MAT: Harm reduction: principles and practice

Session #8
May 12th, 2021

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Welcome
Please write your name, role and organization
in the chat box.

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 A collaboration with:

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 10 Collaborative Sessions
10/14/2020 Trauma Informed care-foundations, integration into clinic culture, patient centered care,
treatment documents
11/11/2020 Fundamentals of MAT - Introduction and overview of MAT

12/9/2020 Identifying staff roles and responsibilities: Prescriber, RN, pharmacist, behavioral health, CADC,
peer, case manager, panel manager, introduction
1/13/2021 MAT and SUD: Review of current best practices around prescribing MAT in the presence of other
substance use
2/10/2021 Staffing models: Clinical coverage, leveraging team-based care, sustainability
3/10/2021 Intersection of persistent pain, OUD and buprenorphine
4/14/2021 Policies and procedures, workflows, EHR tools
7/14/2021 Culturally sensitive and responsive services and care
6/9/2021 Pregnancy- best practices for OUD; in pregnant population, including DHS reporting and
Prevention
5/12/2021 Harm reduction in primary care and behavioral health setting- HR principals, spectrum of HR,
relating to OUD and other chronic diseases
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What about CME & CEU?

Look out for a follow up email

with a survey and additional
information about CME & CEU

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 Technology
Keep your phone muted when (Feel free to use your video
you are not speaking when you speak)

Use the chat function or unmute yourself to ask questions.

We will refer over to the chat box throughout the meeting
Hygiene
Agenda and materials have been shared in an email from
Andrew Huff

•PowerPoint slide deck will be emailed out after the

meeting

•We are noting takeaways and will send them after the
meeting

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 MAT Collaborative Host

CPCCO Innovation Specialist

Andrew Huff,
LPC

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 Stacie Andoniadis - Medication for
Addiction Manager

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 What is Harm Reduction?
Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with
drug use.
Harm reduction incorporates a spectrum of strategies that includes:
• safer use,
• managed use,
• abstinence,
• meeting people who use drugs “where they’re at,” and
• addressing conditions of use along with the use itself.

Because harm reduction demands that interventions and policies designed to serve people who use drugs reflect
specific individual and community needs, there is no universal definition of or formula for implementing harm
reduction.
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Where do you align most in
harm reduction?
Point your phone camera here:

• Using your phone is easiest if you can do that and

it does not require leaving the PowerPoint
• If you are already viewing this meeting on your
phone, go to the chat and click the link
• Vote at this link
here: https://www.menti.com/zcyvirfaos

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Break out!
We will be in smaller breakout rooms for the next 10min
• Share your thoughts on what harm reduction means to you and how it is practiced at your clinic.
• SAFETY! Can be a sensitive topic so monitor your own self-disclosure and connection to this topic
• People who are only on a phone will remain in the main “room”
• If you get bumped out, just rejoin the meeting and we will be continuing around 11:55.

When we return
• A few “popcorn” reflections from your discussions

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 Objectives

• Harm Reduction overview- share how this shows up in your

practice
• Strategies for talking with patients/clients about harm reduction
• Overview of safer use strategies
• Coordination with community services

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 Basic Principles of Harm Reduction

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What is Harm Reduction?
Harm reduction is a set of practical strategies and ideas aimed at
reducing negative consequences associated with drug use. Harm
Reduction is also a movement for social justice built on a belief in,
and respect for, the rights of people who use drugs.

Harm reduction incorporates a spectrum of strategies from safer

use, to managed use to abstinence to meet drug users “where
they’re at,” addressing conditions of use along with the use itself.
Source: Harm Reduction Coalition
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 Examples of Harm Reduction
• Points

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 Syringe Service Programs (SSPs) are proven to
reduce the spread of disease and to improve the
health of people who inject drugs. Years of
evidence confirm the benefits, including cost
savings for health care systems. Additionally, by
facilitating the safe disposal of used syringes, SSPs
help preserve community and public safety.

Evidence shows that the presence of SSPs also

improves community and public safety: they do
not increase illegal drug use or crime, and often are
shown to decrease improperly discarded syringes.

Needs-based access to syringes is now considered

best public health practice.

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Harm Reduction in practice: What might be offered?
• Clean needles
• Sterile injection equipment (cookers,
cottons, tourniquets, alcohol wipes, clean
water)
• Naloxone (Narcan)
• Wound care (gauze bandages, antiseptic
wipes, surgical tape, bandaids, antibiotic
ointment)
• Safer sex supplies (condoms, lube)
• Smoking pipes/foil
• Snort kits
• Fentanyl test strips
• Sharps containers and access to safe disposal
for used syringes (direct collection)

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 What else?
• Harm reduction and naloxone
training/overdose education

• Hot food, clothing, tarps/tents

• Support for housing/shelter, medical care

and/or substance use disorder treatment

• On-site testing for infectious diseases (HIV,

HCV)

• OHP enrollment, expungement services

• Love and support to individuals who wish to

stop using drugs, as well as individuals who
wish to continue using drugs
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Naloxone
• How do you talk with your
patients about naloxone?

