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Life of a young adult IDU

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2 Life of a young adult IDU Life of a young adult IDU People often say that programs need to be “culturally competent.” But what does that mean exactly? For UFO, that means understanding the unique life situations of young adult IDU, and gearing services to their unique needs. In Part 3, we’ll walk you through how to find out what’s happening in your community. Here, we’ll go over some of the things we’ve learned in San Francisco that are key for working with young adult IDU. Below are some examples of how young adult IDU in San Francisco taught us to adapt our program to best fit their needs. ** ** **

Recognizing that our population has extremely high rates of PTSD and depression has made dealing with mental health concerns a priority Knowing that our young adult IDU are frequent travelers taught us to find out various ways to contact our participants for follow-up

Mental health

Young adult IDU have high rates of mental health concerns including anxiety, depression and post-traumatic stress disorder (PTSD), often due to past and current traumatic events in their lives. It is important to consider the importance of mental illness in this population and work with other agencies to provide services for participants. Your staff will also need to understand the role of mental illness in HCV prevention and transmission and have tools to work with clients. 16

Many people with HCV have mental health concerns. One research study

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Persons with serious mental health problems and/or substance abuse may be up to 10-times more likely to be infected with HCV than the general population

There are many ways that mental illness and drug use can affect HCV. **

Learning about the relationship our population has with its pets taught us to include animal services as part of our program

These are some of the cultural factors we’ve recognized in our population. What are some of the cultural factors specific to your community?

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of adults with HCV found that most said they had a history of at least one psychiatric disorder, and almost threefourths had two or more disorders. Depression was the most common disorder, followed by PTSD, substance use disorders, bipolar disorder and other psychotic disorders.

First, being mentally unstable can increase the likelihood that you get HCV, or that you transmit it to others **

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Depression can cause people not to take care of themselves or others ** Other diseases like schizophrenia and manic states can cause a person to take risks that they otherwise would not Second, it is common for people to use drugs as a way to deal with some of their untreated psych issues **

A lot of people who feel sad, anxious, depressed, hear voices or have other psychological symptoms, use drugs as a way to medicate and cover up their problems

Among the tools that are helpful in dealing with mental illness: Referrals. Provide referrals to mental health counseling programs that we have visited and made connections with, to ensure that they are young adult and IDUfriendly.

Emergency help. In San Francisco there are two organizations that provide mental health triage over the phone or in person 24 hours a day. One, Mobile Crisis, is an alternative to calling the police if a participant loses it and can’t be controlled. Mobile Crisis will come and escort the person to the hospital, which is better for them than being picked up by the police. Are there mental health crisis resources in your community?

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2 Life of a young adult IDU often minimal relationships between injection partners. Cocaine users tend to be and experience more violence. They tend to have higher numbers of sexual partners (especially crack users) which increases HIV risk.

Staff education and training. Conduct in-service trainings on issues such as vicarious trauma and violence deescalation. Send counselors to any local mental health trainings and encourage them to bring back materials and share with the rest of the counselors. Check with your local health department to find out about free or low-cost trainings in your area. The Harm Reduction Coalition teaches some great courses as well (harmreduction.org).

Staff safety. Outreach workers always work in pairs. Encourage outreach workers and counselors to use their “spidey sense” and if a situation feels unsafe or potentially volatile, they should leave. Counselors also use their spidey sense and gut feelings if a participant appears unstable or unable to effectively comprehend what is going on. If needed, consider appropriate safety measures and referrals in each individual situation. Pre and post-site meetings. Staff and counselors meet before and after weekly drop-in to discuss any potential upcoming issues (such as a positive test result) and to process what has happened during the counseling sessions. If a participant is known to be violent or unstable, the staff can keep an eye on the participant and the counselor. If a session was particularly hard or draining, counselors can “discharge” and process at the end of the night.

Drug of choice and poly-substance use What drugs IDUs use may change over time, and each has implications for risk behaviors and HCV transmission. **

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Heroin users. Black tar heroin can only be divided evenly between people when it is in liquid form. HCV is easily transmitted through drug preparation equipment: cookers, water, cottons, even tourniquets/ties. Powder heroin can be very pure and strong, which can lead to accidental overdose. Cocaine users. Cocaine users tend to binge. They also inject much more frequently, are often frenzied, and share syringes more often. There are

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Pill users. Pill users tend to be younger, not as experienced using needles and less aware of HCV transmission risks. They also may create their own “cocktails” of pills and other substances with unknown side effects.

