 I'm your host Winston Welch and I am delighted that you are joining us today for this out-and-about show special edition where we're every other week we explore a variety of topics, organizations and events with the people who fuel them in our city, state, country and world. As a disclaimer, any views or opinions expressed by me are strictly my own and not connected with any organization. Joining me today in the studio I am honored to have Leilani Maxera, Overdose Prevention Manager with the Hawaii Health and Harm Reduction Center whose motto is reducing harm, promoting health, creating wellness and fighting stigma in Hawaii and the Pacific. Welcome to the show today and thanks again for being my guest. Thanks so much for having me today. So this is a very great time you guys have been on the show before. You do wonderful work. How long have you been with HHHRC? Well personally I've worked with the organization for about four and a half years. Okay, so you were there before it merged with the two? Yes, so we did merge about it's been a little over a year previously. We were two separate organizations, Life Foundation, which was known as the AIDS Service Organization for Oahu, the main one. And then the CHOW Project, Community Health Outreach Work, to prevent HIV AIDS. And we were mostly known for being the syringe exchange for the state. So your services are not just on Oahu, they are statewide? Our syringe exchange services and our overdose prevention program are statewide. A lot of our other services are only on Oahu, so we do HIV testing, hep C testing. We have a smoking cessation program, we have HIV case management, we have a transgender services program. We have a lot going on. We have almost 60 employees, but the majority of our services are just Oahu based. For syringe exchange and overdose prevention, we have staff on Oahu, Hawaii, Maui, and Big Island. Oh, okay. So you're basically statewide except for Molokai and Lenai. And we can work with them if need. Okay, and so you are the manager of overdose prevention. What does that entail? What is that? So the syringe exchange program started first and our overdose prevention program was born out of that. The syringe exchange program, we're actually celebrating 30 years of syringe exchange in Hawaii this week. And our overdose prevention program, though the whole time we've been doing syringe exchange and education around drug use with our participants, we talked about overdose prevention. It was only in the last two and a half years that the, almost three years now, the drug naloxin has been legal to carry for lay people in the state and that we've been able to distribute it. And what naloxin is, is an overdose reversal drug for people who overdose on an opiate. So that's very much expanded our overdose prevention program and allowed us to do trainings and give that out for free to people. So does Hawaii have a really big drug problem? How is it compared to the rest of the nation? In terms of, and you've probably seen this, if you pay close attention to the news, a lot of news about opiates in the past several years, in terms of Hawaii actually opiates are not the main drug of choice here. So when you look at opiate overdose, we actually are quite low in terms of the numbers per capita. A few years ago, before naloxin program started, we were at 43 out of the state's overdose numbers from opiates. We were at 43rd in the country. Now we're at 50. It's out of 51 because it includes Washington, D.C. So our rates of opiate overdose deaths are actually quite low compared to many other states. We do have opiates here, but ICE or otherwise known to many people methamphetamine is our main drug of choice here in Hawaii comparatively. So we, but we are seeing issues with opiate overdose that is accidental also for people who think they're only taking ICE because we do have an issue with fentanyl being found in all drugs no matter what they are. So people may accidentally take an opiate when they did not necessarily mean to. And that's an issue we're seeing countrywide is fentanyl contamination in the drug supply. Oh, it's interesting because this week you said we're celebrating International Overdose Awareness Day. Yes, we are. And internationally it's celebrated on the 31st, which is Saturday. But this in Hawaii, we're going to do a different day. Yeah, so we're celebrating on the on Thursday, which is the 29th instead of the International Day of the 31st because it falls on a weekday. And it was easier for us to get a venue and to get people to be able to work for us at the event, et cetera. So we're celebrating a little early and it's also because we decided to do the event in conjunction with our 30 year celebration of syringe exchange. So we'll be celebrating both in one day. So celebrating that we've had this program there that have saved so many lives and helped so many people in its harm reduction approach and maybe recognizing and being aware of the International Overdose Awareness Day. But it's both of these. Where's this going to take place? So the event is going to be at Harris United Methodist Church. It's on Numanu and the Cross Street close by is Vineyard. And so it's going to be 1130 to two. And so what we're going to be doing for the event is we're going to have lunch served for fits, events completely free and no need RSVP. We're going to have lunch served and then we're going to have opening remarks from the Department of Health and our executive director. We're going to be debuting a actually a short documentary that's being made about the history of syringe exchange in our islands. And then we're going to have a panel with people who were there from at the beginning who helped to get the syringe exchange started here and then people who do currently also work in syringe exchange to talk about how it's changed. We are also going to do naloxone trainings for people. If someone does not have a naloxone kit, they can come that day, get trained individually by one of our staff and take home an overdose prevention kit with them. We're also going to have a memorial set up to honor the