WEBVTT

1 "Dieter, Angela" (81131264)
00:00:00.000 --> 00:00:20.000
But the design implementation and evaluation of a harm reduction academic detailing program with Shred, the stigma, a grassroots syringe service program in Oklahoma City. They learned earned a master's degree in public health from the University of Pittsburgh. So we are delighted and excited for your presentation.

2 "Dieter, Angela" (81131264)
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Question so you can take it over. I appreciate you stepping it up and going 1st.

3 "J. Ashenayi, MPH (they/them)" (1168678656)
00:00:24.548 --> 00:00:44.510
Happy too. Thank you so much. Thank you all for joining and thank you to the bridge team for inviting me here today. I'm here to share a story about Shred, the stigma, this harm reduction program that I worked with in Oklahoma City and how our experience with the harm reduction academic detailing program connects.

4 "J. Ashenayi, MPH (they/them)" (1168678656)
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To a broader national effort led by NATO or the National Association of City and county health officials to expand harm reduction capacity. I'll cover three main pieces today. 1st, the context for why harm reduction education is needed. Second, I'll share Shred's case study and what we learned from people with lived and living experience. And 3rd, how these lessons connect to nato's new implementation guide that's designed.

5 "J. Ashenayi, MPH (they/them)" (1168678656)
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Before communities like Gary County who are building this capacity right now.

6 "J. Ashenayi, MPH (they/them)" (1168678656)
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Sure the stigma was founded in 2021 immediately after oklahoma decriminalized surge services programs and our mission is simple but ambitious to end overdose and other drug related harms through realistic and achievable approaches to drug use. We started this by delivering safer use.

7 "J. Ashenayi, MPH (they/them)" (1168678656)
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You can see an example there on the right, with things like sterile syringes in the lockstone and woundcare supplies and all of these things that you are already familiar with delivered directly to people's homes in the Oklahoma City Metro area. Everything was volunteer run, so advocacy was kind of a scary word for us at 1st. But with this project, we've started to expand into new ways to help kind of shift these local conversations about drug use.

8 "J. Ashenayi, MPH (they/them)" (1168678656)
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From personal to professional experience, I'm sure everyone here is aware of these harms of drug use and I know we'll hear some statistics later on, so I won't bog you down too much with that. But these harms go beyond, the drug use and the drug itself.

9 "J. Ashenayi, MPH (they/them)" (1168678656)
00:02:32.190 --> 00:02:52.190
These are Oklahoma specific statistics, but we've seen the story all across the country. Skyrocketing overdose deaths from 2019 to 2022 especially over a hundred percent in Oklahoma, especially among people who could have been helped, who had opportunity.

10 "J. Ashenayi, MPH (they/them)" (1168678656)
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These that were missed for intervention and including health care system costs that could have been prevented. Of course, we also have human immuno immunodeficiency virus or HIV and hepatitis C, which are transmittable through unsafe injection practices and other.

11 "J. Ashenayi, MPH (they/them)" (1168678656)
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Medical and legal and social harms and stigma and housing instability and all of these issues compounding that as well. All of these making up this public health burden that the war on drugs has created. One of the issues is that these harms aren't being faced fully addressed in clinical spaces.

12 "J. Ashenayi, MPH (they/them)" (1168678656)
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And this was the focus of Shred's project. Traditional approaches to care tend to emphasize absence based treatment, criminalization, and emergency responses to acute health crisis. And while these services, some of them are life saving, they're not fully addressing these underlying social and structural determinants that are leading to these poor health outcomes being discharged against medical advice, being readmitted for infections, the same infection over and over delaying your health care access.

13 "J. Ashenayi, MPH (they/them)" (1168678656)
00:04:07.340 --> 00:04:31.550
And experiencing poor health outcomes overall as a result. When people who use drugs do have access to health care, they are experiencing stigma, they're facing this discrimination and they're facing these poor health outcomes too. And so instead we look towards harm reduction as offering a different approach to clinical care. Harm reduction.

14 "J. Ashenayi, MPH (they/them)" (1168678656)
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Broadly refers to these policies and programs and practices informed by these underlying values that seek to minimize the negative consequences of drug use without requiring abstinance.

15 "J. Ashenayi, MPH (they/them)" (1168678656)
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There is ample evidence at this point to support harm reduction initiatives and their effectiveness at decreasing HIV incidents, building trust with providers, improving adherence to care. And so as a result, major trusted health organizations have expressed their support that this is something that we need to be.

16 "J. Ashenayi, MPH (they/them)" (1168678656)
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Incorporating.

17 "J. Ashenayi, MPH (they/them)" (1168678656)
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For clinical practice specifically, you can see an example list of values, others like the National harm Reduction coalition and harm Reduction international have their own lists of values. You can find one that speaks to you. But for these specifically tailored to healthcare settings, they are humanism.

18 "J. Ashenayi, MPH (they/them)" (1168678656)
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Or respect and dignity for patients as whole persons. Pragmatism or the recognition that perfect health is not an achievable goal. Individualism or the fact that NO one solution works for every patient. Autonomy or patients having the ultimate say in their choices of health behaviors, incrementalism or the celebration of any gradual positive change towards improved health.

19 "J. Ashenayi, MPH (they/them)" (1168678656)
00:05:57.539 --> 00:06:17.539
And accountability without termination or the responsibility that patients have for their choices and the providers have to continue treatment, not punishment. Together, these principles provide a foundation for this project's core components that are aimed at increasing access to and quality of health care services.

20 "J. Ashenayi, MPH (they/them)" (1168678656)
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Four people who use drugs. And we know these harm reduction principles exist. There's resources out there, but clinicians aren't receiving this education. Opioid use disorder wasn't even a mandatory part of medical education until 2019, out of a dozen or so programs teaching.

21 "J. Ashenayi, MPH (they/them)" (1168678656)
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Harm reduction at all. There were none in Oklahoma where we were based and as a result clinicians feel unprepared and report feeling unprepared to treat their patients who use drugs. Lack of knowledge, lack of consequences, or fear of consequences, lack of time for appointments, and so we focused really on education.

22 "J. Ashenayi, MPH (they/them)" (1168678656)
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Patient as this 1st step to changing behavior.

