So my name is Sarah Canovies. I am with the Opioid Response Network. I've been here for a couple of years. Lurking somewhere is Stephanie, who is also at the ORN. And we are really excited to provide this training and this education for you guys. We do that free of cost. So that's pretty cool. And today we're gonna be talking about harm reduction and the principles in action. And Daisy's gonna be the one who does that for us. And I'm real excited to introduce Daisy. She's here from C4 Innovation. So Daisy, you wanna introduce yourself? Absolutely. Thank you for the opportunity, Sarah. And good afternoon, midday to you all in Washington. I'm checking in from Western Mass, so it's mid-afternoon for me. But happy to be here and share this material. And I call it Harm Reduction Principles in Action because I'm on a mission to normalize harm reduction in a way that we can see it in our everyday life, whether it's for substance abuse, although we're here, or substance use, we're here for the purpose of, right? Opioid and the ramifications of. But being able to start looking at harm reduction connections in our everyday life is also important to me. I identify as a woman with lived and living experience. And I say lived experience because I'm in sustained recovery from substance use disorder. But I'm still have living experience from managing some of my mental health and so much of my trauma experiences that come in different seasons of my life, right? And so I'm happy to be here again. Despite of being in this role, I identify also as a lifelong learner, right? So I hope to create a space where we can learn together and you all can share your professional and or living lived experience to help make connections with some of the materials that we'll cover. That's the paper in their room, hidden on their book. I'll pass it back over to Sarah. So I'm just gonna give you a quick rundown of the ORN and what we do. We are a SAMHSA funded grant, which means that we are across the country. There are several of us. What we do is provide technical assistance. TA looks like a lot of different things just depending on what it is you need. For us and this situation, we're doing some training and education. So that's sort of kind of what we do. We bring in local support to help us, but when we have something specific, we are able to pull people across the country to come in, which is how we got Daisy to be here. If you are interested in learning more, we have a website, feel free to go on there. We do provide any sort of requests that you might be interested in and we do all of that free of cost. And yeah, that's it. That's what we do. That's how we do it. And Daisy, yeah, that's how you can reach us. You can also email us. Brock has our information. Feel free to reach out if you have questions or concerns. And Daisy, I think we are back to you in harm reduction. Thank you so much. So our hope for you today is that after our time together, you can walk away with a better understanding from the review that we'll have on harm reduction principles, have the ability to reference reflections on the data that impacts humanity. And I'll cover some slides on data. Just if you're not on mute, can you mute yourself so we can minimize the feedback from the background noise? Be able to recognize the value of harm reduction engagement and the connection between faith and harm reduction. It's really popular and really easy to talk about some of the strategies and some of the services, but I think the secret sauce of harm reduction is this engagement, how we engage through a harm reduction lens with individuals. And so I'm always happy to lift that up, right? It's like working out, right? If you perfect the form, then the motion comes easy. So if we can perfect our engagements independent of where people are in the recovery process or even the stages of change, right? Then we can really shape a relationship that when the individual is in crisis or is in need, they know where they were treated with dignity and respect, and they'll go back to these spaces to seek support. We would also like to hope that you can walk away with the ability to engage with the individuals you work with and have the ability to explain harm reduction strategies during moments of crisis, right? I mean, it could be different. It could be today, it could be a crisis on, you know, use of tomorrow. They might have three days in, you know, recovery through medication-supported resources, right? But the crisis is something different now, right? And so we can, creating that non-judgmental, compassionate space and relationship, for folks to, you know, seek support independent of what the need is. And of course, increase your understanding of the importance of recognizing the role of harm reduction in the relationship between trauma-informed care and person-centered care, because all these approaches or models really align. Although their principles and their values are worded differently, many of the descriptors do align, and that's what I want to show the connection of towards the end. And feel free to, on chat, ask questions, unmute yourself, ask questions, or even add some of the knowledge from your work and your lived experience. I love interaction, and the computer is not a barrier. So here, I wanted to show that, while many of these harm reduction, right, and I quote-unquote lowercase services are vital, life-saving practices to offer these services without engaging the harm reduction with the uppercase H and R, it's a philosophy, it can potentially increase harm to people who use drugs, right? So it's wanting to connect the little R of harm, or the little, the minor HR, right, with the big or major HR, if that makes sense. Any questions so far? I always feel like I get tongue-tied in this section. I don't see no hands, all right. So harm reduction is based in public health, right? Although when we think of harm reduction, oftentimes individuals directly go, right, to minimizing the risk of transmitting infectious diseases, and, or minimizing the risk of active drug use, it's important to consider that it's effectiveness, or, and looking at public health, right, through the lens of harm reduction, that effectiveness goes beyond just substance use and or infectious diseases, right? And through the lens of public health, if we think about harm reduction, we practice harm reductions through the medical model when we go into our doctor's appointments on a yearly basis for preventative care, right, to reduce the risk of any illnesses that could impact our human development, right? When we think about harm reduction, or public health through the lens of mental health and crisis individuals who rely on, you know, strategies like self-harm, or, you know, struggle with suicidal ideations, and there's harm reduction strategies for that as well, right? And when we think of it in all aspects of our life, right, think of it kind of like social determinants of health, there's harm reduction strategies for every point of our social determinants of health, right? It's just looking at the world through that lens of public health, but through the lens of harm reduction. Many, right, when we think about recovery is, and we'll get to it, I don't want to get ahead of myself, I just get so excited of this material, but let's look at the first myth, and this is where we want some engagement on chat, or unmute yourself. The first myth, harm reduction enables drug use. Do you think that's, have you heard this before, that harm reduction enables drug use? I think this is actually one of the most common ones in my top one. How many can agree you could put a thumbs up or a thumbs down? Go ahead. I was gonna say I can't find my emoji, but I'm doing a thumbs down. So some folks have heard it, but many don't believe it, right? Because the reality is that research shows that harm reduction services do not exacerbate drug use, nor do they undermine treatment efforts. People who engage with harm reduction programs are five times more likely to access treatment and three times more likely to enter recovery compared to those who do not. And this is data from NIH and the CDC. I remember working in an outpatient, OTP, outpatient opioid treatment program. Too many, you know, synonyms and, you know, initials and all this stuff in this field. So, and I remember one of my participants accessed OTP services and inpatient treatment through one of our local harm reduction centers. And so, you know, we know that there's great value to harm reduction. I think that some of our own stigma and bias on all levels, right, individual level, community level, and systemic level. It takes more effort to really understand the value of it. Now let's look at myth number two, which is harm reduction increases crime and makes my communities less safe. Do you believe that's a myth? Thumbs up. Or do you believe that is real? Thumbs down. A real fact. I have definitely still conversations about the safe use sites. I just seen an article on attorney general or somebody talk about the current administration perspective on it and it made me sad but hopeful, because we'll still out here fighting the good fight Myth, yes, myth. All right, let's see what we got. According to the CDC harm reduction programs are not correlated with any increase in crime. They support people getting out of the criminal justice system as they increase participation in treatment services and they also support community safety for reducing risk of encounters with discarded syringes and we have another chart later on that I'll get into of some of the benefits on how harm reduction helps communities, right, not just individuals who use substances. All right, let's jump to three here. People won't get sober without the fear of punishment. Myth or fact? That's a great point, Kevin, I was just talking to. I was just talking to someone about a research that he was part of where there was a harm reduction center, and I don't remember what part of the country it was, but he talked about marking or tracking where every discarded syringe was found by the harm reduction team. And then they created a map that showed the concentration of areas where paraphernalia was with help identify where to deploy teams to, you know, do sweeps and cleans, which I thought was pretty cool and it was used as research. What else I got? I'm not fancy enough for emojis yet. Okay, I see. Oh, somebody said Kathy, just remind me of my nieces and nephew. Oh, a couple. Okay, you guys are up with the lingo. All right, let's see what it tells us here. The reality is that punishment doesn't work. The massive failure of the war on drugs campaign in the US provides