Clean Works

Case Study

Grand Rapids, MI
A needle exchange program in Michigan takes action to expand access to naloxone.

Clean WorksIn Kent County, Michigan, overdose is currently the leading cause of accidental death of all people aged 21-65, yet it is not an issue that is addressed locally by public health. People are dying in Kent County, but they are dying largely silent deaths. At the Clean Works program of the Grand Rapids Red Project, we view this as unacceptable. Overdose fatalities, specifically opiate overdose fatalities, are preventable.  We decided that we should do something about this as an organization, and as a group of people concerned with the health of people who use drugs.

In October of 2008 we began partnering with a local doctor to provide program participants of our syringe exchange program with access to the life saving medication Naloxone and the knowledge and skills to use it to successfully intervene in opiate overdose situations. Prior to this point there had been limited Naloxone access within the City of Grand Rapids, but more was needed to make an impact in the rapidly rising death toll from opiate overdose fatality. Michigan does not have specific legislation dealing with Naloxone and overdose programs, so the same laws apply as with any prescription medication. So in October of 2008 we began providing comprehensive overdose prevention and intervention trainings using the SCARE ME protocol developed by the Chicago Recovery Alliance. A lot of research and work has gone into reducing overdose fatality in other cities and by other organizations; instead of reinventing the wheel in Grand Rapids, we borrowed it from other organizations.

In Grand Rapids we operate a fixed site syringe exchange program 3 days a week. Overdose trainings are available on a walk in basis for free anytime we are open. We are located in the Heartside neighborhood in downtown Grand Rapids. The overdose mortality rate in the neighborhood in which we operate is 45 times the average rate in Kent County. The neighborhood is dominated by shelters, soup kitchens and low-income residences, and has seen a large rate of gentrification in the past few years. A large proportion of our program participants come from the area in which we operate, but we also receive program participants from many miles away as we are the only syringe exchange program in the Grand Rapids area. Through our overdose prevention program we talk with our program participants about recognizing overdoses, the importance of rescue breathing, calling 911, and how to intervene in an overdose.  Program participants are provided with access to Naloxone Hydrochloride.

Almost immediately after starting this program we began receiving reports of people reversing overdoses because of the knowledge and the tools we had the opportunity to put in their hands. Through August of 2011 we have had the opportunity to facilitate 209 trainings, and these trainings have led to 64 reported overdose reversals.

The success of this intervention cannot be denied on an individual level. Anyone who has experienced a friend turning blue, knocking on death’s door right next to them, and not knowing what to do- contrasted to having the tools, the knowledge, and the ability to save that friend’s life- knows that this intervention works. We have 64 reported reversals to show the strength of this intervention on an individual level. What we also like to see is our interventions working on a community level. Shortly after starting to provide overdose prevention and intervention trainings in Grand Rapids, cumulative overdose fatalities began to stabilize. After increasing almost four-fold in the past fifteen years, overdose fatality stopped increasing, and as of 2010 it actually started decreasing in Kent County.

Training people who use drugs how to intervene in overdose situations works. Providing people with the knowledge and tools necessary to save lives, saves lives. People who use drugs are the true first responders in most overdose situations, and its past time we treated them as such.

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