23 "J. Ashenayi, MPH (they/them)" (1168678656)
00:07:03.269 --> 00:07:20.549
So with this clear need for improved healthcare access with clinicians lacking educational on harm reduction, we saw an opportunity for a program. And that project was this piloting of a clinician education program about harm reduction.

24 "J. Ashenayi, MPH (they/them)" (1168678656)
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Designed, and this is was really the core of it designed with input from experts of experience. Our goal was to really understand these barriers and facilitators to accessing health care. We have all of this data.

25 "J. Ashenayi, MPH (they/them)" (1168678656)
00:07:37.529 --> 00:07:57.529
You know, all of this evidence to support it, but we really wanted to also humanize the issue, bringing folks together for focus groups and a really kind of fun participatory research method called photo voice. We sought to recruit participants who we already knew from the syringser.

26 "J. Ashenayi, MPH (they/them)" (1168678656)
00:07:57.529 --> 00:08:17.579
Service program, from very backgrounds. These were mothers and veterans and artists and unhoused people and your neighbors and really just people with a story to share. We brought them together for focus groups in private community spaces led by volunteers, so familiar faces there too.

27 "J. Ashenayi, MPH (they/them)" (1168678656)
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Who facilitated these conversations about past experiences with medical care developed with input from our community advisory board. And our participants reached a really clear consensus on what those barriers were.

28 "J. Ashenayi, MPH (they/them)" (1168678656)
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I'll send slides after this so you'll have this to read through, but broadly that healthcare is expensive, that participants felt judged and misunderstood. Participants avoided seeking care. Participants had better experiences if providers took the time to listen.

29 "J. Ashenayi, MPH (they/them)" (1168678656)
00:08:54.359 --> 00:09:14.359
And participants found other ways to get their health needs met in the meantime. And I'm sure you've seen similar stories with the clients you serve or the folks that you know, but with these answers, we also wanted to dig deeper with a method called photo voice. We introduced this.

30 "J. Ashenayi, MPH (they/them)" (1168678656)
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Concept at the 1st focus group shared cameras with the participants. Either they could use a disposible camera or their cell phone and capture photos that answer these prompts of things like what does a safe place look like? What would you want your dr. to know about you? Really open ended and kind of allowing them to guide where they like the narrative to go. For practice we shared pet photos and that was really a fun pop pillar.

31 "J. Ashenayi, MPH (they/them)" (1168678656)
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Their icebreaker too. And the results that we got were really incredibly moving. Again, I'll let you go through these at your own pace after this. They had just a simple photo with a story combined, made these really, really powerful to see.

32 "J. Ashenayi, MPH (they/them)" (1168678656)
00:10:02.369 --> 00:10:24.229
And so with the voices of our participants and with supporting data from the literature, what we had was evidence, and academic detailing is essentially turning evidence into practice more quickly. There's an off sided number that it takes like eleven or more years from.

33 "J. Ashenayi, MPH (they/them)" (1168678656)
00:10:24.229 --> 00:10:51.139
Research to turn into clinical practice, and people will die in the meantime, so we set out to kind of speed up that process. Academic detailing, is a unique form of clinician education. It is a series of short one on one meetings usually closer to ten to 20 min that borrow some of these same approaches that like pharmaceutical.

34 "J. Ashenayi, MPH (they/them)" (1168678656)
00:10:51.139 --> 00:11:18.169
Sales reps used and kind of starting this opioid of epidemic, but without this commercial agenda. So it's the semi structured open ended conversation that begins with the needs assessments moving into sharing key messages, features, and benefits tailored to the specific provider you're speaking to. Then we listen for barriers and objections and end with this small oh.

35 "J. Ashenayi, MPH (they/them)" (1168678656)
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Thank you. Can you see?

36 "Ables, Lee" (631639296)
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Great yes thanks Jay.

37 "J. Ashenayi, MPH (they/them)" (1168678656)
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You didn't miss too much, but it has the structure ending with some small agreed upon change for next time with this goal really being not to overwhelm providers by throwing everything at them at once, but by giving them small practical evidence based steps that they can act on today. We selected clinicians as this target population for the potential.

38 "J. Ashenayi, MPH (they/them)" (1168678656)
00:12:02.479 --> 00:12:22.479
Impact that they could have on improving health care access. Primarily according to our participants at emergency departments and free clinics was most important to them. And then later on, in part, because we were getting kind of a slow response rate, we expanded that to include non clinical staff and students.

39 "J. Ashenayi, MPH (they/them)" (1168678656)
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Prehealth students, who are much more engaged. These are often the 1st point of contact and they also have this ability to influence how patients are treated. We reached these folks, really from cold calls. We didn't have these existing relationships to begin with.

40 "J. Ashenayi, MPH (they/them)" (1168678656)
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So word of mouth referrals from other organizations was really important in getting that going. Our key messages, you can read these. They were set to be actionable, measurable, designed to move this practice one step closer at a time.

41 "J. Ashenayi, MPH (they/them)" (1168678656)
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To the safer care. Focusing on things like screening, milloxone, these are really common kind of harm reduction practices that you can incorporate. To measure impact, we used pre and post test surveys. The response rate for that again was low, one low.

42 "J. Ashenayi, MPH (they/them)" (1168678656)
00:13:23.899 --> 00:13:47.839
Lesson that we learned was to make that survey part of the visit itself. But in the end we found we had eight health care providers who participated. They tended to have a high baseline knowledge of harm reduction, but they really appreciated that this offering was unique, that this was not something that the aid had access to from anywhere else. We also had many more pre medical undergraduate students participate.

43 "J. Ashenayi, MPH (they/them)" (1168678656)
00:13:47.839 --> 00:14:05.609
Great, we adjusted the key messages for these to focus more on knowledge and less on practice, of course. But we found that students were really powerful messengers. They took what they learned back to their clubs and their workplaces and shadowing physicians and social networks.

44 "J. Ashenayi, MPH (they/them)" (1168678656)
00:14:05.609 --> 00:14:22.469
And so we saw some adoption of these key messages, but we also saw some exciting wins that we didn't expect. E.g., one hospital added safer smoking machines or safer smoking kits to the vending machine that they had at their clinic.

45 "J. Ashenayi, MPH (they/them)" (1168678656)
00:14:22.469 --> 00:14:42.469
And that's a shift that was small, but really meaningful. Lessons learned from this project, it's a start and even small steps like that matter. We learned that defining the audience was really key because this is a voluntary service, we didn't have the authority to like make.