Travelers. Travelers tend to drink more alcohol and use a variety of drugs. They are often less strung out. They don’t inject as much, but have less access to clean equipment.

Suburban young adult adults. Young adult IDU who live in suburban areas are more likely to live at home, and are more likely to share needles and injecting equipment than their urban counterparts.

In San Francisco, we see very high rates of polysubstance use (using more than one drug) among young adult IDU. Research shows that polysubstance use significantly increases sexual and drug use related risks. **

Polysubstance users have wider injecting networks (inject with more people) than do people who use one drug. A wider pool of users increases the likelihood of HCV transmission.

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Polysubstance users inject with people they have known for shorter periods of time than do people who use one drug. They are less likely to talk about their HCV status when they don’t knowing the people they’re sharing with. Drug treatment is complicated by polysubstance use, which means that treatment may be less successful.

Here are some ways to deal with drug of choice and polysubstance use:

Drug preparation equipment. HCV is easily transmitted through sharing drug preparation equipment as well as needles, so counsel participants not to share and we provide sterile equipment.

Individual counseling. Adapt individual counseling messages based on drug of choice. For example, if someone reports shooting crack, they may be shooting up to 25 times a day and, in the spirit of harm reduction, stress the importance of using clean needles. Overdose prevention. There is a greater risk of overdose among polysubstance users. Counsel participants on overdose prevention. Train on and dispense Narcan to participants. Encourage them to never shoot alone, and to use care when shooting after a dry spell or incarceration.

Relationships, power and risk Research shows that for some couples, heterosexual and homosexual, sharing

injecting equipment can be an intimate gesture, and sharing injecting equipment within discordant relationships (where one person has HCV and the other does not) is a bonding act. For many young adult IDU, injecting drugs together is an intimate, personal act that can enhance intimacy. Sharing drug injecting equipment with someone who is close and trusted can be viewed as ‘safer’ in relation to other risks such as threats to physical safety or disruption to the relationship.

Young adult IDU who cannot inject themselves rely on their partner to inject them. Research shows that being injected by someone else is associated with an increased risk of HCV transmission. Also, this could lead to someone being dependent on the person who injects them. Typically, women are less likely to be able to inject themselves and therefore are reliant on their male partners. This reinforces traditional gender patterns in relationships with males taking the more active and dominant role. In relationships where there are issues of conflict and where one partner is dominant, it may be difficult to raise and discuss issues around HCV. If someone gets the virus, there is often anger or blame. This can further inhibit effective HCV management strategies. Addressing risk factors present within relationships is an important aspect of HCV prevention and education. Here are some ways to deal with relationships, power and risk:

Normalize disclosure. Counselors should encourage IDUs to discuss their HCV status, whether positive or negative. Help people learn how to talk about it, so that discussing HCV is normalized among IDU in the community. Partner notification. Counselors may be familiar with partner notification protocols from the world of HIV, so try to adapt those messages for HCV. For participants who have just seroconverted, offer to sit with their partner and help them tell the partner. 18

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Understand ethical issues. Occasionally, you may know that a participant who

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2 Life of a young adult IDU seroconverted is in a relationship with someone who is HCV-negative. You cannot disclose status to their partner, but can encourage them to disclose and offer help with partner notification.

Pets and young adult adult IDU

Young adult IDU often have pet companions. With high rates of depression and PTSD, and low levels of social support, young adults find great comfort and love in their animals. While dogs are the most common pet, we have a number of cats, rats and have had iguanas. To be as welcoming of client’s pets as you are of them:

San Francisco. This research also showed us that travelers had heavy alcohol consumption, drinking alcohol until blackout, polysubstance use, more sexual and injecting partners and needle sharing, sharing drug preparation equipment, backloading syringes and pooling money to buy drugs. Younger travelers were more likely to be HCV-positive than youth who did not travel outside of San Francisco.

The risks we’ve found among our travelers are compounded by the difficulties related to maintaining a relationship with young adult persons who travel frequently. Education and counseling are best provided over time, with important messages reinforced through repetition. Additionally, in this population that tends to distrust authority, it takes time to build the trusting relationship needed to fully understand the extent of risk-taking an individual might engage in. Getting someone in the door once is important, but getting them to return is essential. Among the tools that are helpful in working with travelers:

Suppling dog food at drop-in center. Often, young adult IDU won’t eat until their pets have eaten.

Working with a local veterinary program for the homeless to provide vet care. Advocating for obtaining companion animal licenses, which allows participants to have their animals accompany them on buses when they travel as well as access housing if they decide to settle.

