Harm Reduction Insights from “Bevel Up” Screenings

On Tuesday, October 26^th, and Thursday, October 28^th, The Center for Health Media and Policy hosted two events with Vancouver Street Nurses, Fiona Gold and Jaunita Maginley.  Both evenings began with a screening of their educational documentary entitled, “Bevel Up: Drugs, Users, and Outreach Nursing”, and was followed by a question and answer session with Ms. Gold and Ms. Maginley.  Below are some interesting questions and comments raised during the question and answer sessions after screenings.

From the October 26^th Event at Hunter College, moderated by Dr. Jessie Daniels (CHMP Senior Fellow and Associate Professor of Urban Public Health at Hunter College), and the October 28^th event at New York Academy of Medicine’s Ninth International Conference on Urban Health:

In the film, a Street Nurse asks Becky to step outside of the van to inject her heroin.  Why is this?

From Ms. Gold and Ms. Maginley: The supervised injection site in Vancouver is new and still highly contested, so it was important to the Street Nurses that they not undermine the work being done there by allowing supervised injection in the Street Nurses’ Van.  Ms. Maginley said, “Good care and smart politics go hand in hand,” and Ms. Gold said, “We don’t want to seem like renegade nurses.”

With the complexity of care involved with Street Nursing, how has the program been organized to handle this?

From Ms. Gold and Ms. Maginley:  Key to keep in mind is the saying that came from the HIV/AIDS movement, “Don’t make plans about us, without us” (Ms. Maginley).   Listening to the needs of the people being served is the most important factor in providing good care.  This allows the program to better connect people to housing, clinics, detoxification programs and mental health services.

What have you seen come out of widespread distribution of the film?

From Ms. Gold and Ms. Maginley: The film has been even more than just an instructional tool, but also a way to create dialogue about difficult questions regarding needs of an area where those who are watching it are.  Masha Golovanevskaya from the Open Society Foundations New York was present, and was asked to share her experiences of working with nurses and public health organizations in Russia and the Ukraine.   She said “Bevel Up” has been included as part of a harm reduction curriculum in many harm reduction programs throughout the Ukraine and Russia.  Not only has it helped to promote effective harm reduction strategies, but it has also helped empower nurses to help those suffering from addiction.

Comments on Frankfurt’s success with their supervised injection sites

From Ms. Gold and Ms. Maginley: Ms. Gold had recently visited a supervised injection site in Frankfurt, and spoke about the “continuum of care” those living with addiction are able to receive there.  In the same building, in addition to supervised injection rooms, there is housing available, a needle exchange program, as well as a detoxification program¹.

There was also discussion on applications of harm reduction to the U.S., including California’s Proposition 19 (decriminalization of marijuana)

 

From Ms. Gold and Ms. Maginley: In 2001 Portugal abolished all criminal penalties for possession of drugs including marijuana, cocaine, heroin and methamphetamine.  The new policy has shown significant successes in public health².

Notes:

¹The Frankfurt program has been found to significantly reduce the number of homeless drug users, incidents of drug-related crime and violence, and drug-related deaths (source: Kemmesies, U.E. (1999). The open drug scene and the safe injection room offers in Frankfurt and Main 1995. Final report. Hamburg, Germany: European Cities on Drug Policy.)

²A report on the new policy 5 years later showed positive results, as the deaths from overdoses went from 400 to 290 annually since 2000, and the number of new HIV cases caused by dirty needles to inject heroin went from 1,400 in 2000 to 400 in 2006.

Jen Busse, RN, MPH is an intern for CHMP and is currently working toward her MSN as a family nurse practitioner

[caption id="attachment_10664" align="alignleft" width="276"] "Bevel Up: Drugs,

Doonsbury Cartoon and Harm Reduction

CHMP’s Media Policy and Harm Reduction Panel a Huge Success: Recap #2, Policy, Health Care and Harm Reduction

At the Center for Health Media and Policy’s inaugural event Monday night, “Media, Policy and Harm Reduction”, a number of experts were brought together to discuss harm reduction issues in media, policy and practice. CHMP’s visiting scholars, Juanita Maginley and Fiona Gold, from the Vancouver Street Nurses joined fellow panelists Dr. Daliah Heller, Assistant Commissioner, Bureau of Alcohol, Drug Use Prevention, Care and Treatment for New York City; Dr. Chinazo Cunningham, a physician practicing at a community health care center with a needle exchange program in the Bronx; Allen Kwabena Frimpong of the Harm Reduction Coalition in New York, an advocate with extensive background in international issues of harm reduction, especially among youth; and Maxine King, outreach coordinator for WORTH (Women On The Rise Telling Her Story), a substance abuse counselor and social worker who has experienced the health care system both as an addict and as a healer.

There were a number of key themes discussed throughout the evening. The last blog post was about the importance of humanizing people living with drug use in the media, as discussed by the panel.  This post concerns the health care system and policy issues surrounding harm reduction and health care access.

This topic of discussion began after Ms. Maginley showed a 12-minute clip from the award-winning documentary “Bevel Up; Drugs, Users and Outreach Nursing,” which chronicles the Vancouver Street Nurses as they care for patients facing a variety of complex issues on the streets.  The Vancouver Street Nurses perform patient assessments, care for minor injuries, and administer medications, such as antibiotics.  Importantly, the Street Nurses provide a connection between their patients and other resources, such as community health centers, housing, detoxification programs, and mental health services.

In stark contrast to the training the Street Nurses of Vancouver receive on harm reduction, Dr. Cunningham provided insight into her own experiences as a medical student.  She said that throughout medical school and her residency she had only an hour of education on drug addiction; the material covered being the basic physiology of drug addiction, including how neurotransmitters work in the brain.  This is a similar problem throughout most nursing and medical schools in the U.S., she said.

While providers are not trained on how to have conversations about drug use and addiction, neither, she says, are the drug users, themselves.  With considerable social pressure to use the line: “I just want to quit using drugs,” this becomes the standard interaction between people who use drugs and any clinician they encounter.  There is, in turn, little meaning or thought behind this.  Programs, such as the Street Nurses, are exemplary in educating both health care providers and patients about how to have constructive conversations regarding drug use.

Dr. Heller made the point that use of Suboxone, a medication taken sublingually by a patient and used in place of methadone, would allow a primary care provider to prescribe this for patients, and then closely follow them and their physical health.  Through enabling all providers to prescribe Suboxone for patients, drug users are provided with greater support, flexibility, and likely adherence to the regimen than could be possible in a methadone maintenance program.  Dr. Heller also made the point that if drug use were thought of more as a medical issue this may also help to decrease stigma and encourage expansion of harm reduction programs, and therefore health, in drug users.

Ms. King concurred with the issue Dr. Heller raised about stigma.  She relayed a story of being pregnant, drug addicted, and then treated horribly at an appointment for her first prenatal check-up.  She said she “never went back” until she was in labor.  Upon entering the hospital she was isolated in a room by herself.  Again, she said she was made to feel like a kind of social “pariah”.  The overarching theme here is that federal, state, city, university, and hospital policies around drug addiction create an environment preventing people who need care from receiving care.  The overwhelming consensus of the panel and audience, alike was that we must increase the number of drug addicted persons who are linked to the care that they so desperately need by making changes in outdated, misinformed, and irresponsible policies.

Jen Busse, RN, MPH is an intern for CHMP and is currently working toward her MSN as a family nurse practitioner

[caption id="attachment_10685" align="alignleft" width="300"] Fiona Gold and