46 "J. Ashenayi, MPH (they/them)" (1168678656)
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Candidates something like this. Every provider who agreed to meet with us had already given us that one yes, and so we're really starting on a good foot, which I think helped. I would also recommend partnering with well known organizations to help build credibility, especially offering CME credit, things like that. But the bigger questions that we had are, and I'd love for you all to consider this too, how can you approach like this be scaled up from these one on one meetings?

47 "J. Ashenayi, MPH (they/them)" (1168678656)
00:15:12.679 --> 00:15:25.199
And how can an approach be like this be used to improve access to health care for other populations, right? This is something with promise outside of just harm reduction.

48 "J. Ashenayi, MPH (they/them)" (1168678656)
00:15:25.199 --> 00:15:45.199
Lastly, I'll share a little bit about Nato's guide. Shred wasn't alone in this. This was part of a program with 19 sites across the US, including Shred. Nato brought these sites together and learned these lessons from our work and captured these in their new practical guide.

49 "J. Ashenayi, MPH (they/them)" (1168678656)
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For increasing heart reduction capacity through education and community collaboration. Say that ten times fast. But it has information on selecting your audience, developing these materials, conducting outreach, and evaluating the project. Again, selecting the audience is really going to be the core of how your program operates is based on who you're going to be talking to.

50 "J. Ashenayi, MPH (they/them)" (1168678656)
00:16:10.679 --> 00:16:30.679
You would choose an audience based on what you want to happen, based on your relationship. So like Shred's kind of struggled with some of this medical outreach. If you have those existing relationships, it would just be that much easier. Does the target population have the time and availability to meet with you? And can you incentivize.

51 "J. Ashenayi, MPH (they/them)" (1168678656)
00:16:30.679 --> 00:16:51.439
Is, that engagement, any gaps in knowledge or attitudes that the audience has barriers that might interfere. Medical settings are really kind of the traditional site for harm reduction academic detailing or for academic detailing altogether. But that's not the only audience out there.

52 "J. Ashenayi, MPH (they/them)" (1168678656)
00:16:51.439 --> 00:17:06.779
There with the potential to learn more, other sites across the country chose faith based leaders and police departments and fire departments and drag queens. It really just depends on that local context.

53 "J. Ashenayi, MPH (they/them)" (1168678656)
00:17:06.779 --> 00:17:28.759
Next up is developing responsive materials. Really the central takeaway I hope you get from this is that the meaningful engagement of people who use drugs is what makes this work. So we were able to bring to people together for focus groups and share photo voice with them and get these stories from them.

54 "J. Ashenayi, MPH (they/them)" (1168678656)
00:17:28.759 --> 00:17:49.529
That really were critical to making this program work. Part of that engagement looks like closing the feedback loop, so not just asking a question one time, but coming back and saying, ok, here's what we've got. Like, does this represent your story fairly? Really making this an iterative process.

55 "J. Ashenayi, MPH (they/them)" (1168678656)
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With these engagement, I will get to that. Thank you. With this engagement, draft your key messages, incorporate that local data, and then with all of this together, put together an action kit to really reinforce these key messages. Parts of an action kit could look like.

56 "J. Ashenayi, MPH (they/them)" (1168678656)
00:18:09.529 --> 00:18:35.329
Here on the left, Shred put together our own guide based on what people said. We had a document with the stories and the photos that we could really on that 1st meeting just sit down with and just get kind of a baseline understanding of people or people. Journals, scientific literature, things like that, local surveillance data, public.

57 "J. Ashenayi, MPH (they/them)" (1168678656)
00:18:35.329 --> 00:18:58.309
Patients, whatever else you have available. E.g., we had our, one of the key messages about NO lock zone, and so a supporting action kit material for that was having Narcoun to have on hand that we could give to the doctors that they could then give to their patients and not deal with the process of getting a prescription and jumping through all.

58 "J. Ashenayi, MPH (they/them)" (1168678656)
00:18:58.309 --> 00:19:19.109
All those hoops. Other sites beyond photo voice, which was resource intensive, other sites used things like a participant advisory board, key informant interviews where you sit down one on one with like a specific chosen expert over what these messages should entail.

59 "J. Ashenayi, MPH (they/them)" (1168678656)
00:19:19.109 --> 00:19:38.669
Focus groups again, surveys, really whatever you do to hopefully get that community engagement already. And then the outreach itself, this can look very different again based on who you're talking to if they're expecting academic detailing or not.

60 "J. Ashenayi, MPH (they/them)" (1168678656)
00:19:38.669 --> 00:19:56.219
For clinicians that might look like emails, cold calls, tabling up professional events, for non traditional audiences that might be a lot more of that tabling and that in person outreach or relying on personal referrals.

61 "J. Ashenayi, MPH (they/them)" (1168678656)
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What matters is tracking your contacts in something like a spreadsheet or or whatever else you would use, to keep track of what works and what doesn't. And so, e.g., with Shred, when we saw that cold calls and emails to clinicians were actually not working.

62 "J. Ashenayi, MPH (they/them)" (1168678656)
00:20:16.219 --> 00:20:37.469
Well for us. I suspect they just didn't know who we were and sent that to spam with the rest of it. Can't blame them. We found that cold calls worked better for these pre health students who were getting emails with opportunities all the time and we're looking out for that. And then for clinicians.

63 "J. Ashenayi, MPH (they/them)" (1168678656)
00:20:37.469 --> 00:20:57.469
We changed our focus a little bit to more of that word of mouth referrals. One clinician who had a great experience could get us in, maybe not for academic detailing, but for like a larger group training, a lunch and learn like this. Having that advocate though helped.

64 "J. Ashenayi, MPH (they/them)" (1168678656)
00:20:57.469 --> 00:21:07.619
And so it just really looks like being flexible, pivoting when you need to, focusing on chasing those successes.

65 "J. Ashenayi, MPH (they/them)" (1168678656)
00:21:07.619 --> 00:21:27.619
And then last evaluating the project. This is something you should be doing throughout, based on your organization capacity kind of from easiest to hardest. Just having that spreadsheet is part of your evaluation. Field notes that your detailers are taking with notes on what works.

