• Naloxone has been approved since 1971
• Naloxone is not a controlled substance
• Naloxone is an inert medication, non-addictive
• Naloxone can be administered repeatedly without harm
• Naloxone has no potential for abuse
• Naloxone has a shelf life of two years
• Naloxone can be administered intramuscularly, intranasally via atomizer devise or via an auto-injector

Receive Narcan training for free online and a Narcan kit will be mailed to you for free.  Link:  FCHD.org/FreeNarcan

1. Try to wake the person up by yelling their name and rubbing the middle of their chest with your knuckles (sternum rub).
2. Call 9-1-1. Indicate the person has stopped breathing or is struggling to breathe.
3. Make sure nothing is in the person’s mouth that could be blocking their breathing. If breathing has stopped or is very slow, begin rescue breathing.

1. Tilt their head back, lift chin, pinch nose shut.
2. Give 1 slow breath every 5 seconds. Blow enough air into their lungs to make their chest rise.
3. Use naloxone and continue rescue breathing at one breath every 5 seconds.
4. If the person begins to breathe on their own, put them on their side so they do not choke on their vomit. Continue to monitor their breathing and perform rescue breathing if respirations are below 10 breaths a minute. If vomiting occurs, manually clear their mouth and nose.
5. Stay with the person until EMS arrives.

The process of approval for the SEP in Franklin County took some time due to the extended process that must be followed. The Board of Health was the first step in the approval process. Once the Board of Health agreed, it went on to fiscal court. The fiscal court approved the SEP, and it was sent to the city commission. The Board of Health approved the SEP on August 17, 2015; the fiscal court approved it on October 16, 2015; the city approved it on January 25, 2016. It opened in May, this allowed for time to purchase supplies and participate in the Harm Reduction Summit training. In the beginning, there was no funding available for the implementation of the SEP. The board agreed to fund the program with local tax dollars. There was an estimated need of $60,000 a year. The first year the SEP was opened, the $60,000 was received for opening costs. The rest of the funding sources was broken down accordingly: $4,000 for the state, $4,000 in federal grants, and $40,000 from the Board of Health. The grant funds are used to pay for staff time and other needs, but not the syringes or needles. There is approximately $15,000 budgeted for salary payment.

There are quite a few grants that help fund the SEP. The state provides $10,000 in grants for HIV prevention. The SEP uses this grant because many resources can be provided through the program for HIV prevention. The grants are applied for through the local Agency for
Substance Abuse Policy (ASAP) boards because the health department is not considered a nonprofit organization. The Office of National Drug Control Policy released grants and the local ASAP boards applied for these grants to fund the SEP. This funding is used to purchase alcohol supplies, condoms, and other items. The health department will purchase these items and be reimbursed through grant funding. They must report back monthly stats (visits, testing, drugs, treatment, number of syringes) to the ASAP board. These grants played a role in the functionality of the SEP and allowed for successful implementation.

There were barriers that Franklin County had to overcome to be able to implement the SEP in their jurisdiction. The first barrier was the approval of the Board of Health. The board chair was skeptical due to the concept of permission and the idea that giving clean needles came with permission to use. To overcome this barrier, there was data presented from the CDC and the World Health Organization. They had one on one meetings and provided community education.
The next obstacle was approval from the city commission. During the first vote, two voted “no,” and the third voted to abstain because they wanted more information. Active community members played a significant role in impacting city commission. It ended up passing in city commission by one vote. The only caveat was that there was a requirement for an update every six months and that the program could be taken away at any time. The Public Health Director provided updates twice and after that was not asked to come back again due to success in the implementation phase.
Due to the increasing numbers and 80% return rate, there are still staffing and funding barriers. Every staff member is trained in needle exchange and interns are also utilized to fulfil this need. Grants will not allow for syringes to be purchased with federal money, so the funding must come from other sources. Careful planning of resources comes into play to overcome these challenges. Modifications have been made in terms of the delivery model. There is a cap of 100 needles, which can get them through the week and is enough to give to other people that may need them. The first visit is needs based and it is ideal for participants to return once a week.
There was a bill introduced that could make the delivery model one for one across the board. Due to this, they have been stricter on giving a lower number of needles if participants do not bring back needles. They found that participants are more likely to bring the needles back if they are provided with a sharps container. This container has a card with the information of the health department. If the participant were to get arrested, it would be thrown out as long as there are not drugs present. The hours of operation have expanded since the SEP was first opened. It is now open every day of the week, which allows for the services to be more utilized. There have been some complaints from participants that use other services due to being in the same waiting room as injection drug users. They try to combat this with education of the SEP and the positives of
having one in the county.
Some modifications were made since the program first opened in 2016. When first opened, services were only offered on Fridays. The location was right next to the Sheriff’s Department. These two factors could have contributed to a slow start. The next step was opening a service at another building while utilizing a mobile command center. After this change, there was an increase in numbers and allowed for more accessible public transportation access. The SEP has its own waiting room and area to see participants in the Public Health Department. This change increased participation and use of services.

The SEP is considered a success in Franklin County. For the 2018-2019 year, there were 456 initial visits and 845 subsequent visits. SEP staff made 16 referrals to treatment at the initial visit and 16 referrals at a subsequent visit. There were 85, 330 syringes provided and 67, 380 syringes collected with a 79% return rate. Additionally, there was significant support from community partners and key stakeholders in the local community. The participation rates have continued to increase due to successful outreach practices. There were many moving parts and community partnerships formed to allow for successful implementation. There is a community needs assessment conducted every five years. In 2013, drug use was the number one concern in the community. The hope is by the next cycle this concern will move down due to the resources that are in place for community members to utilize. This needs assessment allows the health department to address needs within the community and develop future goals to work toward. The SEP in Franklin County has continued to grow due to the respect factor that is incorporated into their daily practice. They also are open every day of the week, which allows for flexibility for participants.

The year runs July 1 – June 30th