Best Practice Recommendations 2 for Canadian Harm reduCtion Programs tHat Provide serviCe to PeoPle WHo use drugs and are at risk for Hiv, HCv, and otHer Harms Working grouP on Best PraCtiCe for Harm reduCtion Programs in Canada Acknowledgements We would like to thank the Canadian Institutes of Health Research for funding this project. This document and some specific parts of it were reviewed by community experts to help us ensure that the recommen- dations are usable and the supporting evidence is clearly presented. We also owe many thanks to Heather Dickinson (RCMP) and James Stewart-Haass (Durham Regional Police) for their feedback on the draft chapter on relationships with law enforcement, and to Seth Clarke and Annika Ollner (PASAN) for their feedback on the draft chapter on education and other services for the prison context. We owe further gratitude to Cindy MacIsaac for external review of the complete draft of the document. We thank Ryan White R.G.D. for his graphic design of the document, the accompanying chapter summaries, and presentation templates. We also thank Nora Ottaway for reviewing and editing the full document. We are also deeply grateful to our knowledge translation partner, the Canadian AIDS Treatment Information Exchange (CATIE), for their efforts to ensure that Canadians know about and can access the Best Practice Recommendations. Disclaimer The opinions and recommendations in this document reflect those of the authors and do not necessarily reflect those of their employers or the Canadian Institutes of Health Research. SUGGESTED REFERENCE: Strike C, Watson TM, Gohil H, Miskovic M, Robinson S, Arkell C, Challacombe L, Amlani A, Buxton J, Demel G, Gutiérrez N, Heywood D, Hopkins S, Lampkin H, Leonard L, Lockie L, Millson P, Nielsen D, Petersen D, Young S, Zurba N. The Best Practice Recommendations for Canadian Harm Reduction Programs that Provide Service to People Who Use Drugs and are at Risk for HIV, HCV, and Other Harms: Part 2. Toronto, ON: Working Group on Best Practice for Harm Reduction Programs in Canada. 2015. Best Practice recommendations for canadian Harm reduction Programs: Part 2 Table of contents Overview of the Best Practice Recommendations: Part 2 ......................................................................................................4 Sexual Health Promotion for People Who Use Drugs – A comment ...................................................................................6 Chapter 1: Program delivery models .......................................................................................................................................7 Chapter 2: Needle distribution for anabolic steroid injection, hormone injection, piercing and/or tattooing .......... 36 Chapter 3: Foil distribution .................................................................................................................................................... 49 Chapter 4: Safer crystal methamphetamine smoking equipment distribution .............................................................. 56 Chapter 5: Injection-related complications – prevention, assessment, and treatment .................................................. 64 Chapter 6: Testing services for HIV, hepatitis C, hepatitis B, and tuberculosis ................................................................. 71 Chapter 7: Vaccination services for hepatitis A and B, pneumococcal pneumonia, influenza, tetanus, and diphtheria ......................................................................................................................................................... 81 Chapter 8: HIV and/or hepatitis C treatment referrals ....................................................................................................... 89 Chapter 9: Substance use treatment referrals ..................................................................................................................... 99 Chapter 10: Mental health services referrals ..................................................................................................................... 109 Chapter 11: Housing services referrals ............................................................................................................................... 116 Chapter 12: Relationships with law enforcement ............................................................................................................ 122 Chapter 13: Education and other services for the prison context .................................................................................. 136 Appendix A – Methods: Overview of Research Evidence Review and Synthesis ........................................................... 146 3 Best Practice recommendations for canadian Harm reduction Programs: Part 2 Overview of the Best Practice Recommendations: Part 2 The Best Practice Recommendations for Canadian Harm Reduction Programs that Provide Service to People Who Use Drugs and are at Risk for HIV, HCV, and Other Harms: Part 2 is the second set of recommendations created by the Working Group on Best Practice for Harm Reduction Programs in Canada. These recommendations were developed to help needle and syringe programs (NSPs) and other harm reduction programs across the country improve service delivery to people who use drugs. The table below outlines the contents of Parts 1 (Strike et al., 2013) and 2 of the Best Practice Recommendations. Part 1 Part 2 Needle and syringe distribution Program delivery models (includes fixed-site NSPs, mobile NSPs, pharmacy-based distribution and purchase, peer- based outreach, and needle/syringe vending machines) Cooker distribution Needle distribution for anabolic steroid injection, hormone injection, piercing and/or tattooing Filter distribution Foil distribution Ascorbic acid distribution Safer crystal methamphetamine smoking equipment distribution Sterile water distribution Injection-related complications –prevention, assessment and treatment Alcohol swab distribution Testing services for HIV, hepatitis C, hepatitis B, and tuberculosis Tourniquet distribution Vaccination services for hepatitis A and B, pneumococcal pneumonia, influenza, tetanus, and diphtheria Safer crack cocaine smoking equipment distribution HIV and/or hepatitis C treatment referrals Safer drug use education Substance use treatment referrals Handling and disposal of used drug use equipment Mental health services referrals Overdose prevention: education and naloxone distribution Housing services referrals Relationships with law enforcement Education and other services for the prison context 4 Best Practice recommendations for canadian Harm reduction Programs: Part 2 Both sets of recommendations aim to assist programs and Our team – Working Group on Best Practice for communities to: Harm Reduction Programs in Canada • Improve effectiveness, quality, and consistency of harm Based on the principles of community-based research, our reduction program services project arose from a community-identified need. From inception to dissemination, this project has involved com- • Reduce transmission of HIV, HCV, HBV, and other harms munity members and service providers; the full team has • Make informed decisions about the use of resources for included people with lived experience, service providers, effective and efficient practice policy makers, and researchers. Team members joined the • Advocate for better resources and investment in harm project based on their interest, expertise (e.g., service provi- reduction programs sion, policy), and their roles as representatives within their • Provide benchmarks to evaluate harm reduction communities, stakeholder groups, and/or regions. We used program services a consensus-based process whereby all team members con- tributed to the design and implementation of the project. • Identify targets for improvement at the individual program and systems levels References Together, Parts 1 and 2 are intended to expand upon BCCDC. Best practices for British Columbia’s harm reduction and replace recommendations previously disseminated supply distribution program. BC Harm Reduction Strategies by British Columbia (BCCDC, 2008; Buxton et al., 2008) and Services Committee; 2008. Accessed August 2015 from: and Ontario (Strike et al., 2006). Evaluations of these earlier http://www.bccdc.ca/NR/rdonlyres/17E7A2C8-5070-4A29- documents demonstrate impressive implementation of the 9971-55210F781B58/0/BestPractices.pdf recommendations (Buxton et al., 2008; Strike et al., 2011). We hope to achieve even more widespread uptake of the Buxton JA, Preston EC, Mak S, Harvard S, Barley J, BC Harm new recommendations. Reduction Strategies and Services Committee. More than just needles: An evidence-informed approach to enhanc- Recommended policies versus program activities in ing harm reduction supply distribution in British Columbia. Part 2 Harm Reduction Journal, 2008 Dec;5:37. In Part 2, we draw on evidence primarily about NSPs since Strike C, Hopkins S, Watson TM, Gohil H, Leece P, Young S, these are among the most researched harm reduction pro- Buxton J, Challacombe L, Demel G, Heywood D, Lampkin H, grams. A considerable amount of published evidence was Leonard L, Lebounga Vouma J, Lockie L, Millson P, Morissette available for some chapters (e.g., program delivery models, C, Nielsen D,Petersen D, Tzemis D, Zurba N. Best Practice injection-related complications, testing services, vaccination Recommendations for Canadian Harm Reduction Programs services), while evidence was more