Coalition’s candidate, Debbie McMillan, was given a high profile plenary position.

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Coordinated delivery of harm reduction services for conference attendees including syringe exchange, methadone and naloxone distribution.

Capacity Building Programs Leadership and leadership development has been an enormous part of our work over the last year. Given the shift in the climate as it relates to HIV/AIDS funding and the HIV/AIDS National Strategy, community based organizations largely dependent on HIV dollars are starting to think differently about organizational sustainability. The realization that the money is simply not always going to be there has resulted in a strong interest and requests for trainings that promote real sustainability such as leadership development, strategic planning, burnout prevention, and fund development. Michael T. Everett, Harm Reduction Coalition Team Lead Capacity Building Advisor for CBOs In the past year, Harm Reduction Coalition’s Capacity Building Assistance for Community-Based Organizations Program (CBA for CBOs) has expanded its focus beyond providing organizations with training and technical assistance to helping them improve organizational development and program sustainability. As part of this expansion, CBA for CBOs has developed a number of resources for non-profit organizations seeking to improve their organizational infrastructure, including: 21

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A community forum on leadership development that spawned a series of leadership trainings and tools. Harm Reduction Coalition presented these at various conferences, resulting in training requests from two organizations serving African American men who have sex with men, one in Newark and one in New Orleans.

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A community consultation series focused on Black leadership within harm reduction that explored themes including organizational culture and participatory leadership.

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A series of trainings about managing and preventing occupational and organizational burnout.

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Expanding our support for organizations seeking to enter into a strategic planning process. Interested organizations have included New York City-based organizations providing syringe access services, one in Maine, one in Buffalo and one in Washington D.C. The strategic planning services we provide also includes fiscal management, data collection and fund development support.

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A roundtable discussion on program sustainability in the face of an antagonistic political environment and volatile funding streams.

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A series of tools and resources to monitor, evaluate and support program sustainability efforts. The CBA for CBOs Program hired an Evaluation Specialist to support organizations’ internal evaluations and provide expertise on process outcome monitoring and evaluation. The Evaluation Specialist developed two two-day training programs, one on monitoring and evaluation and another on developing program logic models.

Black Leadership in Harm Reduction Community Consultation Committed to building collective leadership for HIV prevention among Black people impacted by drug use, Harm Reduction Coalition developed and hosted a community consultation series (CCS) to initiate dialogue on: 1) supporting greater African American leadership opportunities for people who work in the harm reduction field; 2) articulating a racial justice framework grounded in harm reduction principles that creates the space for collective goal-setting and execution of community-led strategies, and; 3) developing more effective, empowering and participatory harm reduction strategies for Black people. The CCS engaged over 50 Black leaders at three forums convened in Atlanta, New York and Los Angeles, and additional key informants from across the country 22

through a survey and focus groups. Findings from the CCS illuminate capacity-building needs of Black leaders working within the field of harm reduction and will inform next steps in this process and for the vibrant network of leaders formed during this process.

Resources In an effort to bring harm reduction information and education to an ever-increasing number of people and further amplify the often ignored voices of drug users, Harm Reduction Coalition has dedicated itself to strengthening and expanding its web-based community-organizing, outreach and advocacy resources.

Social Media Harm Reduction Coalition now has over 3,900 followers on Twitter, 4,500 on Facebook and over 6,000 on Tumblr, where it was voted one of the ‘Top 11 Must-Follow Nonprofits.’

Podcasts “I love the podcasts! I've learned so much...keep up the great work!” Barry Lessin, Psychologist, Drug and Alcohol Counseling Harm Reduction Coalition’s weekly podcast series, hosted by Executive Director Allan Clear, addresses a wide range of harm reduction issues and has achieved an impressive following, with over 80,000 visits to the podcast page in the last year and downloads registered across five continents. The entire series is available on I-Tunes and through the agency website. Top ten podcasts in the past year have included: Drug User Activism in Seattle; Ayahuasca, Plant Teacher; Reducing Harm and Building Community in North Carolina; Race, Patriarchy and Pleasure; Drug User Advocacy, Representation, Rights and Fighting Stigma; Beyond Methadone, Methadone Activists Fight to Improve the System; Working with Law Enforcement; International Overdose Awareness Day; Sweet Sweet Baadassss Harm Reduction Communication is Back; and, Prescription Drugs Plus Women’s Services at People’s Harm Reduction Alliance.

Harm Reduction Communication This year Harm Reduction Coalition celebrated the re-launch of its bi-annual publication, The Harm Reduction Communication. Written by and for people on the front lines of harm reduction, The Communication is committed to presenting the views and opinions of those whose voices have traditionally been marginalized or ignored. It aims to provide an outlet for exploring harm reduction issues in an honest and critical way— 23

with full respect for the messy, complex, vulnerable, dynamic, hopeful and inspiring nature of what we do and how we do it. The premier issue featured presenters and attendees from the 2010 National Harm Reduction Conference and articles discussing safer injection, overdose prevention and advocacy, secondary syringe access, drug user organizing and drug related stigma.

The Communication is an essential forum for exchanging practical hands on harm reduction techniques and information, as well as discussing and reflecting on important political issues effecting harm reduction. It is a critical means of keeping the community informed about new resources and events and documenting the lessons of the movement, both as a tool for strategy building and a means of ensuring that our history is not erased.

Website Redo To strengthen our capacity to communicate with, inform and mobilize our constituents, Harm Reduction Coalition invested in a major sixteen month overhaul and redesign of our website and constituent management system. The redesign, launched in February 2012, presents our resources and programs through a more efficient and intuitive navigation system to better meet the needs of our national grassroots base.

The redesign was part of a strategy set in early 2011 to increase Harm Reduction Coalition’s visibility, strengthening both our position as a critical resource of information for drug user service providers and the impact of our campaign for health policy reforms nationally and globally. This strategy also included improving the ability to manage our constituent database and rebranding the agency in a way that more accurately reflects Harm Reduction Coalition’s diverse activities and enhances our impact.

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