Travelers and train-hoppers

While young adult IDU across the country may have stable housing, in San Francisco, our participants travel frequently. Our research found that almost 2/3 of participants reported traveling outside www.ufomodel.org

The internet. These days, almost everyone, including young adult IDU, use email and social networking websites like Facebook. Keeping in touch with your program participants reminds them of your presence, even when they’re not in town. Open all year. UFO’s weekly drop-in is open one evening a week, 52 weeks a year, including holidays. We don’t want someone to arrive in town, come straight to us and find we’re not there. So we just don’t close. Not on holidays, not if it’s pouring rain, not if there’s an earthquake.

Regular, ongoing groups. UFO offers an eight-week HCV education and support group. Although it’s best if participants can come to all eight weeks in a row, it’s not always possible. Having regularlyscheduled groups means that if someone leaves town, or is incarcerated after Session 4, they can always come back to Session 5 a few months later when the group runs again. Interstate referrals. Over the years, we’ve learned a lot about where our

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2 Life of a young adult IDU participants travel and where they go for resources in other major cities. Knowing a little about what else is out there can help, so if your participant tells you they are heading to New York (or LA, or Seattle, etc), you can tell them where they can get their next vaccine, a clean needle or free health care. These are some of the issues we’ve discovered in San Francisco that have changed the way we provide services. Below are some issues that we’ve heard about in other communities. What issues are pertinent with your participants? How might your program address these?

Oxycontin as a gateway drug

“There needs to be help on an individual basis, but two schools of help: help for the ones who are damaged already and help for the ones who you don’t want to be damaged. I saw that so much, there’s always a very clear line between them, and it was the same feeling as junior high, like the rich popular kids and they were doing things they thought were trendy, or they thought would be fun. And we’re looking at them like what are you guys doing?” – UFO participant

Some young adults, especially in suburban areas, start out stealing prescriptions from the family medicine cabinet as teenagers, and then get addicted to oxycontin. Teens who use prescription opiates such as oxycontin easily make the transition to injecting heroin. As a substitute for oxycontin, heroin is relatively cheap, and the high can last several hours. Some of the consequences of this are: **

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Lack of knowledge. These young adults often have no knowledge about safe injecting practices, or the risk of HCV transmission through drug equipment.

It’s not dangerous. Oxycontin is prescribed by doctors, in their parents’ medicine cabinet, so many young adult adults don’t believe that it’s a dangerous drug. They don’t understand that they can get addicted just like with heroin. Overdose. A young adult shooting heroin for the first time may not know how much drug to use. Heroin is often very pure and a little can go a long way. As a result, young adult injectors may have more accidental overdose. No perceived risk. Young adult adults who live in the suburbs don’t see themselves as being at risk for HCV or HIV. They may see older, urban IDU at the SEPs and think they’re not like that so they aren’t at risk.

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More resources. These young adults may have more money to buy drugs, may have jobs or be in school, are usually housed and may not hang out on the street.

How might these issues inform your program?

Young adults in the suburbs Many young adult IDUs in suburban areas live at home with their parents. Some are employed. They may have more money to buy drugs. They may be managing their drug use, and not see themselves as “addicts” needing services. Some suburban parents may have a history of drug or injecting drug use, or be active users. Some issues around working with young adults who live in the suburbs are: **

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Distance. The suburbs may be 30 minutes to an hour from your agency. Doing outreach there would require a vehicle and an increase in time for outreach workers. Legality. Suburbs may be in different counties than your agency. There may be different laws regarding drug use, syringe possession/exchange or condom distribution from county to county. Accessibility. Young adult IDUs in the suburbs may be harder to find. They may inject alone, or at home and not have a large group of IDU friends. At malls and other places where young adults hang out, it may be difficult to tell who is an IDU and who is not.

Confidentiality. Young adults may not want to be seen with or near an agency that serves young IDUs or conducts syringe exchange for fear of being seen by someone they know. Driving. Young adults in the suburbs may be used to using cars and not have a problem driving some distance for services. Because of confidentiality, they may prefer to drive to another town.

How might these issues inform your program?

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2 Life of a young adult IDU Myth Busting Young adult IDU often are a highly stigmatized and misunderstood community. These misunderstandings, or “myths” about young adult, often homeless people who use drugs can be very damaging to a young adult person’s self esteem, as well as to their ability to access services and live safely on the streets. They can also affect the attitudes and behaviors of people working with young adult IDUs.