concrete evidence. Incarcerating people does not address reasons for substance use, and it creates further feelings of isolation and shame that can perpetuate substance use. Incarceration also puts people at risk. Individuals are 129 times more likely to die of an overdose in the first two weeks post-release. I remember that the push for medication-supported recovery in incarcerated settings was because there was a period in time where a lot of individuals were being released and even overdosing right in the parking lot of the incarcerated setting. It's really important for us to really capitalize and leverage on these opportunities. We talk about data, data, data collection, right? But it's not just data collection. We really got to dive into this data because it's going to create a snapshot, kind of like a picture, of where harm reduction strategies, services are really needed, right? Okay, this is our second-to-last one. Showing positive regard or compassion to people who use drugs enables them. Myth or fact? Nice. We're all on the same page. Not true. Right, right. Definitely. Oh, there it goes. So what the data says is that the reality is feelings of shame and social isolation perpetuate drug use. I am not the smartest tool in the shed. And I honestly, I'm no doctorate-level researcher, but I honestly believe, and it's supported by the people that I've supported in their recovery through peer work, clinical work, and all the studies that I've been from prevention to treatment and recovery. There's more of a prevalence of trauma in mental health that, for me, really uplifts this idea that trauma and untreated mental health could potentially be the culprit or the biggest factor for people using substances. There's many reasons on why people engage, right, in drug use. But not all of it is chaotic, right? And not all of it is manageable. But that's a whole other training. I'm sorry, I digress. And so showing positive regard, also consistent positive regard to a person with a substance use disorder works to combat that shame and promote inclusion. This is why there's great value in peer work and recovery communities to really create those communities of, what's the word I'm looking for? Not normalcy, kind of like matching up, right, like being equals. And this is demonstrated by Canadian psychologist Bruce Alexander's rat park where they put rats in a makeshift park where there was one water bubbler with substance, I believe it was cocaine, and the other one was like regular water. And folks or the rats that were in this study leaned more on community and they tried different versions of it to see which ones would want to congregate, right, and be with people and be in community. And so it's really interesting. I mean, you can look it up as a rat park and the internet. But essentially with a little bit of social stimulation and connection, addiction disappears. This also supports the research from Johan Hari where he talks about the opposite of addiction is connection, right? And so as human beings, we naturally want to, you know, congregate and feel part of, and oftentimes people who are in active use really want to just isolate and be on their own because of the shame and guilt, right, and that causes the social isolation. And then we have Gabor subscribes to the motion that, oh, I lost it, where'd it go? Substance use disorder is ultimately the loss of connection to friends, family, community, and agency delivered through stigma, sharing, and incarceration. Yes, and he got a great video on that exact point. Thanks for sharing, Brock. And then Matthew has, what about communities that are centered around drug, right, those same communities, Matthew, that are the ones that house OTP clinics or opioid treatment programs that house, you know, residential treatment, different levels of care, outpatient clinics. It's really, you know, it's like we're fighting a beast, right, where we, you know, know that some folks, right, need to be separated from that type of environment to really thrive and be, you know, sustain recovery, kind of like that research with the veterans that came back from Vietnam War, right? Some were taken away from that environment and didn't need treatment while others did. But then we're restricted to certain settings, which is, or certain environments, which is a little frustrating, but I think that, you know, recovery, because recovery is different for everyone. And this, you know, notion or idea of multiple pathways, which another daisyism for me is having harm reduction as the umbrella to health and wellness, and then all the different multiple pathways underneath that umbrella, because the ultimate goal is health and wellness, right? Which SAMHSA puts it beautifully, and we'll touch on it in a few slides down the line. But if we're all speaking, right, health and wellness, and that looks different for all of us, then we should have the ability to go to, you know, recovery communities that are safe from, you know, out in the open community use and or, you know, those communities centered around geographical areas. You know, areas in certain communities that are high drug and or gang violence or, you know, and anything that comes with, you know, some of the periods of chaotic use or associated with periods of chaotic use. Next slide here, it's our last myth. And seems like my little animation didn't work and the whole response came out, so we're just going to jump right into it. The myth is my tax dollars are being used to people so people can get high, but the reality is harm reduction programs substantially reduce the risk of infectious diseases, which is a tremendous saving measure for, you know, hospital primary care doctors as well. For hepatitis C alone, treatment for one infection can be up to 84,000, and that's per NIH. Communities with syringe service programs or SSPs see 50% decrease in hepatitis C transmission, and that's from the CDC. Harm reduction reduces involvement in the criminal justice system and connects people to treatment services, breaking the revolving door. And incarceration costs taxpayers almost $40,000 per person per year, and that's by the Federal Registry back in 2021. Any thoughts, questions, feedback so far? No? All right. So according to SAMHSA, there were more than 100,000 drug-involved overdose deaths in 2023, and the data is a little slow in coming in because that's the most recent data I can get, but because, you know, it's always like a year behind because all the jurisdictions or the Department of Public Health have to, you know, report their final numbers, but harm reduction emphasizes engaging directly with people who use drugs to prevent overdose and infectious diseases, transmission, improve physical health. Right? This is the part that we often forget, right? We're really fixated with reducing infectious diseases and or reducing the harm of substance use. But it's more than that, right? It seeks to improve physical health, mental and social well-being, and offer low-barrier options for accessing healthcare services, including substance use and mental health disorder treatment, as well as medical, right? Because it's looking at the person as a whole. And this is why it's more than just, right, like I said, infectious disease, minimizing infectious disease transmission, but it seeks to improve mental, physical, and social well-being. And SAMHSA conceptualizes harm reduction as being a set of services, an approach, and a type of organization. Harm reduction has at times been reduced to a singular service or group of services when in fact it is applicable in many different settings. And as an approach of supporting principles and pillars that can be applied to a variety of situations or context, settings, environments where, you know, folks are in treatment, be it or connected to services in the whole spectrum, right? Of addiction services from, you know, prevention all the way to recovery and whatever level of change or stage of change the individual is at. Organizations who practice harm reduction incorporate a spectrum of strategies that meet people where they're at. And we often say meet people where they're at thinking this literal space, environment, but meeting people where they're at, it's like meeting people on their own terms. And that can look like, it can look different for everybody, right? And so it's important on understanding the notion that it's more than just strategies, right? And just meeting people literally in a physical space, but it's where they're at in their journey, right? If an individual, taking back of my time in OTP clinic, if an individual came in, I always get called Miss Daisy, even when I was younger. Oh, Miss Daisy, I'm doing 15 packs of heroin a day. And then a year down the line, he comes and he says, Miss Daisy, I'm down to 11 packs a day. That to me is progress and me celebrating that little decrease is meeting them where they're at, right? I remember having, and this is maybe a little radical, right? But I remember working in OTP and an individual saying, I only have three more weeks to sell drugs because my rent is due and now I don't have to buy heroin, but I got to pay my rent. And I said, have you heard of the local employment agency? And we talked a little bit about that. And I was like, have you heard the local police is really targeting this area? Please be careful. That's harm reduction as well. You understand what I'm saying? It's looking at harm reduction outside of just strategies to use safer, to minimize transmission of infectious diseases, right? It's creating opportunities for them to look at ways in their life to reduce the harm of some risky behaviors, right? Be it a substance use, a mental health, a life need, a life crisis, right? How can you try to meet this need with what you have right now? And that is meeting people where they're at. And harm reduction works by addressing broader health and social issues through improved policies, programs, and practices, right? So we have these strategies, we have these services, but there's policies that have to support this harm reduction approach, right? And programs that line up with the need of the population that access this organization. Yes, right on, Kevin. Thank you so much for your support. So let's look at the 12 core principles of harm reduction. First, we'll look at respect autonomy. And each individual is different. It is important to meet people where they are, and for people to lead their own individual journey. Because, again, health and wellness looks different for each and every one of us in this call. Looking at it through opiate use, right? And I'm going to use myself as a persona, right? If I