66 "J. Ashenayi, MPH (they/them)" (1168678656)
00:21:27.619 --> 00:21:50.189
Dr. did they like this key message? Pre and post surveys are great if you can get survey responses, you know, find what works for you. Keep in mind that this long term change of incorporating behavior changes is slow. Our program lasted only nine months in total. This was just a.

67 "J. Ashenayi, MPH (they/them)" (1168678656)
00:21:50.189 --> 00:22:10.189
Short term pilot project. So you might not be around to see if those messages stick, but also consider these unexpected successes. Talked about the smoking kits in Shred's experience, but in Utah, e.g., detailers who worked with the fire department were able to establish their 1st statewide.

68 "J. Ashenayi, MPH (they/them)" (1168678656)
00:22:10.189 --> 00:22:39.209
Program. In Ohio, they were able to get harm reduction, literature placed in waiting rooms in a hospital system across the state. And so these wins matter too, and it's absolutely something that any of your organizations could do. I'll end with this, academic detailing isn't just about training. It's really about building these relationships to change systems.

69 "J. Ashenayi, MPH (they/them)" (1168678656)
00:22:39.209 --> 00:22:59.209
And so this nature guide is a practical tool. Read it, use it, but know that this real impact comes when communities like Erie County take it and make it your own. And so whether you're working in healthcare or law enforcement or public health or grassroots community organizations or whatever else.

70 "J. Ashenayi, MPH (they/them)" (1168678656)
00:22:59.209 --> 00:23:16.289
You have a role to play here in shaping how your community responds to drug use. So I'd love to invite you to think about who in Eri could benefit from something like this, what's a small step that you could take today to start that conversation.

71 "J. Ashenayi, MPH (they/them)" (1168678656)
00:23:16.289 --> 00:23:36.289
And really every step, it's a step by step process to bringing us closer closer to healthier communities. So happy to take any questions at this time. I see we've got a couple in chat. I'd love to continue supporting your work, important work in the space after today. So please feel free to contact.

72 "J. Ashenayi, MPH (they/them)" (1168678656)
00:23:36.289 --> 00:23:52.769
Me there and let me look through these questions believe I answered about medical providers. Thank you for sharing that photo voice. I really appreciate.

73 "J. Ashenayi, MPH (they/them)" (1168678656)
00:23:52.769 --> 00:24:12.769
Kind of that history of harm reduction too. Any other questions? Great. Well, again, thank you so much for inviting me here today. Wonderful to speak with your group. And again, if I can be of any.

74 "J. Ashenayi, MPH (they/them)" (1168678656)
00:24:12.769 --> 00:24:16.069
For other help, please don't hesitate to contact me.

75 "Ables, Lee" (631639296)
00:24:16.069 --> 00:24:22.088
Thanks so much Jay. You are awesome.

76 "Dieter, Angela" (81131264)
00:24:22.088 --> 00:24:47.106
Yes, I loved the photo voice that what a cool concept. I can't wait to look back at the slides again. Hopefully you can share those with us so we can, you know, look at those more closely. But thank you for sharing and hopefully we can continue this work together. Hopefully, next up we have our data analysts Jason Merlin, who will be sharing some overdose data from Irie County. I can hear.

77 "Lenus (she, her), Marilyn" (2214287616)
00:24:47.106 --> 00:24:54.689
Hear you? Yes, can you hear me? I'm Marilyn was gracious enough to lend me her her machine. So if I can be heard ok here? Yes. Great.

78 "Ables, Lee" (631639296)
00:24:54.689 --> 00:25:06.768
Yes, we can hear you and I just gave Maryland permission to be a presenter, so you should be able to, shouldn't be able to share. Yay!

79 "Lenus (she, her), Marilyn" (2214287616)
00:25:06.768 --> 00:25:21.799
Okay, it looks good, ok. Well yes, thank you jay. That was an excellent presentation and academic detailing is something that we've started to look into very very recently and that we're gonna touch on something related a little later. I very apologize apologize sincerely to the audience.

80 "Lenus (she, her), Marilyn" (2214287616)
00:25:21.799 --> 00:25:53.509
For my audio issues earlier. Hopefully we should be good from here. So let's get started with the data updates for Earry County as of September. So this is 1st we're gonna look at our overdose deaths to in total for the year and over time. This is cases reported through 23 September, so very recent updates. So far this year in 2025, we've had a hundred and 80 confirmed and probable overdose deaths. Of those 98 were confirmed to be opioid related.

81 "Lenus (she, her), Marilyn" (2214287616)
00:25:53.509 --> 00:26:13.509
46 were confirmed non opioid related and 36 are still waiting for a toxicology report. If we continue on at this pace, we are on track for another annual decline, from the 2024, overdose deaths, which was a significant decline from the, the year prior. So we're we're we're looking.

82 "Lenus (she, her), Marilyn" (2214287616)
00:26:13.509 --> 00:26:39.799
Looking at potentially coming in at about 250 overdose deaths for the year or potentially even less. So now we'll look at some overdose death demographics, look at the overdose deaths broken out by, by different age and race categories. So here what we're looking at is population adjusted overdose deaths by race by race and ethnic groups. So we're looking at population adjusted.

83 "Lenus (she, her), Marilyn" (2214287616)
00:26:39.799 --> 00:27:13.519
Debts among the black population, Hispanic population, and the white population, and what the population adjustment allows us to do is to see which groups are overrepresented and underrepresented among overdose deaths by controlling for the size of that population in the community. So we can see in this chart that goes back to 2020 over the past several years, the black overdose rate will be Yes, I see some questions about the shared slides being shared, I believe they will be. Over the past several years, the black overdose debt.

84 "Lenus (she, her), Marilyn" (2214287616)
00:27:13.519 --> 00:27:33.519
Population adjusted death rate has increased dramatically. Peaking out at roughly a hundred and 20 deaths per 100000 residents in mid 2024. So if you if you do the math on that, that's more than one out of every thousand members of our black community that were dying every year.

85 "Lenus (she, her), Marilyn" (2214287616)
00:27:33.519 --> 00:27:53.519
100000 or even less, more like 100 800 at a an alarmingly increasing rate. But fortunately, beginning around August of last year, we saw the death rate among the black population declined very significantly by more than and in all more than halved from a hundred and 17 debt.

