PROVIDERS

Healthcare providers are among those most intimately informed on the harms faced by people who inject drugs.  HIV, HCV, and accidental overdoses are the most common, although cellulitis, endocarditis and a variety of other general welfare and security issues also often complicate the narratives of these patients.    Stigma surrounding people who inject drugs, abstinence-only clinical models, and questions of liability pose barriers to the implementation of harm reduction strategies by healthcare professionals and their respective organizations.

 

In addition to providing direct services to people who inject drugs and their partners, the Harm Reduction Action Center is committed to educating and supporting healthcare professionals wishing to reduce the acute and chronic harms associated with drug use.

 

We know there are challenges and opportunities in working with people who inject drugs.  We provide presentations to physicians, nurses, Emergency Department personnel, prehospital providers, and other stakeholders in the health and welfare of the participants we serve.

 

What liability protections do I have as a healthcare provider when exploring harm reduction alternatives with my patients?

 

A person who can legally prescribe naloxone shall be immune from criminal prosecution for outcomes of its administration by a third-party layperson.  Additionally, syringe access is permissible by law in the state of Colorado and is one of the most effective methods for curbing the spread of communicable disease such as HCV and HIV.  DOWNLOAD NALOXONE LEGISLATION PDF

 

What are some specific harm reduction alternatives that I can explore with my patients?

 

Risk reduction is the core of harm reduction.  It acknowledges that your patient may continue to engage in risky behavior and  seeks to find concrete steps they can take to immediately reduce the risks faced by the patient, their peers, and the greater community at large.  When in doubt, a referral to your local syringe access program is a substantial and comprehensive first step.  Additionally, you may also consider prescribing naloxone, encouraging proper syringe disposal, and encouraging the use of alcohol pads prior to injection to reduce the risk of abscesses.  If you suggest treatment for substance abuse, please note that people in Colorado must be detoxed for 72 hours before they can receive in-patient treatment.  Additionally, pre-planning for suboxone and methadone therapy is critical; methadone clinics require a valid Colorado identification card before considering new patients and very few suboxone providers accept Medicaid.

 

Where can I refer my patients who inject drugs for further support and care?

 

Your local syringe exchange program.  There are seven in the state of Colorado, located in Denver, Boulder, Fort Collins, Grand Junction, and Pueblo.  

 

I am a pharmacist with questions about the sale of syringes in the State of Colorado.  What resources are available to me?

 

Pharmacists can sell syringes in the State of Colorado.  Syringe access programs in Colorado typically operate during very limited weekday hours.  Pharmacies represent the best stop-gap for HIV and HCV prevention during after-hours.  We encourage pharmacists to collaborate with us for the health of our community by making syringes available for purchase to anyone.  

 

I am a physician who prescribes opioid narcotics and am interested in learning more about prescribing Naloxone to my patients.  What resources are available to me?

 

Denver Health has recently added Naloxone to its formulary for those at high risk of a potential opioid overdose.  This includes injection drug users, patients taking a high dose of prescription opioids, patients with chronic pain syndromes requiring high doses of opioids and/or muscle relaxants, patients seen for opioid overdoses, and elderly or opioid naive patients prescribed moderate to high doses of opioids.  Because Colorado expressly exempts third-parties who administer naloxone from liability, naloxone may be administered by bystanders and prescribers should educate the patient’s support network on the proper use of Naloxone prior to dispensation.  For more details on Naloxone programs and its prophylactic use in Colorado click here.

 

Who can be a medical director for a pharmacy or a harm reduction organization for purposes of providing naloxone?

 

Senate Bill 15-053 expands access to the life-saving drug Naloxone, used to reverse opioid overdoses such as certain prescription medications and heroin. As a result of the new law, the chief medical officer of the Colorado Department of Public Health and Environment (CDPHE) may issue standing orders for Naloxone to be dispensed by pharmacies and harm reduction organizations to help expand statewide Naloxone access to those who need it most. CLICK TO LEARN HOW YOU CAN ESTABLISH STANDING ORDERS FOR YOUR ORGANIZATION TODAY.

 

Does COPIC support the prescription of naloxone?

 

Yes.  Excerpted from COPIC’s May of 2015 Newsletter: “COPIC encourages physicians, physician assistants, advanced practice nurses, and pharmacists to understand their important role in providing this tool to at-risk individuals, their families, or those likely to encounter such persons.”  DOWNLOAD THE FULL NEWSLETTER HERE

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