am looking to reduce the use of prescription opiates, right, and I'm in action stage, I don't want to go to medication-supported recovery, I want to reduce the use to eventually get to a place where I can wean off myself without severe withdrawals, right? So I'm using three, I was using 30 prescription opiates, whichever one you want to put in there. Using 30 prescription opiates in two months, I'm down to 19. And so when I'm speaking to my, let's say, recovery coach, or peer specialist, and I say, you know, I'm struggling with being on 11, I think I just said, right, 11. I'm down to 11, but I'm still having, you know, restlessness at night. And I'm still feeling a little nauseous in the morning. And so my recovery coach says, oh, you know, I really recommend you check in with a MOUD or OTP clinic, right? Medication-supported recovery, medication for opioid use disorder, I mean, and or an OTP clinic. And I tell my participant, I mean, my recovery coach, that I don't want to, that I can do this, right? It's for the recovery coach to really look at opportunities for me to reduce harm, right? Alleviate some of what I'm going through, connect to services referral, right? And support and uplift my decisions, even though as a coach, I know that I'm, that the participant or me will be suffering, right? But it's because of, it is through that harm reduction lens that we can look at how we respect autonomy, by just allowing the individual to really name, right, and really voice what they feel they need at the moment. We also have to educate, right, on some of the downside of a decision like that, right, of detoxing on my own. And it's important to, I don't know, hey, support, encourage, you know, have you talked to your doctor about your symptoms? Maybe they can offer something just to calm the symptoms instead of, you know, medication for opioid use disorder, whatever, right? But respecting autonomy, it just creates this relationship where the person feels empowered and with the ability to make decisions, even if those decisions are not, we know in our house as a provider, right, that are not the healthiest. Also, practice acceptance and hospitality, love, trust, and connection are important in harm reduction work. Harm reduction approaches, initiatives, programs, and services hold space for people who are at greater risk for marginalization and discrimination. These elements emphasize trusting relationships and meaningful connections, and I also understand that this is an important way to motivate people to find personal success and to feel less isolated. Provide support is also a principle. Harm reduction approaches, initiatives, programs, and services provide information and support without judgment in a manner that is non-punitive, compassionate, humanistic, and empathetic. Peer-led services enhance and support individual positive change and recovery, and peer-led relationship leads to better outcomes. Oftentimes, you'll find, you know, a harm reduction specialist working in a certain setting and peer workers working in another setting, but you do need that lived experience to work as, like, a harm reduction specialist, at least for most organizations that I've worked with. But it's really important to have that lived experience, right? There's great value in peers, and there's data for decades supporting that, right? But even if you don't have lived experience, but having that non-judgmental, compassionate approach to engagement can create this mutuality in your, what's the word, professional, therapeutic, professional relationship, therapeutic relationship for those clinicians in the room. Also, provide many pathways. I touched on this a little bit about, you know, there are many pathways. I know somebody who's working right now on a Salsa class becoming a pathway of recovery because it's his pathway of recovery, right? He gets together with people in the rooms, and, you know, they hang out at each other's houses, and, you know, they dance Salsa and talk about, you know, life together and support each other, create a little support group, and it's mostly men, actually. And so, who knows? Maybe you'll work with an individual who someday might develop a whole new pathway, right? Because if recovery looks different for everyone, then those pathways to recovery and of recovery must also look different for everyone. Value practice-based evidence on the ground experience. Structural racism and other forms of discrimination have limited the development and inclusion of research on what works in underserved communities, right? But this helps us, right? This is not just bad news, right, that we don't have enough data, right? But leaning into the principles of harm reduction will help you better understand the individual for the individual. When you met one Puerto Rican, I'm of Puerto Rican descent, when you met one Puerto Rican, you've met one Puerto Rican, right? When you've met one Black person or an individual who identifies as African American, you've met that one person, right? Just like my experience to my sister's experience in growing up in a north end of Springfield underserved drug and gang violence community, we lived in the same house in the same neighborhood, but our experiences were different, right? And so it's really important to consider the 12 core principles of harm reduction because they're all going to look different. All these principles will look different when engaging with the individuals that you work with because they're all different. And so that will support the, you know, having a multiple pathways of recovery as we call it. Because if we're engaging individual as that one individual and respecting their autonomy, then they're going to help us support whatever they feel they need to develop to support their journey of health and wellness. Any thoughts or questions so far? This one's a long one. Cultivate relationships. Relationships are of central importance to harm reduction. Harm reduction approaches, initiatives, programs, and services are relational. There's a great intersectionality between them as well, right, for many different diagnoses and or disorders. Excuse me. Assists no direct, right? If we're leaning in with curiosity and allowing, you know, the individual to be the subject matter expert of their own life and or respect their autonomy, then we must be assistants, right, stewards and not directors. Harm reduction approaches, initiatives, programs, and services support people on their journey towards positive change as they define, right, because it's their health and wellness. Support is based on what the person with a use disorder identifies their own needs and goals, not what programs think they need, offering people tools to thrive. Also, promote safety. Harm reduction approaches support safety as defined by the people they serve. And this goes back to, you know, who defines also crises, right? What I'm going through right now, X, Y, Z, is this a crisis to me or is it a crisis to, by definition, right? Because just like, I mean, if it's safety-related, of course, it's an instant crisis, right? when we have to pull in, you know, the big guns, right? But if the individual says, oh, no, it's not a crisis right now, but I need to figure out how I'm going to get my rent paid in the 13 days that I have before this eviction, right? There's different levels of it, and we have to allow our participants or the individuals we work with to really identify what that looks like. When we're talking about, you know, we want to promote safety, but again, crisis looks different for individuals. And so, you know, being available and having the door open with this nonjudgmental and compassionate engagement type of environment will allow participants to come and seek support independent of what that crisis looks like, right? It could be immediate or it could just be a referral source type of service. Now, we have engaged first. The community has different cultural strengths, resources, challenges, and needs. Harm reduction approaches, initiatives, programs, and services are grounded in the most impact and marginalized communities. It is important that meaningful engagement or shared decision-making begins in the design phase of programming, right? This is, again, speaking to the fact that harm reduction is more than just strategies, right? It's like organization-wide. Prioritize listening. Each community has its own unique story that can be foundation for harm reduction work. We talk about, and this goes with a previous one as well, engage first, right? When we think about harm reduction, right, I always, we cannot not think of cultural humility, right? We think about cultural competence. We're saying, yeah, we understand that people have differences. We're all really diverse and we can all play in the sandbox together. Whereas cultural humility puts this responsibility or onus on us providers to really lean in with curiosity and engage folks so they can voice their experience, right? So, they can speak their truth and tell their story for how they perceived it when they experienced it, right? And so, that also falls in with prioritized listening because that's leaning in with that curiosity of cultural humility. It's really what's going to give us the information of or synthesize the information of the individual's whole wellness, right? A lot of these behaviors, risky behaviors, are self-reported. And this is why I always emphasize how important the engagement and building rapport part of harm reduction conversation and engagement is because I just got distracted with the RCA question. The recovery coach academies, is that what you're saying, Edie? I think they, yeah, I think they touch on it. I'll have to go back and check it out how much it aligns. Thanks for bringing that up, Edie. Also, and then lastly, work towards systems change because, again, I reiterate, right, it's not just the strategies and the services. It's a systemic change that we strive for, right? Because it's also a social justice movement. It's not just an approach with services and strategies. All right. And so here I have the six pillars, which is the first one is led by people who use drugs and with lived experience of drug use. And the work is led by individuals. They have the lived experience. Harm reduction interventions that are evidence-based have been innovated and largely implemented by people with use disorder. I know here in Massachusetts, I recently learned of the history of harm reduction and how it was individuals who were actively, still actively using, who was spreading the news and a big part of the early movement of providing strategies, resources, and tools. Then we