DAP Health’s New Harm Reduction Program Seeks to Curb Rising Overdose and HIV Rates in the Coachella Valley
Words by Ellen Bluestein
According to Riverside County Strategic Health Alliance Pursuing Equity (SHAPE), recent data indicate an upward trend in the death rate from drug use. In California, there are 13.1 deaths per 100,000 people. In DAP Health’s service area, however, that number jumps to 17.5 per 100,000.
With an increase in drug use comes an increase in HIV transmissions through shared needles. As reported by the Riverside University Health System, the HIV incidence rate in Riverside County is 10 cases per 100,000. However, in DAP Health’s service area, the incidence rate is almost double that at 18.4 cases per 100,000. “DAP Health continues to respond to community needs,” said to CJ Tobe, DAP Health director of community health and sexual wellness. “We saw new HIV infections increase through the COVID pandemic and we saw that the 92262 ZIP Code had a 300% higher death rate compared to the state average caused by opioids.”
In response to these increases, DAP Health recently launched its harm reduction program to combat the rise in preventable overdoses as well as the increase in new HIV cases. “The goal of the program is to create a safe, stigma-free environment to establish trust for those living with addiction so they can have conversations with harm reduction staff to see how best they can be supported,” said Tobe. "Harm reduction is a strategy to engage with folks during their journey with addiction, meeting them where they are at and as part of a path to using drugs safely, reducing their use, or to recovery.
Also known as a Syringe Service Program (SSP), DAP Heath’s new initiative, overseen by Harm Reduction Supervisor Neil Gussardo, offers participants the opportunity to turn in their used syringes and leave with whatever clean paraphernalia they need – sterile water, filters, pipes – to safely use drugs. It is not, Gussardo emphasized, a needle exchange program.
In a study by Dr. Alex Wodack, an international leader in harm reduction, it was determined that when people who inject drugs use an SSP, they are five times as likely to enter drug treatment as those who don't use one. In addition, “syringe service programs are one of the most effective interventions in decreasing new HIV and hepatitis C infections,” said Tobe.
Response to the program has been positive. “Participants are thrilled to have it “They're really grateful,” said Gussardo. “One of the things that we're providing is Narcan, which is a medication that reverses overdoses and fentanyl test strips.”
The Center for Disease Control (CDC) defines fentanyl as a synthetic opioid that is up to 50 times stronger than heroin and 100 times stronger than morphine. It is a major contributor to fatal and nonfatal overdoses in the U.S. “Fentanyl is a manmade opiate that is cheap to produce and is being put into everything,” said Gussardo. “So, everything from opiates like heroin to methamphetamine...These drugs are being cut with it.” With test strips, “people are able to test their drugs and then make a better-informed decision as to how they move forward should they find fentanyl in the drugs,” he said. To use the strips, a person would either cook or mix up some of their drugs in water. “You put the test strip in, then it’s like a COVID test,” said Gussardo. “If it's got a couple of lines, it's positive [for fentanyl]; one line, it's negative.” The test takes about five to seven minutes to process.
The harm reduction team also provides Narcan and naloxone to those who request it. Both will reverse an overdose. Narcan is used as a nasal spray while naloxone is injected, like an EpiPen. Each has its benefits. “One of the advantages of the naloxone, the needle, is that it's more difficult to use a nasal spray on somebody that is having a seizure,” said Gussardo. “The needle can be put through clothing; it can go directly into muscles.”
“A person might anticipate that they're injecting or even smoking methamphetamine, which is going to give them a different high than an opiate,” said Gussardo. “And the next thing, you know, instead of kind of being amped up, they're now fading out because of the fentanyl. And should somebody go into an overdose and somebody else has the Narcan, it will reverse the overdose temporarily. Narcan can last anywhere from about 40 minutes to 90 minutes,” he said. “So, the person does need to seek medical attention.” The same holds true for naloxone.
Learning to identify the signs of an overdose is the first step to help treat them. “Breathing is the biggest thing,” said Gussardo. “The opioids...start to slow down the whole body to the point where somebody stops breathing and that's what kills them.” He added, “You can check the pulse and you want to see if there's any kind of response, so you certainly want to yell at somebody: ‘Hey, hello! Wake up! Are you okay?’”
Should either drug be administered, “a minute or two later, they should come out of the overdose,” said Gussardo. “What happens is there are literal opiate receptors in the brain and opiates come in and they connect to that receptor. The Narcan gets in the way of that and takes the opiate off the receptor. “
While some may be hesitant to use Narcan or naloxone for fear of causing harm if a person is not actually overdosing, Gussardo reassures that neither drug will negatively impact somebody if they are not overdosing on an opiate.
As the program grows and a solid foundation laid, Gussardo’s team will start to reach out to other areas of the valley. “I anticipate the needs in other areas of the valley are going to be similar, but different,” he said. “Different demographics, different needs, probably different drugs being used.”
Ultimately, Tobe would like the harm reduction program to connect participants to other medical and social support services. Currently, the program includes testing participants for HIV and Hepatitis C with the goal of getting them on medication as soon as possible if they test positive. Other services available will be counseling, DAP Health’s Outpatient Drug Free (ODF) program, help with insurance enrollment or with making an appointment with a primary care physician for the first time.
“At DAP Health we accept all people, period, said Tobe. “We choose to value the lives and choices of others with respect and compassion over discrimination, judgment, and stigma. The harm reduction program does just that for folks in our community who need support.”