86 "Lenus (she, her), Marilyn" (2214287616)
00:27:53.519 --> 00:28:23.159
Is for 100000 to 46 deaths for, for 100000. Now that still is a significant over representation compared to the population level, but significant we've come a long way from where we were a year ago and that disparity is starting to close. We see a similar trend although not as extreme among the Hispanic population, also has decreased significantly over the past year and white overdose deaths have decreased as well.

87 "Lenus (she, her), Marilyn" (2214287616)
00:28:23.159 --> 00:28:43.159
So debts are down across the board, but the most extreme decrease that we've seen is the decrease among the, the black community, which is very encouraging to see. Looking at age, this is the same population adjusted concept here, but broken out by age groups instead. We're gonna go from the bottom.

88 "Lenus (she, her), Marilyn" (2214287616)
00:28:43.159 --> 00:28:58.289
Down to the top here. So that bottom line is ages 29 and younger. And we can see that over the past year, that death rate has fallen although it was already our lowest our least affected age group and it has now fallen even lower.

89 "Lenus (she, her), Marilyn" (2214287616)
00:28:58.289 --> 00:29:18.289
The next affected age group, the purple line is ages 60 and older. That age group also had a significant decline in the past year after a pretty startling rise throughout 2023. If you have been an attendee at our previous task force meetings.

90 "Lenus (she, her), Marilyn" (2214287616)
00:29:18.289 --> 00:29:51.319
From the past year or two, you'll recall us noting this this this alarming trend of of of a substantially increased overdose rate among people aged 60 and older, but that has started to reverse as of the past year. Next we have the 30 to 3039 age group. That has group has had a very significant decline, more than 50 % over the past year and previously back in 2023 that was our most effected age demographic, the 30 to 39 age group in the orange line.

91 "Lenus (she, her), Marilyn" (2214287616)
00:29:51.319 --> 00:30:15.119
But it has fallen significantly below some of the other age groups. Next we have age 50 to 59. That's another age group that has seen a very, very sharp decline over the past year, used to be up there with our 30 to 39 year olds, back in 2024, roughly a very similar number, but it has fallen substantially.

92 "Lenus (she, her), Marilyn" (2214287616)
00:30:15.119 --> 00:30:35.119
The one age group where we haven't seen as significant of a decline, although we still have seen somewhat of a decline, is the 40 to 49 age group. This is one that we hadn't really focused on in prior in prior data presentations. But as of the past year, the, the, the population adjusted death.

93 "Lenus (she, her), Marilyn" (2214287616)
00:30:35.119 --> 00:30:47.429
Rate of 40 to 49 year olds has remained stubbornly high and has not seen the dramatic decreases that we've seen in some of the other age groups. So just interesting to note.

94 "Lenus (she, her), Marilyn" (2214287616)
00:30:47.429 --> 00:31:06.269
Now we'll look at toxicology. These are the substances that are detected by the medical examiner's office in overdose deaths, and these percentages are the average of the past six months of overdose deaths up to that point. So six month periods and the percentages of each drug category represented here.

95 "Lenus (she, her), Marilyn" (2214287616)
00:31:06.269 --> 00:31:26.269
So the 1st thing we'll look at is the blue line for deaths where both opioids and cocaine were detected. We've seen a significant decline, starting in 2023 but persisting and accelerating through 2024, where a year ago opioids and opioid and cocaines in conjunction was more than half.

96 "Lenus (she, her), Marilyn" (2214287616)
00:31:26.269 --> 00:31:50.689
For half of our overdose deaths, and now that's closer to about a 3rd. So we hope this trend continues, but it does seem to reflect a potential change in the drug supply of ofentinel and cocaine being found together less frequently. Opioids only being detected in absence of cocaine or other substances, has increased somewhat very much.

97 "Lenus (she, her), Marilyn" (2214287616)
00:31:50.689 --> 00:31:56.309
Loudly sitting at about a 3rd of our overdose deaths.

98 "Lenus (she, her), Marilyn" (2214287616)
00:31:56.309 --> 00:32:16.309
Cocaine only in the absence of opioids has increased from 13 % to 21 % over the past past year. And so that's a trend that we are monitoring very closely. It does seem like we're seeing general rise in overall stimulants related deaths, so we'll be we'll be tracking that throughout through the future.

99 "Lenus (she, her), Marilyn" (2214287616)
00:32:16.309 --> 00:32:47.609
And perhaps breaking out a new category here of stimulant related deaths, incorporating with anthetamines and other stimulants along with the cocaine deaths. Cause we've seen that that rise as we've seen opioids deaths deaths. And that other substances category has increased as well. That's things like infetamines, benzotazipines, and other things that aren't even controlled substances such as, you know, tylenolicy demennefine. Any other substances are in that, that group.

100 "Lenus (she, her), Marilyn" (2214287616)
00:32:47.609 --> 00:33:07.609
Yeah, tea greenish line, anything that does not contain cocaine or opioids. So we're seeing that increase and in general we're seeing kind of a more, a more diverse range of of of of substances in our death population. It used to be predominantly just opioids and cocaine, but now.

101 "Lenus (she, her), Marilyn" (2214287616)
00:33:07.609 --> 00:33:12.929
We're starting to see a much greater range of of substances.

102 "Lenus (she, her), Marilyn" (2214287616)
00:33:12.929 --> 00:33:32.929
So now we're looking at overdose deaths by zip code. We're looking at six month periods here by zip code. On the left is September 2024 through February 2025. On the right is March 2025 through August 2025. In September through February, the areas with the most depths were 142 oh seven, which is the black rock river side area.

103 "Lenus (she, her), Marilyn" (2214287616)
00:33:32.929 --> 00:33:52.929
14201, which is the lower west side of Buffalo and Allentown and 14215, which is the upper east side bordering chief Duaga. In the most recent six months from March through August. We see two of those zip codes pop up again, to 142 oh seven and 14215. But we didn't.

104 "Lenus (she, her), Marilyn" (2214287616)
00:33:52.929 --> 00:34:25.129
We see a significant increase in depths in West Seneca. We had seven overdose deaths in West Seneca, 142224 in the past year. And that was a rather significant increase and is something to to be monitoring. Other areas with high numbers of deaths are broadly the east side. We can see broadway, 14212 had six deaths in both time periods and broadly the east side sees sees overdose a lot of overdose deaths although it has a.

105 "Lenus (she, her), Marilyn" (2214287616)
00:34:25.129 --> 00:34:28.619
Decreased in recent months.