have the second pillar, embrace the inherent value of people because all individuals have the inherent value and are treated with dignity and respect and positive regard. And this is why harm reduction, another reason why harm reduction is so important because being a person who uses substances does not negate or take away your right for healthcare, right, for treatment services, for social services. And when we uplift harm reduction, then we uplift that equity, right, and justice that we are entitled to because of birth, right, humanity, to have access to these things, right, our human rights. And third, we have commits to deep community engagement and community building. I, over in Massachusetts, I work on a project, the Recovery Education Collaborative for supporting peer workforce development. And every year, I always try to lead, be part of, co-facilitate, like a refresh of harm reduction. And I focus a lot on engagement because the conditions aren't always right for an individual to seek treatment, right, like inpatient treatment. If we think about single moms who might have relocated or, you know, are, have fled from a DV situation, try recovery in another state because they were achieving sustained recovery where, you know, they were crying it out and have lost contact, right, or broke bridges, how we say, in the rooms and doesn't have a strong support network, but is a single mom and she would like to access detox, let's say, right, for alcohol, something severe like alcohol with severe physical symptoms, right? Who is she going to call for support to stay with her kids while she's in inpatient treatment, right? It's not like she could call the Department of Children and Families and say, hey, can you stay with my kids for 15, 14 days while I go to detox? No, they're going to be there for like 14 months, maybe 14 years, right? And so it's really important to understand that not everyone, not the conditions are right at the moment for some people to access treatment. And so when we create, you know, harm reduction engagements, right, to support meeting people where they're at, right, this mom would be where she would be at in this case, but how do we support her in still actively using, but reducing the harm to herself and some harm that some of that secondary harm that might impact the children, right? I hope this makes sense. Any thoughts, questions so far? And so many people will say that harm reduction lives in the pre-contemplation and contemplation stage of change, but I feel like it fits the whole stage, all the stages. It takes, it looks different, right? It takes shape differently in different stages, but engaging the community to really, one, help dismantle the stigma around harm reduction, right? Educate and inform folks of what the resources are out there and what strategies, what tools, what services, right, are out there to support minimizing the risk of use, the risk of not managing some mental health symptom presentation well, right, and the risk of physical health, all these other risks that I spoke about previously. Then we have, let me see here, I think we're at promotes equity rights and reparative social justice. This also looks different. I mean, I know some organizations do some community, I mean, some states do community organizing harm reduction work through like the policy stage. Some folks do harm reduction work with the individuals. Some folks do harm reduction work in communities, right? Maybe a recent, we have a harm reduction center here in Massachusetts that does harm reduction work with the LGBTQ plus community and even offer affirming services or gender affirming services in their harm reduction office, right? So it really looks different. It's kind of like, it takes the feel for the need of the community that mostly access it, but again, right, reiterating the value of harm reduction approach, taking shape differently for different needs or crises in the community. All right. Then we have offers most accessible and non-coercive support because all harm reduction services have the lowest requirement for access. Participation in services is always voluntary, confidential, self-defective, and free from threats, forced, and the concept of compliance. There is oftentimes data collected just to support, you know, maybe the funder or whatever of what, you know, the funds are being used for, but that data also helps support the fact that there's great value and reduces the risk to human life, right? And then lastly, in terms of the pillars, it focuses on any positive change as defined by the person, because all harm reduction services are driven by person-centered positive change in the individual's quality of life. Because if we think again, right, of the goal being health and wellness, any movement forward supporting the goal of health and wellness is a success. So just by showing up, that to me, I celebrate because you showed up for yourself. You didn't show up for me, you showed up for yourself, if that makes sense. And, you know, in terms of the pillars, I feel like harm reduction initiatives programs, services, they should include these elements and similarly include, you know, going back to the principles, right? Be able to see it in the organization that's offering harm reduction services, and the little departments are offering harm reduction services, centers offering harm reduction services. And so, like I previously shared, right, it looks different in different settings, but it happens at all levels of care. Very much so, Amy, and this is, MI is, I've been practicing MI for like nine years, and I feel like I always need a new training, right, just for that opportunity to build skills, because, right, you're thinking on the fly. But you're absolutely right, especially those core skills, right, those or skills of engagement through MI. I think that's the best approach when engaging with folks and also aligns with, you know, allowing the participant or the individual you're working with to lead, right? That's common in both harm reduction approach and MI engagements. But harm reduction, thanks for uplifting that, Amy. Harm reduction is part of comprehensive prevention strategies and the whole continuum of care through recovery. It has a place in and among all those different levels of care. As an approach, harm reduction emphasizes kindness and autonomy in the engagement of people who use drugs. It also increases the number of touch points and opportunities that peers and or service providers have with people who use drugs. Specifically, harm reduction services look different in every level at that continuum, and that is why it's valuable at each level in the settings they are practicing. Independent of the stage of change of individual, it is also important, right, because even through a maintenance stage, right, how are we going to reduce the risk that can impact your sustained recovery, right? Connect in practice at these different levels can look different, but for the most part, they connect individuals to overdose education, counseling, and referral to treatment for infectious diseases and substance use disorder, right? And that connection to treatment or referral to treatment can look like a spider web kind of referrals, right, when we think about infectious diseases and substance use and then all those other aspects of determinants of health. Distribute opioid overdose reversal medication. Educate communities and individuals, families, on the use of it, where to access it, right? Lessen harms associated with drug use and related behaviors that increase the risk of infectious diseases. Reduce infectious diseases as well. Transmission among people who use drugs, including those who inject drugs by equipping them with those sterile and or new supplies. Provide a space for returning new supplies. Reduce overdose deaths. Promote linkage to care. Facilitate co-locational services as part of a comprehensive integrated care approach. I know that in OTP, for example, there were many OTPs, at least where I'm from, that have like a day of the week where harm reduction services, you know, come in and present to some of their new clients. It's creating those relationships we were talking about previously, and they promote philosophy of hope and healing, which is the most important, right? Because during that active and chaotic use, like, we lose all hope, right? And we think this is something that we're destined or stuck with for the rest of our lives. But recovery is possible, and recovery is real. Like one of our friends, one of my colleagues, always screams out when we're out in the recovery activities. And harm reduction also helps build community, increase protective factors for people who use drugs and their families. I remember working in OTP and working with family members, right? Who will seek, and I remember, well, I remember, you know, because of HIPAA and non-disclosure, because I didn't have any consent, I would be like, well, if you have a family member who is going through this, a recommendation would be such and such, right? Connect them with this service, you know, connect them over here. And they would leave feeling like I supported, but not know whether that person I was working directly with them or not, right? And so engaging and supporting families through the, you know, with education and community engagement is also important, right? Because it'll dismantle some of those myths that we talked about in the beginning of the session. All right, where are we at here? Next slide. Oh, it's not moving for me, okay. So what does the data say, right? Harm reduction services saves lives. We know that's something that's, you know, been pretty from page-like for us for many years since the movement of harm reduction back in the HIV era, right? It does so by being available and accessible in a manner that emphasizes the need for humility and compassion for people who use substances. And there I go again with humility, right? Because even if we have lived experience and we've maintained a certain period of recovery through whatever pathway that might be, right? I cannot speak if as a Puerto Rican Latina that grew up and did her research in the north end of Springfield, my experience through my active use is not the same as another Latina Puerto Rican from the north end of Springfield, right? And so it's important for us to lean in and engage with folks with this humility of even though we both use the same substances, even though we both come from the same cultures, how was your experience, right? And this is where we're opening up this non-judgmental and compassionate space for folks to say, hey, listen, they make me feel