1. COMMUNITY PLANNING & S YRINGE A CCESS A DAM R EILLY P ROJECT D IRECTOR

2. C OMMUNITY SUPPORT FOR HARM REDUCTION Identified key individuals to champion harm reduction in various sectors of the community People who take drugs Family members Law enforcement Judicial and corrections system Drug treatment and prevention Health care system City and county government Business community Private funders

3. E NGAGING THOSE WHO TAKE DRUGS IV Conducting street outreach Outreach to those in treatment Conducted community assessment 189 surveys completed 67 participants in focus groups All individuals were currently using or had used in the past year Community assessment was used as a way to make national and international data on harm reduction have a real connection to what was going on at the time locally

4. G AINING LAW ENFORCEMENT SUPPORT Have worked closely and continue to do so with CPD and Hamilton County Sheriff’s office Outspoken support from city police Chief and county Sheriff Engage community liaison officers, those for individual neighborhoods and those for specific groups Maintain relationships with district commanders and liaison officers Provide training to law enforcement on harm reduction and Naloxone use Local law enforcement understands how harm reduction protects them and other first responders

5. B USINESS AND FUNDING COMMUNITY SUPPORT Support from major local foundation, Interact for Health, has been a catalyst for harm reduction in Cincinnati Early support of such an approach has lead to more support in the wider funding community Connections made with business leaders, prominent individuals and families

6. H AMILTON C OUNTY ROE PLAN Individuals from more than 30 organizations joined forces in 2013 During that time they were split into four main categories Treatment/recovery Harm Reduction Prevention Supply reduction A more than 40 page detailed plan will be released to the public in the coming weeks Plan has endorsement from key city and county officials

7. GETTING PEOPLE THE TREATMENT THEY NEED Treatment Outcomes:  More Hamilton County residents will achieve long- term recovery as a result of addiction treatment and related services.  Fewer Hamilton County residents will overdose on opioids TREATMENT STRATEGIES Increase the capacity of all levels of addiction treatment care, particularly for indigent and underinsured Hamilton County residents. Enhance addiction treatment services through the continued use of evidence-based counseling practices and by making Medication Assisted Treatment (MAT) more available in conjunction with treatment services. Increase the number of sober housing units available for Hamilton County residents. Strengthen treatment providers’ collaborations with mutual help groups such as Narcotics Anonymous, Alcoholics Anonymous, and SMART Recovery. Make peer mentoring and support more available to people in recovery and for providers of Medication Assisted Treatment.

8. REDUCING HARM CAUSED BY THE OPIOID EPIDEMIC Harm Reduction Outcomes: - Decrease the number of new Hepatitis C, HIV, and other infections caused by intravenous drug use - Decrease the number of unintentional overdoses due to opioid use - Decrease the transmission of Hepatitis C, HIV, and other infections through accidental needle sticks. HARM REDUCTION STRATEGIES Increase community based Naloxone distribution Expand syringe exchange programs in Hamilton County Increase community support and education efforts Increase access to healthcare for intravenous drug users Provide overdose education and prevention services throughout Hamilton County.

9. PREVENTING OPIOID MISUSE Prevention Outcomes: Fewer people begin misusing prescription opiates Fewer people begin using heroin and other illegal opioids PREVENTION STRATEGIES Provide information by educating the public and professionals about heroin and prescription drug issues. Build skills, connected to trust and communication Improve the safety of the physical environment Advocate for policies that increase the availability of permanent drop boxes and education about SBIRT and pain management practices.

10. CUTTING THE SUPPLY OF OPIOIDS IN HAMILTON COUNTY Supply Reduction Outcomes: Reduce the supply of heroin in Hamilton County Less diversion of prescription opiates SUPPLY REDUCTION STRATEGIES Enforce current laws and regulations Collaborate with others to educate the public Explore the feasibility of implementing harm reduction measures on a larger scale

11. P UTTING THE PLAN INTO ACTION Funding collaborative has been established Comprised mostly of local private funders ROE admin team will pursue local, state, and federal funds for portions of the plan as well Plan is a living document and will be updated periodically Once fully implemented ROE will be able to show the success of each strategy and how they work together

12. M ISSION S TATEMENT The Cincinnati Exchange Project is a local advocacy organization that promotes education and the harm reduction model. We advocate for policy change that will enable local community based organizations to conduct outreach, testing and provide safe injection equipment to the injection drug use community. Upholding every individual’s right to health and well-being. These efforts will increase their competence to protect themselves, loved ones, and the community as a whole.