106 "Lenus (she, her), Marilyn" (2214287616)
00:34:28.619 --> 00:34:48.619
Now we're gonna talk about our a little bit about our forensic lab data. So, IRI county law enforcement will sometimes seize samples from from a crime scene and send that to central police, the central police services forensic laboratory to be analyzed to detect what substances are present in any, you know, any narcotics or any other illicit substance.

107 "Lenus (she, her), Marilyn" (2214287616)
00:34:48.619 --> 00:35:08.619
So, in 2025 so far we have had 72 samples analyzed, and here are some of the contaminants that have been detected. We can see the chart on the right is by month, and it's showing metatomidine BTMPS, and xylosine detections. So we had six metatomidine.

108 "Lenus (she, her), Marilyn" (2214287616)
00:35:08.619 --> 00:35:38.029
Detections. Metatobinine is another veterinary trancolizer similar to xylizing that we're starting to see pop up in the drug supply. BTMPS is like an industrial chemical that doesn't have any pharmaco pharmacological uses but it's something that we've been seeing pop up in the in the drug supply quite significantly. We've had twelve detections so far this year, three of which were in July.

109 "Lenus (she, her), Marilyn" (2214287616)
00:35:38.029 --> 00:36:02.479
So this is an emerging contaminant that seems to be present in our drug supply here in Theory County. We also had eight zylizing detections, which is another veterinary tranqualizer that has been that is known to be in the drug supply and has been for some time in Theory county. Hence the xyalzine test trips that we give out. So this is something that you can expect to see more of from us as we keep tracking these contaminants.

110 "Lenus (she, her), Marilyn" (2214287616)
00:36:02.479 --> 00:36:12.929
And see if there's any new ones that emerge. But for now the ones of primary interest are, are metatomadine BT and BTMPS.

111 "Lenus (she, her), Marilyn" (2214287616)
00:36:12.929 --> 00:36:32.929
So we'll look at the comparison of your county's overdose death numbers to the statewide trends. The CDC puts out overdose deaths by state showing a change over time. Their data was last, is through April is the most recent data point.

112 "Lenus (she, her), Marilyn" (2214287616)
00:36:32.929 --> 00:36:52.929
As of April, New York State had seen a 37 % decrease year over year from April to previous year, in overdose deaths. At that same point in the year, Eury county, was at a 29 % decrease. We have a little more current data so we can look through August. We are now at a nearly 40 day percent decrease year over year.

113 "Lenus (she, her), Marilyn" (2214287616)
00:36:52.929 --> 00:37:12.929
From, from overdose deaths a year ago. In the twelve months leading up to August of last year, so August 2023 to 2024, we had seen about 35 deaths per month. So that's more than one each day, very high number of overdoses. And in the past year from August 2024 to 2025, we've seen.

114 "Lenus (she, her), Marilyn" (2214287616)
00:37:12.929 --> 00:37:32.929
It's about 21 deaths per month, so still far too high, but that's a significant decrease, a 40 % decrease in just a single year. So our overdose deaths do seem to be lagging slightly behind state trends where you seem to catch up to the statewide decline a few months after they hit that benchmark, but it has been a very continuous.

115 "Lenus (she, her), Marilyn" (2214287616)
00:37:32.929 --> 00:37:55.009
Lying down for the past year, which is very encouraging to see. So we'll talk a little bit about our non fatal overdose reports. These are aggregated by our local high intensity drug trafficking area office, our Heida office, and tabulated by our, by our internal OHHR team, and we really have to thank Heida to.

116 "Lenus (she, her), Marilyn" (2214287616)
00:37:55.009 --> 00:38:25.710
Tremendously for all the work they do and getting us these reports on a daily basis. They enable us to do a lot of the work we do with case follow up and with mapping and all that. So thank you to our to our Heida office for that. This is showing basically our average report non fatal reports per day over the past several years. We can see we fairly consistently get about two or three report non fatal reports each day. We had an anomalous spike last September where it went up to about four or five reports per day.

117 "Lenus (she, her), Marilyn" (2214287616)
00:38:25.710 --> 00:38:45.710
Per day and often we see some level of seasonality where we see fewer reports in the colder months than we do in the warmer months. So we can see in the months leading up to where we see 15 March, we had less than two reports per day, so much fewer than we were than we typically expect. But since March in the past several months.

118 "Lenus (she, her), Marilyn" (2214287616)
00:38:45.710 --> 00:39:12.620
We've been seeing more and more reports, and now we're actually towards the high end of our range where we're seeing about three reports per day. So just to kind of give you an idea of the volume, it works out to be about a thousand reports per year. Looking at where these reports are occurring, this is another six month comparison. We got September 2024 through February 2025 on the left, March 2025 through August 2025 on the right. The most.

119 "Lenus (she, her), Marilyn" (2214287616)
00:39:12.620 --> 00:39:32.620
Notable zip code with increased reports, is 14206, which is the love joy area, which is just south of broadway, on the east side of Buffalo. There we saw a rather significant increase in over in in overdoses, in overdose reports. As always, we don't we know there is significant under reporting of overdoses. We know we're not getting the.

120 "Lenus (she, her), Marilyn" (2214287616)
00:39:32.620 --> 00:39:52.620
Full picture but based on reporting we're seeing an increase in in the lovedray area. Decreased reports, we see fewer reports in Chic Duaga in the Broadway area. So rather interesting that we saw reports go down in, in broadway, 14212. But in the zip code immediately to the south of that.

121 "Lenus (she, her), Marilyn" (2214287616)
00:39:52.620 --> 00:40:16.730
14206 we saw an increase. So, it could be activity shifting from that zip code to the other or it could be new pockets of activity popping up. Areas with consistent levels of higher ports, which we've talked about in previous task task force meetings. Broadly the the west side and blackrock riverside. So 142-011-4213 and.

122 "Lenus (she, her), Marilyn" (2214287616)
00:40:16.730 --> 00:40:30.810
142 oh seven. Those are a continu continuous block of zip codes on the west side of Buffalo including the Blackrock rubber side area, where we persistently see our highest levels of of nonbatal reports.

123 "Lenus (she, her), Marilyn" (2214287616)
00:40:30.810 --> 00:40:50.810
Comparing, overdose deaths to non fatal reports. So this is March through August with non fatal on the left and fatal on the right. There are several areas where we, we see more deaths than we would expect given the the the number of non fatal reports. So in these areas we see not.