Below are some of the myths that we commonly hear in San Francisco. As you conduct a needs assessment and talk to other stakeholders in your community, you may hear these types of myths that may affect the services you provide. What are some of the myths in your community? Myth: These kids are homeless by choice. They should just go home to their parents.

Reality: Many young IDU don’t have a family, they are not welcome at home, have left for reasons such as lack of support or abuse. Some of the parents of young adult IDU may have their own problems with addiction, mental issue or homelessness. Drug use can intergenerational, when parents or extended family introduce the kids to drugs. Myth: Users want to get high

Reality: There are many underlying reasons for people to use drugs like heroin. Many have chronic physical pain issues and don’t have access to doctors.

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Young adult IDU often suffer from some form of emotional and mental pain such as abuse, trauma, PTSD, depression, anxiety. Many IDU know what dose they need and take their daily amount, controlling and managing their drug use. It is important to note, however, that some young adults ARE injecting just to get high and have fun.

“The other day I was walking down the street and I saw one of the kids I work with, Myth: Young adult IDUs don’t want sitting there on the street and services. someone walked by and he said, “Oh that coffee looks Reality: Most young adult IDU need and good, what kind is that?” want help of some kind. But they want They just walked right past, services that are non-judgmental, friendly and you know what? I felt so to youth and understanding of their bad for him. Because I knew situation. Young adult IDU have learned to him and he’s really a nice, be highly guarded, so earning their trust is sincere kid. He’s probably key to helping them access services. compromising his values or Myth: Young adult IDU are incapable of his body to make ends meet understanding HCV. so he can survive on the Reality: With clear explanation, young street. My heart went out to adult IDU can grasp the complexities of him. The guy didn’t even look hepatitis, testing, diagnosis and treatment. at him in the eye. Many of our trained staff have learned things from clients. And then I thought,’ I was like that.’ That surprised me. How Myth: Kids in the suburbs don’t shoot calloused I was before and drugs. how compassionate I could Reality: Rates of young adult IDU are be. It doesn’t cost anything on the rise in urban and suburban to smile at someone, to look areas. Suburban IDU may be more them in the eye. You’re not a likely to live at home and may be less sucker for just acknowledging knowledgeable about safer injecting and them as human beings.” HCV transmission. -UFO counselor What are the myths in your community?

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2 Life of a young adult IDU Harm reduction Harm reduction is an approach to care for drug users that provides a range of services that reduce the negative consequences related to drug use. Harm reduction strategies meet drug users “where they’re at,” whether they are active users or are looking for treatment and want to quit. Harm reduction initiatives including syringe exchange programs (SEPs), safe injection facilities and drug treatment have been shown to reduce morbidity and mortality associated with drug use.

The public health benefits of harm reduction are important, but the environment that a harm reduction approach creates increases your appeal. Creating a safe and non-judgmental environment, and providing the resources most needed by young adult IDU increases the attractiveness of your program, which means more young adults will access and benefit from your services. The Harm Reduction Coalition outlines these principles central to an organization that promotes harm reduction practice: **

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Accepts, for better or worse, that licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them. Understands drug use as a complex, multi-faceted phenomenon that encompasses a continuum of

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behaviors from severe abuse to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others. Establishes quality of individual and community life and well-being--not necessarily cessation of all drug use--as the criteria for successful interventions and policies.

Calls for the non-judgmental, noncoercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm. Ensures that drug users and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them.

Affirms drugs users themselves as the primary agents of reducing the harms of their drug use, and seeks to empower users to share information and support each other in strategies which meet their actual conditions of use.

Recognizes that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination and other social inequalities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm. Does not attempt to minimize or ignore the real and tragic harm and danger associated with licit and illicit drug use.

Youth and harm reduction

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As noted earlier, young adults are at higher risk for HCV acquisition and are more likely to share injecting equipment. Additionally, younger people have less access to prevention programs. Harm reduction services such as needle exchange programs not only provide young adult IDU with equipment to keep them safer, but serve as points of access for education and treatment. Research suggests that the more times a young adult person gets treated for substance use, over time, they more likely they are to maintain www.ufomodel.org


2 Life of a young adult IDU cessation. Providing harm-reduction based programs for young adult IDU is an important component to facilitating risk reduction in young adult IDU.

Harm reduction and the UFO Model One of the core elements of the UFO Model is a harm reduction philosophy. Another core element is collaboration and referrals. This is how you can operationalize these core elements: **

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Operate a small syringe exchange and distribution on site to ensure participants have access to sterile injecting equipment and drug preparation equipment such as cookers (bottle caps), cotton, alcohol wipes, sterile water, tourniquets and twist ties.