good when I go meet with them and they hear me, right? They see me, they know my needs. And that comes from this humility of approaching and engaging with individuals with this, you know, them being the expert, I say subject matter experts of their own life, right? Oftentimes we meet with the people that we work with for 45 minutes, maybe an hour a week, every two weeks, maybe once a month. However, that relationship, that professional working relationship works, right? But they have to live their lives and they stick with themselves 24 seven. Nobody knows them better than they do, right? And so it's really important to lean into that humility that we don't know everything. And that curiosity to wanting to learn life through their eyes and their experiences, it's only going to- I'm sorry, Natalie, did you want to share? Oh, maybe not. I lost my train of thought. Support their engagement when, you know, individuals connect with you for, you know, some support. So what does that say? The first one, we'll look here at the CDC Sutter's dashboard, which is the State Unintentional Drug Overdose Report System. That's what Sutter stands for, the acronym for Sutter's. It's a reporting system and it captures the data for 2023, because like I shared, that is always like a year behind for like reporting purposes, making sure we get the final data and that kind of stuff. Anyhow, in 2023, Washington had a total of 25,000 deaths. Anyhow, in 2023, Washington had a total of 3,339 unintentional overdose deaths. What's the population of Washington? I think the last time I checked was almost 8,000 or something like that. Correct me if I'm wrong, anyone, please. Now keep that number in mind, 3,339 overdose deaths in 2023. All right, so our next slide here, keep it in mind, the total number of, oh, okay, let me turn my video off, make sure it sounds like I'm freezing. I hope it's better. Oh, nice, thanks, observer. I do, almost 8,000, I was right. So here, the Sutter's dashboard is letting us know, right, that there were 305 of the, can somebody remind me what the number was, of overdose deaths and unintentional overdose deaths in Washington? 3,339. All right, thank you. So 305 who were, of the 3,339 who were ever treated for substance use disorder or disorders, 178 were actively in treatment for substance use disorder, and 146 were prescribed medication for an opiate use disorder. Now, many know there is a high prevalence of co-occurring mental health disorders and substance use disorder. Let's look at these same metrics through the lens of mental health. Intended opiate deaths in Washington for the 2023 year, 841 of those had evidence in their medical record of having a mental health, for a mental health or a substance use disorder, or they did with mental health and or substance use disorder services, and, oh, I don't know what's going on. I mean, it says I have all my bars. I mean, it says I have all my bars. Does it sound any better now? Yeah, you're a lot more clear now. Oh, just keep me posted says spoken. I'm so sorry about that. Not today, Internet, not today. I did turn my camera off in hopes that it can get better. And 201 had a history of suicide ideation or self-harm in their medical records. This data affirms that the value of harm reduction throughout the continuum of care. I shared it looks different at every level, but important to consider it is led by the individual so it will look different anyway. This last data that we will review is the most impactful for me because it uplifts the value of harm reduction again and the value of peer work, right? And then. And here we wanted to show the CDC Sutter's data gives us a snapshot of the potential opportunity. Yes. Your screen is black. Oh, now we're back. OK, I think we're OK, maybe. Are we OK, can you guys see the right screen? Well, it says why reduction is important. Yes. Oh, I'm getting nervous now, what's going on? All right, I think we're good. OK, so the CDC Sutter's data gives us a snapshot of the potential opportunities providers had for intervening to prevent overdose of the 3,339, although not the whole 3,339, but missed opportunities with 1,950 of those individuals that make up the 3,339. It also says that there were potentially 1,236 bystanders were present, 322 of them had prior overdose, upwards 800 had an evidence of a mental health diagnosis, right? Again, fortifying that correlation between substance use and mental health, for which both have come with their own difficulties, but both also have their own harm reduction strategies to support and minimizing the risk. Harm reduction plays a significant role in preventing drug-related deaths and harm from mental health and increasing access to health care, social services and treatment, and there's nothing like it. The way it aligns with many models of care through the lens of medical model and even the behavioral health continuum of care model. Can you hear me and see me OK? Can hear you, but we can't see you. Oh, yeah, my camera's off, but you can still see the slides. Yes, OK. I'm a little nervous now. So just a reminder, you know, SSP, the acronym is a Syringe Service Program. And this data was gathered from CDC's prevention researchers of their 30 years of collecting and synthesizing data from syringe service programs. The dates for this research is from a while back, but it's still pretty prevalent. There is another fact studies show that. SSPs save lives by lowering the likelihood of deaths from overdose, providing testing, counseling and sterile injection supplies helps prevent outbreaks of other diseases. For example, SSPs are associated with 50 percent decline in the risk of HIV transmission. Users of SSP were three times more likely to stop injection drugs. Even law enforcement benefit from reduced risk of needle sticks, no increase in crime and the ability to save lives by preventing overdoses. When two similar cities were compared, the one with syringe service programs had 86 percent fewer syringes in places like parks and sidewalks. So that just shows, you know, 30 years of research. And it's this data is from a while back, right, how even the community benefits from harm reduction. So faith and spirituality play a significant role in addiction recovery. It offers a framework for emotional well-being, connection and meaning, enhancing resilience against challenges encountered during recovery and alleviating feelings of isolation and despair. Addiction and spirituality are mysteriously intertwined. There's a wide shared view that spirituality is central to understanding and overcoming addiction, coupled by faith, of course, and individuals in addiction treatment frequently cite spirituality, faith as a helpful influence during recovery. I obtained this quote from Reverend Erica Pellett, who is part of Faith in Harm Reduction, and she says, we are in crisis when whole people created in the image of the most divine are redacted and fractured, reduced to behaviors and pathologies, the humanized. Right. And harm reduction stands against that part of, you know, looking at folks because of behavior. Right. It's looking beyond the behavior and looking at the human experiencing those behaviors. Faith in Harm Reduction believes in affirming and celebrating the divine and the sacred in people vulnerable to structural violence and beautifully that beautifully aligns with principles of harm reduction. And that affirmation is not symbolic, but necessitates a material and political response because, again, like I shared, right, it's not just about the individual. It's about systems and communities to support the reduction of risk. Right. And enough. We must respond to their actual needs, support their agency and work for systemic justice that will alleviate suffering and provide access to means of pursuing physical, mental, emotional, spiritual wellness to those who have been denied of that freedom. So a quick review of how some of the principles of harm reduction align with the principles of faith in harm reduction, harm reduction is centered, right, because it recognizes the individual as the human, not just the behavior. Right. It challenges stigma, seeks to eradicate the stigmatization of people with lived and living experience of substance use disorder and even, you know, the risk of engaging in sex work, evidence based, understands substance use as a complex phenomenon and compassing a continuum of behaviors for which they promote reality based and cultural competent drug education and support scientific strategy for reducing health risk. Right. And it's also associated not just with substance use. Right. But with, you know, some of the risks associated with engaging in sex work, some of the risks associated with the physical health risk from using substances and or the potential risk from experiencing, you know, severe mental health that can lead to a crisis level like ideation and or self harm. Oh, we're at intersectional justice rooted, understands that poverty, class, racism, trauma, sex and gender based discrimination and other social inequity affects people's vulnerability to drug related harm. And those intersections, too, as well, right, important to highlight. It's led by people who use drugs, people who engage in sex work, centers the dignity, humanity and wisdom of people who use drugs, people who and people who engage in sex work and amplifies their voices and leadership to achieve healing and social justice. Also, respect multiple pathways of healing, acknowledges that healing encompasses an individual's whole life, including mind, body, spirit and community of value, self-determination and supports people in crafting their own unique path to positive change. And lastly, theologically based. For me, when we talk about theologically based. It's kind of, you know, validating everyone's faith to help increase hope for what their experiences in or for what they haven't experienced yet or for what they've overcome and. And resist submitting what we believe is right in recovery for others, right, and that it should be individual based. So far, any thoughts, questions, I feel like I'm. OK, so people who use drugs and people who engage in sex work are sacred, inherit. And these are some of the beliefs that come from that correlation or how, you know, faith principles and harm reduction principles kind of align. People who use drugs and are people who engage in sex work are sacred, inherently beloved. Their lives are sacred and are always worth saving and celebrating because, again, we're looking at the human being, right, the human, the spiritual being having that human experience and engaging or dealing with the ramifications of active use and the body