124 "Lenus (she, her), Marilyn" (2214287616)
00:40:50.810 --> 00:41:17.210
A whole lot of non fatal reports, but we see a high number of fatals and that's 142-121-4215 and 14224. So the east side of buffalo border, Chicawap Chicagoaga, the Broadway area, and West Seneca. We see fewer deaths than we would expect in some of those west side zip codes, 14213, which is the Grandfarry area and 142 oh one, lower west side in Allentown.

125 "Lenus (she, her), Marilyn" (2214287616)
00:41:17.210 --> 00:41:44.390
There we have more non non fatal reports than we would expect given the number of overdose deaths. So, so yeah, some just some interesting comparisons there. I'm gonna talk very briefly about the prescription monitoring program dashboard, which is, this is a s a dashboard that's run by the New York State health department. It has 14 metrics related to opioid and venzodaskine prescriptions. It compares.

126 "Lenus (she, her), Marilyn" (2214287616)
00:41:44.390 --> 00:42:03.390
You can compare your county to other counties and it tracks improvement across these various metrics over time and our county is actually working with the state Health Department directly in order to obtain more detailed data on this. Actually ideally for the purpose of performance and academic detailing, like Jay explained earlier.

127 "Lenus (she, her), Marilyn" (2214287616)
00:42:03.390 --> 00:42:18.630
So a couple of the metrics that we are particularly interested in. 1st is essentially prescriptions of Beepron orphan that are prescribed continuously for six months or more. For those of you who may not be aware, Beepron orphan is a common opioid.

128 "Lenus (she, her), Marilyn" (2214287616)
00:42:18.630 --> 00:42:38.630
Opioid replacement therapy for medication assistant therapy that is intended to get people off of using other other opioids that they might get off the street. And so we're trying to, to get that, that number to go up. We want more people to be prescribed continuous beepnorfid prescriptions for.

129 "Lenus (she, her), Marilyn" (2214287616)
00:42:38.630 --> 00:43:11.670
Opioid used disorder, as opposed to shorter term prescriptions that you know that they might fall off of. So if we, if we see this metric go up it indicates that people more people are sticking with AMT MAT and that providers are on board. Another one of those metrics that we're interested in is opioid naive patients, so people who have never had opioid support before, who are prescribed more than seven days for with their 1st prescription and that metric is an indication of potentially for of overprescribing.

130 "Lenus (she, her), Marilyn" (2214287616)
00:43:11.670 --> 00:43:30.090
So for that 1st metric, it had not changed from year to year, but New York State rated us an area of low concern, so that's a good thing. For 2nd metric, New York State says that we that we improve from year to year and that we are this metric is of moderate concern.

131 "Lenus (she, her), Marilyn" (2214287616)
00:43:30.090 --> 00:43:50.090
So you might be hearing about more of these metrics in the future from us, and we're gonna be using some of this this hopefully more advanced data that we can get from New York State to do some academic detailing potentially with some of our providers. I'm gonna briefly briefly go over some of our heat map updates, where we look at overdosea of.

132 "Lenus (she, her), Marilyn" (2214287616)
00:43:50.090 --> 00:44:14.450
Frequency across the city of Buffalo. So many of you have seen these before if you've been to past these past meetings. But our data source for these is once again Heida. Hida aggregates all of our law enforcement reports and emergency service calls. We get both fatal and non fatal reports although about three quarters of them, 75 % are non fatal. They send us to them on a daily basis.

133 "Lenus (she, her), Marilyn" (2214287616)
00:44:14.450 --> 00:44:41.240
Basis, how to determines which calls are OD OD events, they screen them and they send them over to us. Heat maps are specific to a location and a time period, and we're gonna be looking at eight week periods within the city of Buffalo. If you haven't seen these before, a helpful analogy for how these work is you can think of an overdose report as like a pebble dropped in some water that makes ripples, and we can show where wribbles overlap and the more ripples that overlap, the hotter the cluster is going to appear.

134 "Lenus (she, her), Marilyn" (2214287616)
00:44:41.240 --> 00:45:06.170
And we use the color scale of yellow to red to to display this. So here is an overall view of the city and I'm gonna look at each different sub region of the city and we can comp draw some some comparisons. I'll try and go quick cause I know we're short on time. So 1st we're gonna look at the north northern region of the city of Buffalo. This includes blackrock Riverside.

135 "Lenus (she, her), Marilyn" (2214287616)
00:45:06.170 --> 00:45:26.170
North Buffalo and the University Heights area. So if we look at the area labeled A, this big circle just north of Buffalo State University, we see in the previous eight week time period from June in June and July, we had a cluster near the intersection of military Road and amperst Street.

136 "Lenus (she, her), Marilyn" (2214287616)
00:45:26.170 --> 00:45:43.200
And then another smaller cluster near hurdle in Elmwood, and then in a later time period in that circle A, we just see one cluster that's kind of between the two and that's set to directly on the intersection of the military and hurdle. So lately military and hurdle has been a a significant hot spot.

137 "Lenus (she, her), Marilyn" (2214287616)
00:45:43.200 --> 00:46:03.200
If you look at the circle labeled B, in the earlier time period in June June and July, we saw a very significant cluster around the Amherst street station on main street. So that's right near the intersection of main Street and Amherst right around that rail station. We saw a very significant very centered cluster. In the later.

138 "Lenus (she, her), Marilyn" (2214287616)
00:46:03.200 --> 00:46:20.880
Time period, we see a decreased activity. We do see a cluster a very small cluster right on the Street station. And we see another one nearby right near the 33 and, and the ECMC. So kind of the activity there kind of diffused a little bit.

139 "Lenus (she, her), Marilyn" (2214287616)
00:46:20.880 --> 00:46:40.880
If we look at the area labeled C, that is in riverside, right near the intersection of Vulcan and skilling. And we can see that was a very significant cluster in June July, not so much in August September. And lastly D, we see a cluster that's a long.

140 "Lenus (she, her), Marilyn" (2214287616)
00:46:40.880 --> 00:47:05.210
Bailey Avenue between East Amber Street and Windsbir. That's a new cluster that we see in the current and recent weeks that we haven't seen that we didn't see earlier in the summer. Next we're gonna look at the east side of Buffalo and South Buffalo at the same time. 1st, we'll look at A A is in South Buffalo. We see, a, a cluster that moved north.