13. HOW CEP GOT STARTED Coalition of interested parties started work in 2007; reps from drug treatment, health care, law enforcement, and others (separate from ROE) Ohio is a home rule state Cincinnati Health Department declared a health emergency on 2/28/2012 Health emergency allows CEP to operate within the city of Cincinnati only Gained support of CPD and Hamilton County Sheriff’s office

14. T URBULENT START TO CEP Operations started in Springdale in February 2014 with an emergency order After 6 weeks of operations it was claimed that CEP decreased business at surrounding businesses by 20% All levels of Springdale government withdrew support No incidents occurred and police or first responders were never call for anything related to CEP Next neighborhood we approach was Lower Price Hill which ended up being a media nightmare!

15. CEP OPERATIONS STABILIZE Change over in city and county law enforcement leadership Greater knowledge of issue in the general public Partnership with Episcopal church in Mt. Auburn Large scale support for harm reduction in Northside

16. C OMMUNITY BUILDING FOR CEP CEP operates in 2 Cincinnati neighborhoods Mt. Auburn and Northside 3 rd site to start in late-April, this site will have a focus on Transgender services To gain access and support CEP… Canvassed neighborhoods, talking to community members and cleaning up trash and needles Identified key neighborhood supporters/advocates Met with community councils and business associations Conducted community education sessions Secured support from CPD and both district commanders along with community liaison officers Continue to build and maintain relationships with those in each community

17. W HO MANAGES AND RUNS CEP Medical Director Dr. Judith Feinberg, MD Project Director Adam Reilly Project Manager Libby Harrison Volunteers Much of the community work CEP does is through the work of our amazing volunteers! www.cincyep.orgwww.cincyep.org or follow us on Facebook www.facebook.com/cincinnatiexchangeproject www.facebook.com/cincinnatiexchangeproject

18. W HAT S ERVICES ARE OFFERED 1-for-1 syringe exchange FREE rapid HIV, HCV, syphilis and pregnancy testing Safer sex & injection equipment/education Community based Naloxone distribution Active referrals to detox and drug treatment Active referrals to other social services ACA enrollment through Free Store Foodbank A conduit for entering drug treatment

19. W HAT ’ S THE CLIENT EXPERIENCE Initial paper work (only done once) Agrees to participant’s rights and responsibilities No Drug use, drug dealing, weapons, or other illegal activity Given a participant code AREI5723 All services are offered, but not required Initial visit may be 20 minutes, subsequent visits may only be 5 minutes.

21. W HAT CEP HAS SEEN AS OF 3/16/2014 240 total clients Exchanged 15,500 syringes Distributed 200 Narcan Kits through Project DAWN and 26 Evzio kits 27 lives saved 7 deaths, nearly doubled since running our of Project DAWN supply 15% given to second party, 85% to first party 10 organizations trained and supplied with Narcan CBD unit trained and District 3 is in the process Average age of client is 37, youngest 19, oldest is 67 Average length of use 8.4 years 10% of clients have been using less than 1 year 30% of clients have been using for more than 20 years

22. CEP RACIAL / ETHNIC BREAKDOWN

23. CEP EMPLOYMENT STATUS

24. CEP GENERAL DATA 56% have overdosed in lifetime 71% report being HCV positive 4.3% report being HIV positive

25. N EXT STEPS AND EXPANSION CEP is a data driven program, but can only operate in communities that are welcoming We have plans to expand within the city and are in talks with other jurisdictions in the region CEP needs communities to approach them, we have found that when approached by community members we have more success than the reverse We hope that data collected by CEP and the successful operations for more than a year will help to open more community member’s minds, leading to greatly expanded services in the region

26. M OBILE U NIT