If you cannot provide syringes on site, have referrals, vouchers and other means for participants to get sterile syringes. Agencies can provide sterile injecting equipment.

Know the local pharmacy access, syringe possession and other laws and inform participants. Partner with local clinics and the Department of Public Health to provide referrals for methadone and buprenorphine/suboxone for participants.

Arrange residential treatment. Visit these programs and stay in touch to make sure there are indeed spaces available for participants. Train counselors in overdose prevention education and provide Narcan on site.

Train counselors in relapse prevention counseling as well as risk reduction counseling.

The next section, Part 3 - Preparing for UFO, will discuss conducting a needs assessment before you start your program. The needs assessment will help you figure out how to learn about the various harm reduction policies in your communities.

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Syringe exchange programs (SEPs) SEPs provide free sterile syringes in exchange for used syringes to reduce transmission of HIV, HCV and related diseases among IDU. The first needle exchanges in the US were established in the late 1980s. By 2002 there were nearly 200 needle exchange programs throughout the US. These programs offer a variety of services to IDU, including HIV and HCV prevention education and testing, referrals to drug treatment, primary medical care, and distribution of sterile ancillary drug injection equipment and safer sex supplies. It is important to note that UFO operates as a partner and collaborator with existing SEPs in San Francisco, NOT as competition. We make sure that our dropin center does not happen at the same time as a local SEP.

Are SEPs present in your community? Are these programs funded by your city, or do they operate underground? Which neighborhoods do they serve? What other services do they offer?

Why are SEPs important?

The only way for young adult IDU to prevent getting HCV is by using sterile drug injection equipment. We can’t give that message, yet not give them the tools they need to stay safe. Without providing access to clean syringes, the UFO Model would simply be an education program, but would not work as HCV prevention.

By distributing clean injection equipment and disseminating risk reduction strategies, SEPs have caused a reduction of HIV among IDU. SEPs often serve as the sole access point where IDU, especially young adult IDU, can receive services without judgment, and therefore are a powerful site for service provision and disease prevention to a population that is otherwise difficult to reach. In San Francisco and other cities with strong SEPs, there has been a cultural

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2 Life of a young adult IDU shift; young adult injectors learn how to access clean syringes early in their injection careers, and are quickly informed of safer injection techniques and disease prevention strategies.

Pharmacy sale of syringes

California passed a law allowing pharmacies to sell or otherwise provide needles without prescription in any county in which local officials have authorized needle exchange. Similar laws have been enacted in 21 states across the US. Although young adult IDU frequently report use of SEPs, they also report buying syringes on the street, a potentially more dangerous outlet, as the source and sterility of the syringes is not guaranteed. Pharmacy sales of syringes can make clean needles more widely available to IDU since some pharmacies are open 24 hours a day, as well as potentially decreasing the stigma that can be associated with attendance at an SEP.

Naloxone distribution

Overdose is the number one cause of death among young adult IDU. Overdoses can be prevented, and in regions where Naloxone is available, overdose deaths have decreased. In San Francisco, Naloxone (also known as Narcan) has been available to IDUs and people likely to be around someone who overdoses since 2003, and has saved an estimated 500 lives since then.

NOTE: What are the laws governing pharmacy sale of syringes and Narcan distribution in your community? Where do young adult IDU go to buy syringes? Are pharmacists receptive to young adults purchasing syringes? For help in answering these questions, please see Part 3 – Preparing for UFO.

Helpful resources for harm reduction ** ** ** ** **

Harm Reduction Coalition provides support, training and many valuable resources. harmreduction.org Temple University, Project on Harm Reduction in the Healthcare System. www.temple.edu/lawschool/aidspolicy/ apolicy.htm

CDC’s Prevention among injection drug users (note this site is no longer being updated) www.cdc.gov/idu Chicago Recovery Alliance

www.anypositivechange.org/

The DOPE Project

harmreduction.org/article. php?list=type&type=51

Three-quarters UFO participants have ever witnessed an overdose and half have witnessed an overdose in the past year. UFO provides Narcan and training both at the drop-in site and during street outreach. For more information, please see Part 4D - Syringe access.

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Quick ‘n’ Dirty

Life of a young adult IDU Leave your preconceived notions at the door Young adult IDU often are a highly stigmatized and misunderstood community. These misunderstandings, or “myths” about young adult, often homeless people who use drugs can be very damaging to a young adult’s self esteem, as well as to their ability to access services and live safely on the streets. They can also affect the attitudes and behaviors of people working with young adult IDUs.