lives of people we've lost to overdose. We do this every year and you can come and add a name if you would like the memorial as well. And for someone that would be coming to get a naloxone kit, are these family members of a user or is it mostly for law enforcement? So we recommend that anybody who has any sort of every community member actually we really recommend people get a naloxone kit. We really focus on getting the kits out to the drug using community. So our participants of the syringe exchange and their loved ones because who's more likely to be present when somebody overdoses. It's going to be other people who use drugs and their loved ones, family members, people they live with. We also focus on training service providers in social services. So people at treatment centers, people at the houseless shelters and other nonprofits that work with the community we serve. We also have trained some of the police departments, they carry naloxone. Maui Police Department actually has had several overdose reversals with naloxone that we've given them that they have actually come across people who've overdosed. But really anybody who may come in contact with someone who's overdosed even if you just live in Chinatown and you're walking down the street, we have had one individual who's reversed two overdoses on separate occasions just walking down the street and coming across someone who's overdosed. It's really powerful and I think it's important to remember that these are diseases. These affect the mind and the body in ways that are very complex. And well, we'll get into the pros and cons of that later, but can you tell us how do the... And one of your things is fighting the stigma in Hawaii and the Pacific so that people can have access to resources and harm reduction. Can you tell us what is harm reduction? Well, harm reduction is something that we all use in our everyday lives and it's just what it sounds like, reducing the harm of things that hurt us. So every day we each do something that we know is bad for us and we do it anyway. If you drove here today, you put your seatbelt on. If you rode a bike, you put a helmet on. So harm reduction is really what we use every day in our lives. We all do things we know have negative consequences. The difference with harm reduction in the work that we do is that people oftentimes see drug use as a moral issue. So it's hard for them to discern the differences when in reality we're trying to do the same thing, is reduce the harm of activities that hurt us. And what would some of those tangible results be from this program? So the most basic definition of harm reduction is any positive change. So if we're working with folks to create any positive change in their lives, that's much better rode to go down than abstinence-only education. Because when you use abstinence-only education, you're telling people, stop what you're doing is bad, you're a bad person. You're not giving them the tools they actually need to make change in their lives. And so if I'm counseling somebody and we're talking about their use, and we call ready for change, because someone's not ready for change, nothing's going to stick. Like if I decide I want to make any sort of change, I want to start going to the gym every day, starting tomorrow. And I'm not really ready for change. It's not going to happen, right? So what we do is we use motivational interviewing and other techniques. When we work with folks to elicit where they're at, we have to meet them where they're at, not where we're at, not what we think is best for them. What they think is best is usually we're going to start because they know what's best for them. And so sometimes that might look like, oh, so you're looking to make a change and use less. So if you shot up 10 times yesterday, let's try what would it look like for seven tomorrow, and make small incremental changes with folks. And then sometimes they're very much ready for change, and they want to quit that day. And that's fantastic too. But we meet people where they're at so that we can match how our interventions and our referrals with what they need at the time. So you have case managers and people come in and they, whatever their health or housing or mental condition is, you have our physical health, you have case managers where you can connect them with appropriate services. Well, I'd love it if we had funding to have more case managers. We mostly have outreach workers. And so the folks we work with, they come to us, they come to the syringe exchange and talk to our syringe exchange outreach workers, and we build rapport with people. So there can be times where actually we have folks we serve for years. We never know their real name. We're an anonymous service, and we're anonymous so that people can feel comfortable trusting us and coming to us. And sometimes people right away tell us their story, tell us their name, we build a rapport quickly, and when they're ready for a referral, we'll make that. But sometimes it takes much longer. A few years they'll come, they'll start talking story with our folks, finally tell us what they need. And so they work with my outreach workers quite a bit. We can do referrals to other services outside of the agency. And now that we've merged, one great thing about our organization now is that we have tons of services within one agency to refer to. And we do have a certified substance use counselor. We can refer folks who are ready to go into treatment. And so tell us about the mechanics of this. Do they come down to your headquarters or do they meet a van? Or how can they find out information about a syringe exchange? So on Island, on Oahu, we actually have two outreach fans, one parks in Chinatown, Monday through Friday during the day. Where is that? And that's 9 AM to 2 PM downtown. And then we have another van that each day of the week, it goes to a different part of the island. And that's really to reach the folks that are the most vulnerable who can't make it in to see us. So if somebody's North Shore living under a bridge, we're going to go to them. And so we go Waikiki in