Prevention Point Pittsburgh-2

Case Study 2

Pittsburgh, PA
Taking overdose prevention into the jails to reach those at risk.

Prevention Point PittsburghThe Overdose Prevention Project (ODP) was started by Prevention Point Pittsburgh(PPP) in 2002 in response to the alarming increase in overdose deaths in Allegheny County, Pennsylvania.  The ODP Project provides training on Overdose Prevention & Response to individuals at risk of drug overdose, as well as to staff of agencies who work with individuals at risk and other individuals, family and friends, who might be present at the scene of an overdose and might be in a position to save someone’s life.  Trainings are offered at needle exchange, at methadone and other drug treatment programs, community settings as requested, and the Allegheny County Jail. PPP offers a Naloxone Prescription Program at their Oakland Needle Exchange Site.  All participants in the Naloxone Prescription Program receive training on Overdose Prevention & Response and learn how to perform rescue breathing and how to administer naloxone.  Individuals who use opiates are also given a prescription for naloxone and receive naloxone to take home at the time of the training. Only individuals who use opiates can be prescribed naloxone, but anyone can take the training.

In 2000, Allegheny County established the Jail Collaborative, a cooperative effort among the Allegheny County Jail, Department of Human Services, Health Department, Court of Common Pleas, and community partners with the purpose of reducing recidivism and increasing success for inmates following incarceration by focusing on treatment and services in the jail as well as intensive support for inmates and ex-offenders.  The staff person for the Collaborative had been an early supporter harm reduction and had testified at public health hearings resulting in legalization of needle exchange in Allegheny County. In 2002, as Prevention Point Pittsburgh (PPP) was developing the Overdose Prevention Project, this woman suggested that the warden of the Allegheny County Jail (ACJ), Calvin Lightfoot, might be open to Prevention Point implementing Overdose Prevention and Response trainings for inmates in the jail.  She facilitated a meeting and Warden Lightfoot asked that the training Prevention Point had developed by presented to senior staff of the ACJ.

While we had assumed that trainings in the jail would be open to inmates who asked to participate, with 8-12 in a training group, Warden Lightfoot felt strongly that all inmates should receive the training and asked us to conduct trainings on the “open pods” (housing units) with those who did not wish to participate required to remain in their cells during the training.

PPP began conducting trainings at ACJ in June of 2003.  Trainings were conducted 2-3 times a month, rotating between different pods, male and female.  Trainings involved anywhere from 20 inmates, on a pod where many were elsewhere in the jail on work assignments, to 80 inmates on an exceptionally crowded pod.

While we were hesitant about conducting essentially mandated trainings, this actually worked out quite well.  Many inmates seemed leery or uninterested in the trainings, some presumably because they expected a “just say no to drugs” message, some because they weren’t drug users and some because they felt they knew everything they needed to know about overdose.  As we started the trainings, introducing ourselves as “from the needle exchange” and started to get into very practical information on risks and responses, the audience warmed up considerably and by the end of the each training we had lots of great questions and discussion, with particular interest in the demonstration of how to use naloxone and how to do rescue breathing.   People often come up, individually, after the training with questions or concerns.

Trainings are conducted by two trainers working together, typically one staff person and one regular PPP volunteer.   Permission was granted to bring in an aluminum collapsible tripod with a paper flip chart pad with pre-printed slides on the chart that were used in lieu of PowerPoint slides.  Trainings are one hour long and at the end trainers demonstrated how to do rescue breathing by having one trainer lie on a table while the other trainer demonstrated on the “live dummy.”  This is generally a major highlight of the presentation and received cheers from the audience.    We take in literature on HIV and Hep C, in addition to the regular ODP curriculum and also specific literature on cocaine overdose and prescription opioid overdose.

In the 8 years of conducting the trainings there have been 2 fights witnessed by PPP staff, one of which resulted in cancellation of the training, the other did not.  In addition to limitations in PPP staff time, other challenges have involved imperfect communication among jail staff.  At times PPP staff arrive and the correctional officer on the pod has not been informed which sometimes results in trainings being cancelled.   To date, we’ve trained over 6,700 inmates and feel the program has been an overwhelming success.  We see lots of people at the needle exchange for naloxone who say they learned about us from the “jail trainings.”

A Pre/Post Test Evaluation indicated a 250% increase in knowledge among training participants in the first year of the program.  But, more significant are the stories we have heard:

“I think everybody needs this training who is in active addiction or knows someone who is,” said one of the inmates who attended the training. “I learned some things today that may help save a life — maybe my own life, though my goal is to go out of here and stay clean.”

From another training attendee: “if I would have had this training a year ago, I think my daughter would be alive today.”

Another said: “I had this training a year ago when I was in jail. Last week my girlfriend overdosed and I knew just what to do…I saved her and she is alive because of what I learned.”

Future Directions:

The Overdose Prevention Project is building on our success, developing strategies to make Overdose Prevention & Response education and naloxone accessible to prescription opioid users with equal effectiveness as our efforts to reach heroin users have shown.  Prevention Point began working with local physicians to facilitate a practice of routine prescription of naloxone to individuals prescribed opioids in a variety of traditional medical settings.   Prevention Point is currently involved in a project with the Schweitzer Fellowship program to develop a model to facilitate naloxone prescribing in a variety of traditional medical settings.  This involves educating physicians and pharmacists and developing educational materials, printed and video, specifically tailored to this type of practice.   In addition to making naloxone more easily accessible to non-injection opioid users who are not reached through needle exchange programs, this practice also serves to reduce the stigma associated with participation in overdose prevention efforts by making the general population aware of the risk of opioid overdose involved in pain management efforts.

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