141 "Lenus (she, her), Marilyn" (2214287616)
00:47:05.210 --> 00:47:25.210
And gained intensity. So that in the earlier time period that was closer to tiffed street. So a little further down in South Buffalo later on I shifted further north, like right over the Buffalo river, like right when you get into South Buffalo, closer to like, you know, McKinley Parkway, South Park Avenue, you know, further up.

142 "Lenus (she, her), Marilyn" (2214287616)
00:47:25.210 --> 00:47:46.490
North. If we look at B, that's that's includes the intersections of Broadway and Bailey and Bailey and Williams Street. And we see in June and July we had a significant a significant cluster right near Hennethan Park and East love joy. So that area in.

143 "Lenus (she, her), Marilyn" (2214287616)
00:47:46.490 --> 00:48:06.270
South of broadway. That's where we saw a significant cluster there in the looking at B in the later time period in August September, we still see a cluster right up right near East Lumprove street in Hennan Park, but we also see see another cluster right near the Broadway and Bailey intersection.

144 "Lenus (she, her), Marilyn" (2214287616)
00:48:06.270 --> 00:48:26.270
So that's worthy of note. In, the area labeled C, we see a cluster that's right near Clinton and Bilmore and Francheck Park. That was around a significant cluster earlier in the summer, not really any activity there later in the summer. And lastly D.

145 "Lenus (she, her), Marilyn" (2214287616)
00:48:26.270 --> 00:48:45.060
We had some activity in the delevant grider area that shifted around a little bit. So, activity towards the pine Hill area that is pretty consistent in both in in both time periods, and then lately we saw some activity pop up near where the 33 comes into cu meets ECMC.

146 "Lenus (she, her), Marilyn" (2214287616)
00:48:45.060 --> 00:49:05.060
I'm looking at this kind of the center of Buffalo downtown and the west side. If we look at A, the area A is basically Niagara street, the lower on the lower west side. We can see earlier in the summer tons of activity all along Niagara Street.

147 "Lenus (she, her), Marilyn" (2214287616)
00:49:05.060 --> 00:49:25.760
Pretty pretty diffuse throughout the west side. We saw it to settle down quite significantly later in the summer where those clusters were mostly around prospect Park and the intersection of Niagara Street in Carolina street. So we kind of saw the the activity on the lower west.

148 "Lenus (she, her), Marilyn" (2214287616)
00:49:25.760 --> 00:49:54.500
Side calm down and kind of condensed into two distinct areas as opposed to being kind of very widespread and intense along the entire area. If you look at B, that's downtown near Lafayette square. Yeah, I know I'm wrapping it up. Yeah, so activity settled down in in area B and area C that's an area near Wazworth street, between Symphony service.

149 "Lenus (she, her), Marilyn" (2214287616)
00:49:54.500 --> 00:50:14.500
And Days Park that we saw some new activity. Area E is made in Nudica made a new to go, we saw a significant increase in activity. That's one of our typical hotspots that was was actually really strange that we didn't see activity there earlier in the summer. And in area D we're seeing ah broadly activity pick up on the west side, particularly in your hampshire.

150 "Lenus (she, her), Marilyn" (2214287616)
00:50:14.500 --> 00:50:37.489
Street. So that's about it for me. If you would like to see more heat maps, please come to one of our webinars. The next one is on 1020. You can, follow that QR code and I'm gonna put a link to the, to the, to that in the chat, and thank you very much.

151 "Dieter, Angela" (81131264)
00:50:37.489 --> 00:50:46.787
Thank you Jason. Do we have any I don't have the ability to see what's in the chat, Lee I'm not sure if we have any questions lingering in there.

152 "Ables, Lee" (631639296)
00:50:46.787 --> 00:51:06.090
We do have one question from dr. Burstine. Where do you find more deaths compared to non fatal overdoses? Have you looked at the top screens in the high overdose death rate areas compared to other overdose areas?

153 "Lenus (she, her), Marilyn" (2214287616)
00:51:06.090 --> 00:51:23.690
We looked at the talk screens in high OD death rates areas compared to other OD areas. Oh, like in terms of the substances that are detected, NO, we have we had I don't yeah, so we have, we haven't looked at it in that way. We haven't looked at the, the, the non.

154 "Lenus (she, her), Marilyn" (2214287616)
00:51:23.690 --> 00:51:43.690
Ratio and using that to kind of and using kind of looking at the talk screens to predict that that is would be worthwhile to do, however, and fortunately we have a brand new intern who was interested in doing that kind of work. So we will definitely look into that and put together a report for you.

155 "Ables, Lee" (631639296)
00:51:50.605 --> 00:52:00.180
Any other questions at all for Jason?

156 "Dieter, Angela" (81131264)
00:52:00.180 --> 00:52:22.140
If anybody has any other questions, feel free to email our bridge area email address, questions, comments, concerns, any trends that you're seeing in your communities or your work that you're doing in, you know, boots on the ground and stuff. We love as much data as we can obviously, you know, get and compare.

157 "Dieter, Angela" (81131264)
00:52:22.140 --> 00:52:42.140
But we hope that this was beneficial for you. This is our 1st one, so thank you for being patient and bearing with us with these technical difficulties. We promise that moving forward things will be a lot smoother, and hopefully we can have some open dialogue about some of the stuff that's going on. You can find any of our.

158 "Dieter, Angela" (81131264)
00:52:42.140 --> 00:53:02.140
Future presentations either on our website. There's a QR code there. There's also, like Jason had mentioned, he has some data webinars where we can share some of our data with you in our maps. That's something that you're interested or you and your organization want to jump on board. We're happy to share that with you.

159 "Dieter, Angela" (81131264)
00:53:02.140 --> 00:53:22.606
You all as well. And then any other cool things that we're doing in the office of harm reduction, please visit our website wish we are in the middle of revamping, which is kind of exciting. Yeah, Lee has been a huge part of that, so proupts to, to them and we look forward to our next meeting next month. Thanks everyone.

160 "Ables, Lee" (631639296)
00:53:22.606 --> 00:53:29.881
Thanks so much everyone.

161 "Dieter, Angela" (81131264)
00:53:29.881 --> 00:53:34.080
Okay.