1
Allisha Hall
HIV Alliance
Overdose Prevention Program
Family and Human Services Program
College of Education, University Of Oregon
January 12, 2012
2
Introduction
My senior site internship is at the HIV Alliance. HIV Alliance supports individuals
living with HIV/AIDS and prevents new HIV infections through harm -reduction and education
services. Needle exchange is a harm- reduction program at the alliance that provides clean
supplies to clients who are injection drug users. The needle exchange program goes out into the
Eugene community to provide exchange services, HIV and Hepatitis C testing, safe injection
information, wound care and community referrals. The clients of needle exchange are primarily
drug injection users with the majority injecting heroine and speed/meth.
My senior project will be to create an overdose prevention program. The program will
address the clients’ needs on overdose by receiving information form a survey about overdose to
help fill in the gaps and needs of our clients. This program will be implemented at needle
exchange and focuses on overdose education and rescue breathing instruction. There will be a
new binder full with information and recourses about overdose available for the clients. This
program will directly impact the drug injection user population by helping them learn how to
address any overdose situation that they might experience. The project’s main purpose is to
educate our clients on how to prevent an overdose and for them to feel more confident in helping
if overdose situation arises.
Rationale
Project Importance
In Lane County alone, there were thirty-three drug related deaths in 2009. Heroin-related
deaths outnumbered meth fatalities in 2009 as well (Christie, 2010). In the past three years
heroin has become the drug of choice for many users, because of the increase of meth labs
getting shut down and the increase in prices of cocaine. Drug overdose has spiked in Lane
3
County due to a type of heroin called gunpowder. Gunpowder heroin is heroine laced with
fentanyl. Fentanyl is a powerful synthetic opiate analgesic similar to but more potent than
morphine. When combined with heroine to make gunpowder, the dangers enhance because it is
30 to 50 more times potent than heroin (drugabuse.gov). Since gunpowder is just getting
introduced into the market many dealers and users aren’t educated on the strength of the drug.
Drug dealers don’t always know how much to cut fentanyl-laced heroin to get proper dosage
concentrations. In many cases users don’t always know how much to take to get high (Christie,
2010). An overdose prevention program is important for Lane County to have a new service for
drug injection users and for people who use gunpowder heroin or inject drugs.
Agency and Population Needs
At this time the HIV Alliance does not have an overdose component to their prevention
program. They focus on safe injection but do not have any information on overdose for their
clients. The project will address a large need for the alliance by implementing an overdose
prevention component to their agency and as a result will also, address the needs of the clients
and for the community. Rene Yandel, the director of HIV Alliance, opinion is that the number of
drug deaths doesn’t account for the larger number of people who overdose and survive (Christie,
2010). Taking this into account, the program could be a contribution to those lives that are not
lost in an overdose.
Many times when our clients have experienced an overdose themselves or seen one
happen, they express fear and sadness over the experience. One client expressed to me his
experience while getting emotional about his occurrence with trying to revive a friend from
overdosing. His stress and sadness of the situation that was expressed justifies that this overdose
program is a definite need for people who inject drugs (Personal experience). Many clients have
4
express interest in getting Naloxone, which blocks opiate receptors in the brain and helps a
person who is overdosing to breathe and recover (drugabuse.gov). Since gunpowder heroin is so
strong, people who are overdosing aren’t aware of how potent it is (Christie, 2010). Drug
injection users are not educated about gunpowder and are in need of learning how to inject the
strain safely and to know what to do in an overdose situation. In order to make an impact, the
population in is need of a harm-reduction approach to overdose
Research Evidence
There are many risk factors present for people who inject drugs. With thirteen milliondrug injection users in the world the negative health risks associated are HIV and Hepatitis C
(Wagner, 2010). An overdose risks factor is injecting due to the lack of dose control once the
drug has been injected (Philips, 2010). The use of alcohol and other depressant drugs such as
benzodiazepines also represent a known risk factor for overdose. Fentanyl, the component found
in gunpowder heroine, is similar but more powerful than morphine. Fatal overdoses that involve
heroin alone are less common, the majority of cases involve at least one other drug (Philips,
2009). When combined, heroine, alcohol and other depressants can cause respiratory depression,
which can induce loss of consciousness. Overdoses are frequently witnessed, which leads to the
notion that drug-takers themselves should be trained in resuscitation methods (Strang, 2008).
A group prevention approach to heroin overdose proves that their outcome has been
beneficial to the target population. The intervention took place one afternoon and taught
participants to recognize and respond to an overdose. Their focus was defining overdose,
discussing known risk factors and on-site instruction in cardio-pulmonary resuscitation (Philips,
2009). The participants were self-referred and heroin users. Of the 107 participants reported
feeling ‘quite or very confident’ in managing an overdose situation, confident in assuming CPR
5
with someone who had overdosed, and were less likely to pursue rumored remedies on overdose.
The study shows that the project has been done in other locations and has had a positive impact
on the drug injection user population.
Project Description
Project Development
For my senior project Cheyenne Peters and I will be working with one another to develop
an overdose prevention program for the HIV Alliance. By talking with clients and providing an
overdose survey at needle exchanges, it is apparent that overdose is a prevalent issue for the drug
injection user population. To address the needs of our clients, the overdose prevention program
will focus on education and harm reduction for overdose. The three components of the program
will be rescue breathing classes, education and data collection. We will be teaching rescue
breathing to our clients at needle exchanges and at any other events that applies to our
population. Education is a major component to the project because we will inform our clients
about: what to do in an overdose situation, what not to do in an overdose situation, how to
recognize an overdose and information about mixing drugs. The data collection component is the
overdose prevention survey that we give to clients at needle exchange to help us to address the
needs of our clients, fill in the gaps pertaining to overdose knowledge and understand the
overdose experiences that our clients have been in. We will use the information gathered to
provide documentation and develop reports for our community. The main hope for the project is
to make a sustainable prevention program for our clients and other communities.