Young adult IDU have unique needs based on their life situation

Young adult IDU may have multiple physical, mental and emotional health needs. Learn from your IDU how to adapt your program to best fit their needs. Some of the issues we found in San Francisco include: travelers and trainhoppers, pets, mental illness, polysubstance use, relationships, power and risk. What are the needs in your community?

Harm reduction is an integral part of the UFO Model

** Operate a small syringe exchange and distribution on site to ensure participants have access to clean injecting equipment and drug preparation equipment such as cookers (bottle caps), cotton, sterile water, tourniquets and twist ties.

** If you cannot provide syringes on site, have referrals, vouchers and other means for participants to get clean syringes.

** Develop a list of IDU-friendly pharmacies that will sell syringes.

** Partner with local clinics and the Department of Public Health to provide referrals for methadone and buprenorphine/suboxone for participants.

** Arrange residential treatment. Visit these programs and stay in touch to make sure there are indeed spaces available for participants.

** Train counselors in overdose prevention education and provide Narcan on site.

** Train counselors in relapse prevention counseling as well as risk reduction counseling.

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“This isn’t glamorous, this isn’t fun, you know? I had to go steal cars and do things like that. And that is scary and weird and I got shot at, and I never wanted to do it in the first place, and I don’t ever want to do it again. But when I was on heroin I had only one guarantee, and that’s that I had to wake up and do it again.” –UFO participant

“A person does not come to us empty. We have a lot of respect for the choices they make. They’re doing these things for a reason. Our job is not to change them, but to offer them more choices.” -UFO counselor

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YOUNG ADULT VOICES Loki’s Story I’ve been travelling for 10 years, since 9/11. Been to Louisiana, Illinois, Texas, Florida. I’ve got friends all over the US. I’ve lived everywhere. I travelled with the Grateful Dead for 20 years. I have friends who were born in the parking lot of a show, I know their grandparents. My Dad’s a musician, he and my mom were Dead followers. I’m still mourning Jerry Garcia. I was in Venice Beach when I heard the news. A news van came up to me and asked me “What do you think about Jerry Garcia dying?” That’s how I found out. What do you say to something like that? I just walked away. I’m a lineman, I build fiberoptics. I’m on methadone now, but I’ve got a truck and a job at an air force base in Missouri that’s waiting for me. Four weeks ago I found out I had hep C. I’m in a 6 month window. I have a chance to get hepatitis out of my body. My job’s not going anywhere, so if I could get it out of my system, that’d be awesome. I’m trying to get on interferon. UFO helped me out, they’re showing me how to get treatment. I want to do it. I was prepared over a long period to maybe get hep c. Hey, I’m playing a game. I know I take chances. But it sucked to find out. Now it’s in my face, I have it. But you can’t block it. You gotta get up in the morning, go to your appointments. You’ve got to be on it, you can’t ignore it. I’ve got to be clean, get on SSI, get on anti-depressants. I gotta occupy my time, I get bored when there’s nothing going on – idle hands are the devil’s workshop. I’m my worst enemy, technically. I just gotta worry about myself. I’m trying to get off probation, so I’m by myself a lot. I’m very choosy about who I hang out with. I don’t like a lot of people’s get downs—it’s just them being them—how they make their money. I don’t steal or break into cars. I recycle in the middle of the night. I used to sell pot in front of clubs, but I can’t do that now because of probation. I don’t have no money. Being honest sucks sometimes when you’re broke, but at least you’re not playing yourself. My job now is to stay healthy. I make sure I eat 3 times a day, try to eat healthy. Recycling is good exercise. Try pushing a shopping cart full of bottles uphill— it keeps you pretty healthy, you break a sweat. I’m making an effort, you know what I mean? I try to show up every week at UFO. They’re awesome, dedicated people trying to do good. They need more programs like UFO in other places. I’ve hung out with people that were junkies and now work at these programs. I’ve also seen quite a few die, lose it, not change at all—they get HIV, lose and arm, get abscesses, gangrene. A lot of people would rather be in familiar hells than unfamiliar heavens. My recommendations for anyone doing this work? Learn to be open. Be honest. You’ll see unexpected things and meet unexpected personalities. You’re gonna learn new things. Just work with us, man. We’re really trying.

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UFO Model Intervention Manual - 2 - Life of a young IDU