• How do you ensure your

patients have naloxone?

• Have you ever tried to get

naloxone at a pharmacy?

• Do you know other community

resources/ways for patients to
get naloxone?

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Safer Use
• How do you talk with
patients who use drugs about
safer injecting and use
practices?
• How do you educate yourself
about safer injecting
practices, including “works”?
• How do you support or
ensure safe disposal of used
syringes?
• Do you know where patients
can dispose of larger
amounts of used syringes?

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 Syringe Services
• How do you talk with patients
about syringe services?

• Are you aware of syringe

services and harm reduction
clinics that operate in your
area, and what they offer?
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Safer Use: Deeper Dive

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 Safer Use:
Continued

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 Language.
Matters.

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Harm Reduction for Clinicians
 Learning Objectives
• Review best practices for reducing harm during COVID-19
• Review utility, frequency, and interpretation of Urine Drug Screens in
Opioid Use Disorder treatment
• Describe essential risk mitigation components including checking the
PDMP and co-prescribing naloxone
• Screen for and discuss side-effects of injection drug use

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 Reducing Risk During COVID-19
People who drugs have multiple vulnerabilities:
• Lack of housing
• Reduced ability to self-quarantine, socially distance
• Lack of access to soap and water
• Difficulty accessing health care
• Multiple health conditions

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 What Can We Do?
• Continue access to telehealth format, start to reinstate groups safely
• Expect patients to have increased stress, exacerbated behavioral health symptoms,
possible recurrence of use
• Consider offering more frequent visits via telehealth
• Offer resource for on-line peer support, meeting, groups
• Encourage patients to get the Covid vaccine (consider J&J for highly unstable patients)
• Prescribe naloxone: ask if patient family/friends know where naloxone is

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 Reducing Harm- How to plan?
• No judgement, safe space
• Help patient plan for the following:
• Safer use- Not using alone, naloxone
• Stock up on supplies- sterile syringes, medications
• Understand and identify the symptoms
• Understand high risk of fentanyl contamination
• Review the Harm Reduction Coalition for resources

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 Urine Drug Screens
“No standard exists in clinical drug testing for addiction identification,
diagnosis, treatment, medication monitoring, or recovery” ASAM Drug Testing
Pocket Guide

DATA waivered clinicians must have “diversion control plan”, UDS is not mandatory as part of diversion
control plan

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careoregon.org
 UDS Principles
• Drug testing should be used to explore denial, motivation, reveal actual drug use patterns,
and build evidence of abstinence
• Discrepancies between self-reporting and testing should be an opportunity for engagement
with the patient, not disengagement or discharge from treatment
• Negative screens are an excellent opportunity to recognize hard work towards abstinence
and can reinforce motivation
• Avoid stigmatizing language such as “clean” or dirty” urine

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 UDS Principles
• Investigate whether your laboratory uses automatic confirmation for positive results
(“reflex” testing) or if confirmations must be ordered manually
• Always order a confirmation test if a patient’s self-report and testing do not agree
• Be curious about results, curiosity allows for mistakes on both sides- never be
confrontational
• UDS positive for opioids is a contraindication for naltrexone and warrants a
conversation about precipitated withdrawal prior to buprenorphine induction

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 UDS Principles
• Frequency:
• More at first, at least weekly
• Less in stable recovery, monthly
• Random
• Have policies in place for positive screens THC and amphetamines, some programs are
removing THC from their assays

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 UDS Interpretation

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 UDS Interpretation

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 PDMP for diversion control
Prescription Drug Monitoring Plan:
• Regularly check and document- use a delegate to do this consistently, even at every visit
• Medications dispensed from emergency departments are often not reported, methadone
from an OTP is not reported due to 42CFR

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 Naloxone
• Co-prescribe to EVERY patient prior to or at induction
• Naloxone teaching groups for family or friends
• Discuss safely storing medication at home

• Nasal naloxone is easiest to use and covered by many insurances; naloxone vials/harm
reductions programs are inexpensive or free for cash pay patients

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 Reducing Injection Risks
• Screen and treat Hep C and HIV
• Inform patient about endocarditis and sepsis risk; teach less risky injection
techniques
• Assume fentanyl- go slow
• Help patient identify local Harm Reduction resources/supplies
• Prescribe sterile syringes, especially in rural areas

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 Questions?

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 Reflection:

What has resonated

with you today?

What will you take with

you after this training?
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Thank you!
Next session:
Wednesday June 9th, 2021
Kerri Hecox, MD and
Hillary L. Handelsman, CNM

MAT: Pregnancy- best practices for OUD; in

pregnant population, including DHS
reporting and Prevention