driven wisdom, right, as individuals and have the inherent right to pursue, you know, health and happiness. Thanks, Lena. Then, oh, then we have interfaith and which. As a reminder, right, the individual, what your faith or religious traditions are, spirituality brings us together through harm reduction and faith to remind us of the importance of each other and the intersections we find that supports our recovery in that recovery community. You'll find others that also connect with that, that supports their recovery, even if you might have different spiritual beliefs or religious beliefs, right, that that space of interfaith, right, everyone's welcome. Free will, people who use drugs deserve more choices, not fewer. Free will and agency are gifts to be supported. Prayer and action, prayers are vital, but prayers without spirit of harm reduction. It's only emphasized, only emphasizes that faith and hope that we have in our journey, right, independent of whether we're in the beginning of the journey, months in or years in, right. People first. Also, people come first. Harm reduction embodies compassion, dignity and justice for the human being. Love and law, loving people is more important than purity codes or civil laws. The highest law is love. I remember when I was during my own active and chaotic use. I remember my grandparents would argue because my grandma would say that she was applying tough love to my support and my grandpa will tell her love is love. There's just it can't be tough and love at the same time. Love is love. And they were arguing about that. Right. But. It was in them holding me accountable that I was able to hold myself accountable in support of my recovery, if that makes sense, right. Because at the end of the day, I would break all civil laws just to get what I needed at that moment so that I didn't feel withdrawal symptoms. Right. But behind it all, I was just a human being in suffering, right, if that makes sense. And you might have people who have this punitive response to people who engage in risky behaviors to obtain and meet the need of not feeling these withdrawal symptoms. But then you have. The group of people who, independent of what you've done, they still provide that knowledge, that nonjudgmental, compassionate space for you to come in and feel the love, the hope of a life and recovery and whatever it looks like for you. Also, community partners come together and organize to build strong relational bonds and reach out in unity. You know, when we think about recovery community, right, and how I've been really intentional about my recovery community reflecting the different components of recovery capital, right, and my probation officer and my case manager from reentry are still part of my recovery support network. Right. Because community is so important, both the community that's seen you through active and supported you through active and chaotic use and those that are supporting you in. You know, after getting some good time under your belt in a sustained recovery program, right, and they become partners in your success as harm, as we engage in harm reduction. Relationships and conversations with the people that we serve, we become part of that community as well for that individual, and we also serve as a tie to connect different folks from our recovery communities and networks with additional folks in support of the same goal, right, health and wellness. And then lastly, liberation, work towards liberation from oppressive systems, love each other where we are and co-create a new future. And if that doesn't embody. What faith is in humanity, right, through a spiritual lens, not just a religious lens and the principles and approach of harm reduction, it's. It's probably the perfect word to describe that relationship between both. Any thoughts, questions? I did want to share, I was just this had me thinking about something that I've heard in recovery settings that I've been in before as a participant, which is that religion is for people that are afraid to go to hell, whereas spirituality is for people that have already been there. I love that. Can you put that in chat? I got to copy that. That's going to be a teacher's T-shirt phrase. Yeah. And I'm going to wear the church too. Kevin shouting you out. Um. So. This is my favorite definition of recovery. Because I feel like. But we'll talk about it, but SAMHSA's working definition of recovery, a process of change through which individuals improve their health and wellness, live a self-directed life and strive to reach their full potential. What stands out for you all in SAMHSA's definition? Can you repeat that question, please? I'm sorry. Absolutely. And we're looking at the definition of SAMHSA's working definition of recovery. What stands out for you all from the SAMHSA definition? It's client led. Self-directed. It's emphasizing process, not product or where you're where you'll end up, but how you get there. Right. I love that. Somebody just share something along those lines of it doesn't give you like this complete or finished feel. Right. It's a process, a journey. Thank you, Amy. Then we have the word improve. Right. It lines up with any progress forward. Right. And. Self-directed, living a self-directed life, that's a big one. You know what stands out for me is the SAMHSA definition of recovery does not include absence. It does not include mental health recovery from mental health recovery of substance use. Right. Doesn't speak of none of that. And I agree with that. And I also align with a lot of those folks of you that have focus on health and wellness, not abstinence, and that makes it achievable, makes it feel like it's achievable for me. Right. Without limits. I love this. Yes. And this is a great question. I'm going to read it. I'm going to read it. Yes. Yes. And this is why, you know, that focus health and wellness. Right, it's not just saying abstinence, right? I mean, because at the end of the day, the definition is looking at it like a reduction in harm and an increase in wellness. Essentially, right. And it's self-directed and I absolutely love it. And so remember, recovery is unique to every person. Harm reduction is unique to each person. We don't get to decide what that looks like for someone. And we only get to offer support and share guidance as wanted and needed. So when we think about harm reduction strategies, I want to start with engagement and strategies. Best practices, recommendations suggest that a variety of delivery models, especially for distribution of harm reduction supplies, may be working complement to one another and are not mutually exclusive. Implementation of a wide spectrum of delivery models can contribute to minimizing drug-related harms, as well as meet a number of the core principles of harm reduction and trauma-informed care or practice, which we'll get into. But let's look at engagement strategies first, right? Ensure individuals come first. This has been kind of like a repetitive message. Meet an individual's needs, reducing the spread of infection. Care for our community, right? Sharing information and educating individuals. Because it also helps dismantle stigma. Place importance on the health of people with the use disorder. And respect is a two-way street. And let's tap into our friend here, Makayla. Let's learn a little bit about Makayla's story. So Makayla is a 28-year-old woman who has been using opioids for more than 10 years now. She was kicked out of her family's house nine years ago and has been on the streets off and on since then. She couch surfaced when she can and stays in shelters when it's freezing out. She gets locked up from time to time for shoplifting and possession, average of two times a year. But she shrugs it off and says it's three hots and a cop. She gets tested for HIV and HCV when someone offers. Three months ago was the last time and her results were negative. She has a boyfriend, Johnny, who she's been with for years. For a year, I'm sorry. He is 34, also homeless, and uses heroin. Johnny doesn't have HIV, as far as she knows, but does have hep C. She has unprotected sex with Johnny and occasionally with Rob, her high school sweetheart. He's a successful businessman, but he is married with a child. They meet at nearby motels, and she states it feels like making love because he's gentle and caring. But she always feels horrible afterwards because she knows he goes back to his wife and nice life while she returns to the street. She states, she states, I just want to reiterate that, she states she has tremendous shame for ending up a active user. Apologies for that term there. This is what she states. So what stage of change would you all think that Mykaela might be resting in? Any thoughts? Anyone want to take a guess? Shame? Stage of change. Oh, stage of change. Sorry. Pre-contemplation? As in pre-contemplation. Right on. Okay, so we're all on the same wavelength, we're thinking the same thing. What successive or protective factors could we celebrate or affirm her on? What is she doing right already? She's getting tested when someone offered. Wonderful. Yes, Samuel. Right on. Ooh, going to shelter, right? When it's freezing. You know what my grandma used to do? She used to open... You know how there's... Dear Lord, my grandma was troubled. You know how there's certain bank ATMs that are, like, you have to pop the door, it's not connected to a bank, it's like in a dry parking lot or something, and you have to use your car to open it for folks? My grandma would let folks... Like, she'll use her car to open her bank's little ATM hut door and let folks sleep in there. Meeting at hotels. Okay. What seems like it would be motivating for her to, you know, seek some additional services? Yeah, grandma was pretty awesome. I know it would be motivating for me if I had a universal basic income because then I wouldn't have to, like, do, you know, survival theft, like shoplifting to get my needs met. So there's a little mix of motivating factors and maybe some harm reduction strategies that we may offer her, right? Sharing access to meals without jail time, seeing the sweetheart leave and, you know, the high school sweetheart and kind of love the life that he has can kind of motivate and inspire her to make positive choices and be able to be stable, right? Going into a shelter instead of being homeless, right? Any other harm reduction strategies any of you would recommend to Makayla? Actually, I have a question kind of related to some of the advice that you typically get in, like, recovery settings, which is trying to find exterior or external motivation, like maybe Johnny's the, oh, Rob, like Rob divorcing his wife to be