6
Target Population
The target populations for the project are the clients of HIV Alliance needle exchange,
injection drug users and people who are at risk of seeing an overdose. In some cases people who
inject drugs are homeless which creates more of a lack of services provided to them. The drug
injection user population and the homeless population are very judged and stigmatized
population which decreases their education to learn more about harm reduction for their life
choices. The program at the HIV Alliance will provide services to our clients so that they are not
judged and will address their needs.
Benefits
The overdose prevention project will benefit our clients in many ways. The main goal is
to provide a new recourse for our clients to get their needs met by providing information.
Gunpowder heroin is extremely potent and is the cause of many overdoses in the Eugene
community. Since this drug was brought to Lane County, the overdoses have increased and there
is a lack of education about gunpowder in the drug injection user population. Having recourses
on education about overdose for the community will hopefully help our clients feel confident to
asses and handle an overdose situation.
Existing Services
Overdose prevention information and services are very limited for HIV Alliance clients
and for the DUI community. Due to the fact that gunpowder heroin is the main type of heroin in
Lane County, drug injection users are not informed about overdose and what to do in the
situation. There are not many services in the Eugene community that focus on overdose
prevention and there is not an overdose prevention component at HIV Alliance. This project
would be groundbreaking in our community and will create a new service and resource for
7
people who inject drugs.
Future Stability
It is my greatest hope for this project is for it to be continued after Cheyenne and I have
graduated. The Alliance is in full support of incorporating an overdose prevention program to
their prevention sector of their organization. The project and all of its components will be
outlined in detail about how to sustain and maintain the overdose component to needle exchange
and other services provided by HIV Alliance. Implementing the program in the spring will allow
the staff and volunteers to get comfortable and understand the project in order to continue it for
years to come.
Challenges and Barriers
The two main challenges that might arise for the project are the funding and inconsistent
client participation. Working at a non-profit organization that is dependent on grants and outside
donations results in a lack of funding for the project. We will need dummies for the rescue
breathing class and also training to be a CPR certified trainer. Both require funding, and at this
time the funding is not determined. The other barrier that could be presented is that clients could
not show up to the workshops. Even though the clients are in need of overdose prevention and
have expressed interest, their life situation in general has many barriers keeping them from
attending when they say they will.
Evaluation of Project
The evaluation process will be to communicate with our clients and to also pass out a
survey assessing the effectiveness of the program. Our clients are very helpful in terms of
addressing their needs and giving advice on what will and will not work in terms of
effectiveness. Open communication about the program will able us to get an understanding of
8
how the program is being evaluated. After clients have completed the project they will have the
option of an evaluation survey. Our main goal for clients who have completed the rescue
breathing class is to feel more educated and confident about recognizing an overdose, and how to
assist in an overdose situation. We would hope that they would feel as though our program is
benefiting them and addressing their needs.
Management Plan: Overdose Prevention Program
JANUARY
TASKS
DATE
Supervision meeting:
Discuss regular supervision meetings, and
upcoming tasks.
Senior Project proposal presentation
January 11
Work on becoming trained as a rescuebreathing trainer. Figure out process and
logistics.
Find donation for supplies needed (rescuebreathing dummies)
Get in touch with Lane County Public Health
and EPD to set up meetings.
January 23
January 12
January 31
FEBRUARY
TASKS
DATE
Begin gathering OD information for project
binder.
Keep up with donation requests and
community support.
Collect and compile all data from survey
February 1
February 10
February 29
MARCH
TASKS
DATE
Finish compiling OD information and create
project binder
Set date for first rescue-breathing class
Create rescue-breathing flyer
March 10
March 17
March 23
9
APRIL
TASKS
DATE
Complete client evaluation form
Rescue-breathing class completed
Complete OD information binder
April 8
Specific date TBA
April 30
MAY
TASK
DATE
If allowed, continue with rescue-breathing
classes at needle exchange
Continue to refer clients to the OD binder and
provide information
Work on project presentation
Senior Project Presentation
May, TBA
May
May- June
June
Budget
Supplies
Copies
Binder
Dummies
Mats
Rescue-breathing training costs
Food
Costs
Free
$2.99
By donation
By donation
$100+
$30.00-50.00
10
Reference
Christie, T., & Moran, J. (2010, April 11). Area Drugs Pose Potent Problems Powerful Strains of
Heroin and Meth Bring Overdose Concerns. Register Guard, p. A1.
Fentanyl . (n.d.). National Institute on Drug Abuse . Retrieved December 3, 2011, from
drugabuse.gov
Phillips, P., Glover, C., Allan, T., & Khoo, M. (2009). Using a Group Approach to Preventing
Heroin Overdose in North London. Drugs: Education, Prevention & Policy, 16(4), 328342.
Strang, J., Manning, V., Mayet, S., Titherington, E., Offor, L., Semmler, C., & Williams, A.
(2008). Family Carers and the Prevention of Heroin Overdose Deaths: Unmet Training
Need and Overlooked Intervention Opportunity of Resuscitation Training and Supply of
Naloxone. Drugs: Education, Prevention & Policy, 15(2), 211-218.
Wagner, K., Unger, J. B., Bluthenthal, R. N., Andreeva, V. A., & Pentz, M. (2010). Cognitive
Behavioral Theories Used to Explain Injection Risk Behavior among Injection Drug Users:
A Review and Suggestions for the Integration of Cognitive and Environmental Models.
Health Education & Behavior, 37(4), 504-532.