with Makayla. Rob divorcing his wife to be with Makayla. Isn't that the wrong motivation, right? Like they say you want to find internal motivation. Am I off base there? No, not at all. I mean, I think a little bit of both. Okay. Our decision making, right? Sure. God willing, it's always, it could always, we could always rely on that intrinsic motivation, right? Internal motivations that, you know, a resilience and determination and that kind of thing, right? Where externally could be, who knows? What's this intervention that's so, I feel like it's radical because nobody wants to do it, but contingency management, right? If you, I don't know, if you want to be in this housing program, you have to be in medication supported recovery or something, right? But just knowing what's out there and being able to inform Makayla so she can make an informed decision slowly, but surely can move her forward and increase either of her motivations, right? But I know a lot of people sideway look at contingency management, right? Because some folks believe that individuals shouldn't get paid to engage in treatment. But I, you know what I say? Whatever it takes, right? Because if we're looking at reducing the harm and supporting health and wellness, if, and this is the program I started and they done messed up at school when they talked to me about contingency management. When I was in OTP, I had this little cabinet, right? And I remember having people from my church, my friends in my recovery network, like give me things like body sprays, this detergent, laundry detergent. And then I remember buying this fake money from Amazon and with a marker, super ghetto and probably unprofessional. It said recovery bucks. And every time like the participant would do their required OTP group or they met with their recovery coach or their counselor, they went to a doctor's appointment. They went to a special appointment, everything, every service, the engagement, and they got these recovery bucks. And then at the end of the month, the last Friday of the month, they will be able to go on my cabinet. And there'll be things from lollipops to tampons, to socks, you know, laundry, all types of things. And people just had the freedom to go in there and purchase things with their recovery bucks from my cabinet. Right? And so whatever strategy we can develop to support and encourage folks, right, to engage in anything that can reduce the harm of some of the risky behaviors they engage in, whatever it takes. Of course I'll ask permission and then try to negotiate like an attorney, you know, for my supervisor. But oftentimes when it comes to supporting recovery and reducing harm, it often works. I think I have a good, I always got a good debatable argument when it comes to reducing the harm, you know, and engaging folks in treatment. So we'll look at here some service delivery models. The county uses during the PIT count to increase engagement. See, and the contingency management looks different. You know, employers do it. Behavioral health doesn't do it as much, but it is, there is enough data out there to support, especially with individuals with substance use. It's like an innovative intervention. I mean, if we think about OTP and I'm sorry that I keep going back to OTP, opioid treatment programs, the take home model, right? You got to earn it. So it's contingency management right there where you can meet the criteria for a take home. And then you get to get bottles at home and you don't have to come in for your dose, right? That's contingency management. And so it's being innovative, creative, right? It's trying to find ways for individuals and wherever they're at in their journey to be able to apply strategies and engage in things to support, reduce that harm in any aspect of, you know, I know that we're focused on opioid use, but in any aspect of their social determinants of health to help reduce the harms of that. So some service delivery models of harm reduction are supply, distribution and recovery programs, outreach strategies. Now, outreach harm reduction specialists, they're like the Robin Hood of, you know, harm reduction because they're, when we talk about trenches, they're in the trenches, right? They do delivery work. They do cleanup work. It's just amazing the work that they do. And also another service delivery model is overdose prevention strategies like take home naloxone. You can get them at the pharmacy now. Interestingly enough, and this is probably stigma, and this is just a daisyism, right? It's not a reflection of C4. The take home naloxone, like when you go in the pharmacy, this is a daisyism. Again, that's my disclaimer. I've always wondered if, you know, how many states have the PMP program where providers get to monitor prescriptions and they have to put in certain prescriptions. If I was to go to the pharmacy and say that I need a naloxone because we have the ability to do that in many states, does that mean that in my record, it's going to show that I seek naloxone services, right? Or medication, and that I might be actively using, you know what I mean? Because nobody ever knows who's monitoring these systems or what their moral view is of substance use and infectious diseases. Oh, I love this, Rose. Thank you so much for adding this. You're absolutely right. And many religions are also creating models of peer work for peer workers in the religious space, right? Based on their traditions and their services and all that stuff, which, I mean, even here in Massachusetts, there's a Muslim community we work closely with who has a peer recovery cafe network attached to their mosque, right? And that's innovation because historically, you know, individuals in said religion have their own views of what recovery and substance use are, right? And so to see this nowadays, that's intrinsic motivation in itself, right? For us providers to see this movement and inclusion of some of the harm reduction principles, you know, in our society. And so, you know, there's a lot of principles and values in, you know, many religions looking at it and contemplating, right, the value of it for humanity. Medication therapy, that's medication for substance use disorder. It could be, you know, opiate use disorder medication. It could be medication for stimulant. There's not too much research and too much access out there, but they're coming along. And then we have housing first, that although we don't think, you know, we think, well, that's not harm reduction, that's more than harm reduction, right? I don't know, but working in a clinical space, I've always said the individuals that I'm working with who are experiencing homelessness, they can't remember, they don't care about nothing we talked about or practiced behind the clinical doors, because when they leave the office, the first thing they're thinking about is, where am I going to sleep, where I'm going to shower, what I'm going to eat, right? And so housing first, especially with, you know, the concept of, you know, low threshold and the different levels of threshold housing that's offered out there. If an individual has housing, that's half the battle right there, right? And definitely, Christine, right? Starting off and meeting, supporting the reduction of harm to any other basic needs, that right there, it's a catalyst, right? Because once we support those basic needs, then everything else will start falling in place. And supervised consumption, and supervised consumption services, despite having decades of data of the value of supervised consumption services here in the U.S., we're a little slow in that movement, right? But we're chugging along. But that's also, you know, a resource for supporting individuals in, you know, accessing some of these low threshold services provided by harm reduction model. Excuse me. Yes, Brock. I just had that argument. I have a family member who owns, like, a bar grill. And I just had this argument with him, too. And he's even, because of myself and other family members that are always at his neck, he's implemented some strategies. He calls them strategies. I think it's a great initiative where he closes the bar at 12 o'clock but leaves the kitchen open until 4 o'clock so folks could just hang out and drink regular fluid, you know, soda, juice, and stuff like that, virgin drinks, and eat. So it could kind of, you know, reduce the level of sobriety. And it all started because of the conversation that we had on bars being safe consumption sites for people who use alcohol. He thought I was special, but I won the argument. Go ahead, Brock. Yeah, I was just going to say, like, the first time I heard that comparison, I was like, oh, yeah. And you could even argue that safe injection sites are better for the community because their bottom line is just public health, whereas a bar's bottom line is profit, right? To Sam's point, like bars encourage use, despite the fact that, like, according to the law, you're not supposed to get anyone drunk at a bar, which is doesn't make any sense because that's the whole point of it. Right. But yeah, I think it's a great correlation. I love it, too. Yes. And when you bring that up to folks, they often like have this perplexed look like, wait, what do you mean? Well, right. But it's true. That's true. So when we look at strategies, we can group them right through different lenses. Right. When we think of strategies and offering supplies to reduce risk, right. Like safe injection supplies and that could be new needles, you know, clean cotton, because folks, you know, rubbing the cotton in their hand can transport all those chemicals or or infections or whatever, bacteria, whatever they have in their fingers into the cotton. And so, you know, it makes for a real mess. So offering, you know, some new equipment for injection use to Sharpe's disposal, many organizations that I know that service the population of people who actively use have, you know, those light alarms in their or movement alarms in their bathrooms. They have sharp containers in their bathrooms. I even know a shopping centers now that have sharps containers in their bathrooms, safer smoking supplies, both for. Smokers of crack, cocaine and even cigarette in terms of strategies to support reducing the harm of cigarette smoking, especially for the youth. Safer sex supplies, wound care supplies now with the mix of fentanyl and xylazine. Right. This is an important resource to share where individuals on Naloxone prep and distribution. And this is mostly done in collaboration with like medical providers. Right. Unless the harm reduction center is connected to a hospital where they will have a provider who will, you know, give access to PrEP and PrEP. And then in terms of services, right, general information of the risk of engaging in high risk behaviors, referrals to services. Oh, I did that twice. I was so excited. I put it on there twice. Navigate services, care coordination. Oftentimes, you know, we talk about harm reduction being led by people, you know, with lived experience, be it substance use, be it mental health or even engaging in sex work. Right. Because individuals have navigated the craziness of navigating of health care, behavioral health services system. Right. So that that care coordination will come natural. And it's it just makes for. It just makes for. Easier transition and. Engagement with some of these services, housing first, so can I continue to uplift housing first, meet individuals where they are at in terms of their journey and not just a physical space, encouraging safer injection use or a safer use period. I mean, because even if it's not infection use, right, I'm going to educate my individuals that snort. Right. Make sure you crush. Do you need some equipment to make sure everything is crushed and not chunky? Right. So that it reduces any risk to your nasal. I don't even know what they're called. You know, your nose internally and low threshold services. Right. And membrane. I don't know either. Low threshold services. Right. Because we want to minimize, like, let's say to the lens of navigating and supporting care coordination. If I know that this organization only takes this insurance and this service is no longer offered, but you need to meet this criteria. Right. By offering all that services, all that information right through general education, that we can help reduce some of the barriers and connecting to some of the services. Right. But, I mean, of course, engaging in services that have low threshold access because our individuals are not always going to have their IDs or individuals are not always going to remember who their PCP is. If they have one, have they been engaged? You know, those kind of things that can create barriers to services. All right. Let's see here. I got 10 minutes. So, some of the strategies when we look at it, again, to the lens of strategy or supplies and services, we think a lot about injection use. Right. We think about reducing the risk of engaging in sex work, reducing the risk of infectious diseases. But strategies also apply to alcohol consumption. Right. Especially with certain populations is more prevalent than others. But understanding that there are strategies to minimize the risk of alcohol consumption. Self-harm. Right. Harm reduction strategies for self-harm look really different. If I'm a cutter, I've been offered, I can offer, you know, rubber bands or other strategies to reduce the harm of butter knife versus a regular knife. Right. Overeating. Harm reduction strategies for overeating. Right. And or eating healthy. So, it can look different. Again, just want to reiterate. Right. We're focused on the opiate use. Right. But again, harm reduction in action fits anything of our day to day. And it's for more than just substance use and risky behaviors around engaging in sex work. And that's what my mission is to normalize. Like, we practice harm reduction on a daily basis. And so, harm reduction messaging and communication versus first language should be used when speaking to and about people with a substance use condition to ensure the person remains at the center of the conversation, not the condition. Right. We're not looking at the behavior. Right. We're looking at the human being. Be thoughtful about the language you use that may label someone. Avoiding words such as addict, clean or dirty, and substance abuser. Create an open and non-judgmental environment. Active listening is crucial. Focus on safety and well-being. Trust and empathy is essential. Encourage open dialogue. Hopping open and collaborative conversations is important. They lead the conversation because, again, some of these behaviors are only known if self-reported. And when we create these non-judgmental, compassionate spaces, we create the trust and engage with folks through empathy, then they'll be more comfortable and trustworthy in sharing some of these behaviors that might propose a risk in their life. Okay, it's not moving now. Now, so the relationship between harm reduction, trauma-informed, and person-centered, it just appears, right, that they pretty much align, right, the principles of trauma-informed care, person-centered care, and, of course, harm reduction. But there's also the impact of mental health and well-being that harm reduction has, right, because it promotes the philosophy of hope and healing, reduces stigma associated with substance use and co-occurring disorders, supports change, that motivational support includes but not limited to really affirming a person's decision, right, as the expert in their life, engaging through a lens of equity and empathy, I mean, and consistent positive regards, celebrating those small achievements that's going to lead to that overall health and wellness goals, right, and that might change, right. Your individual you're working with might reach their health and wellness goal, and so now they develop new health and wellness goals, right, and that's okay. That's what we expect. Also, exploring reasons for change. It's part of some of that motivational support. Connect with individuals to overdose education, counseling, and referral to treatment for infectious diseases, and, of course, substance use disorder, and build community and increase protective factors for people who use drugs and their families. Overall, harm reduction emphasizes engaging directly with people who use drugs to prevent overdose and infectious diseases transmission and improves physical, mental, and social well-being, and I can't emphasize enough, like, I could repeat that, do a little, you know, a cartoon about it, put it in, you know, flashing lights because it's so important to remember that harm reduction improves physical, mental, and social well-being, right, because at the end of the day, it's also the use is harmful, right, and it causes risk, but all these different areas, right, to improve on physical, mental, and social well-being, they're intersections. If one is off, it's going to be impacted, right, like when you have a bad knee and you lean on the good knee because the bad knee is sore, and then you find that your bad knee is getting messed up or your good knee is getting as messed up as your bad knee because you're relying on it too much, you know, it's a similar concept. Harm reduction is a practical and transformative approach that incorporates community-driven public health strategies, and it has to be community-driven, right, because there's different needs in different communities, right, like I was talking about the gender-affirming care at one of the harm reduction centers in one of our towns near towns here in Massachusetts that has a high LGBTQ plus population, so it's fitting, right, that they would have gender-affirming services in that harm reduction, right, because those are the needs of that community, so it's going to look different for everyone, the communities as well, and harm reduction works by addressing broader health and social issues, right, because it's not just one thing. There's too many intersectionalities. We have about five minutes. Oh, thank you. I have two slides. Nice. Okay, so trauma-informed care. I'll try to fly through it. When engaging in peer interactions, understand there's a common connection between substance use and trauma. People may exhibit a range of responses to a certain situation. People who have experienced trauma experience difficulty forming trusting relationships. It takes time. Disclosure of trauma is not required. Treat all individuals in a way that creates safety and understanding, regardless of whether or not they disclose trauma as part of their history. Recognize when someone might be responsible or responding to the effects of their trauma, and practicing in a trauma-informed way requires a shift in thinking and language. And harm reduction services align with trauma-informed practices in that they provide ways that recognize the need for physical and emotional safety, as well as choice and control and decision-affecting one's treatment and recovery process. And then harm reduction interventions can create an environment that promotes patient-centered care for people using psychoactive substances. A harm reduction approach reorients the care to acknowledge each patient's symptoms and needs and ensure that their personhood takes priority. This includes providing harm reduction services and supplies. The harm reduction approach is based on a foundation of person-centered and family-centered care. With respect and dignity, listen to and honor patients with family perspectives and choices. Incorporate patient and family knowledge, values, beliefs, and cultural background into planning and delivery of care. Informing, information sharing, communicate, and share complete, unbiased information with patients and families in ways that are positive and useful. Give patients and families timely, complete, and accurate information to support their decision-making. Partner participation. We encourage patients and families to participate in care and decision-making at the level they choose. And then lastly, collaboration as a component for person-centered care is to include patients and family on an institution-wide basis. Healthcare leaders collaborate with patients and families on policy and program development. Healthcare facilities design professional education and delivery of care. At minimum, a suggestion box and ensuring that our voice is lifted through these suggestion boxes. Person-centered care requires an intentional partnership at three levels, consultation, services, and symptoms, where the consultant is the individual sharing the decision-making as a subject matter expert of themselves with service providers and systems collaborating to provide access to the services that support the individual's health and wellness. Person-centered planning is a way to learn about the choices and interests that make up a person's idea of a good life, right, what their health and wellness looks like, and if we allow them to lead that process of person-centered planning as well, it just facilitates the work and increases buy-in from the participant.

Opioid Response Network

harm reduction

SAMHSA

substance use disorder

mental health

trauma

public health

syringe service programs

overdose prevention

community safety

recovery

autonomy

trauma-informed

faith

systemic justice