town, West Side, North Shore, and then Wynward, different days of the week. It looks a little bit different on the neighbor islands because we actually have much less people that use our services on the neighbor islands. We only have one outreach worker on Kauai and one on Maui, and they're appointment based. So they don't have a set place they go. They get calls and people come meet them. And then on Big Island, Hilo side, we have a outreach worker that does hark several different places. We have our schedule published on our website. And then also you can call. They have a voicemail that changes every day where they're at. And what is your website? It's hhhrc.org. Hhhrc.org. So, hhhrc.org. And then quickly in Kona, we actually work with HiHaf, which is Hawaii Island HIV AIDS Foundation. And people can go to their office to exchange. Sorry, I just wanted to get that in. No, thank you. And I suppose that information is also posted on your site as well. Yes, and we have the phone numbers for each island. You can call for services. Well, when we get back, I suppose we'll take a look at some of the photos that we have about the actual mechanics of the exchange and then some other things that bring us into awareness about this issue that's, I think, the most shocking thing I read earlier this year was that for Americans under 55, it is overdoses the leading cause of death. Is that true? I think it is. Which is, it was in time, or news week, so we're going to go with that that's not fake news. And so this is enormously high accidental death, I suppose would be a better way to say that, but that these are part of the diseases of despair and that these are affecting all races, all ages, all ethnic groups, all socioeconomic levels. And I'm actually glad you brought up that term. It's not a widely used term, diseases of despair, deaths of despair. It's absolutely true. And in Hawaii, one of the overdose deaths are one of the main causes of accidental death in our state. And then one of, and they're also one of the top in causes of injury related deaths in the state, but also suicide. And those are both considered deaths of despair, which we really need to look at as a society why these rates, suicide rates have skyrocketed. Not just in Hawaii, but all over the country. And we really need to look at why people are turning to drugs more often, why are people thinking there's, having such hopelessness as well. It's a really important topic. I'm so thrilled that you're here today to share with us in the very important work that you do. I, we've got to take a short break. I'm Winston Welton, a host of Out and About on this Think Tech Livestreaming Network series where you will always find the most interesting guest and host and topics that are really relevant to our lives here. Today we are especially pleased to have Leilani Maxera who's the overdose prevention manager from Hawaii Health and Harm Reduction Center. We'll be back in a minute, so stay tuned. Thanks to our Think Tech underwriters and grand tours. The Atherton Family Foundation. Carol Mon Lee and the Friends of Think Tech. The Center for Microbial Oceanography Research and Education. Collateral Analytics. The Cook Foundation. Duane Kurisu. The Hawaii Council of Associations of Apartment Owners. Hawaii Energy. The Hawaii Energy Policy Forum. Hawaiian Electric Company. Integrated Security Technologies. Galen Ho of BAE Systems. Kamehameha Schools. MW Group Limited. The Schindler Family Foundation. The Sydney Stern Memorial Trust. Volo Foundation. Yuriko J. Sugimura. Thanks so much to you all. Oha, we are back and we're live. I'm Winston Welch and this is out and about on the Think Tech Live Streaming Network series talking with Leilani Maxera, the overdose prevention manager from the Hawaii Health and Harm Reduction Center. And this week we are honoring those who are on this path and who are working, we're celebrating 30 years of syringe exchange here in Hawaii and also seeing that this is international overdose prevention, I'm sorry, international overdose awareness day. And today, normally internationally we celebrate on the 31st, here we're gonna do it on the 29th. We're celebrating on Thursday the 29th. Thursday the 29th at Harris Methodist Church from 1130 till two. So if you're just, if maybe you've got a loved one who is using or you're using or what are you just curious about with the community? Yes, we would love it for folks to come. You don't have to RSVP, but yes, if people are worried about themselves or a loved one and they'd like to come get overdose prevention kit for, which is naloxin that can reverse an opiate overdose, we will have them for free. Or just anyone in the community who wants to talk about these issues, many people have lost loved ones to overdose and we invite everyone to come and learn more about our services, celebrate 30 years of syringe exchange in our islands and also be there to pay tribute and give love to the folks we've lost from overdose. Yes, and that's part of it is that because this is every age group, it's every race, it's every ethnicity, it's all socioeconomic levels hitting some folks harder than others that you would typically might expect. But I think since it is the leading cause of accidental death in the nation, obviously it's going to be affecting us and you hear about it, it's something that your organization is right on the front lines helping. So how does this work? Let's say I'm a user and I've got this needle and I don't wanna share it with somebody else because I don't want to get or transmit HIV or hep C or anything else and I just wanna clean needle. How does this work? So we are a one-for-one syringe exchange, it's actually written into the statute that in order to get a clean syringe you must give us your dirty one first. And so if people want to come to see us, it's an anonymous exchange and we do ask some questions of ethnicity, age, et cetera for our own data purposes and we give people a card that they use that is also anonymous but it has a number so we can kinda keep track of how many times people come. We do a yearly evaluation. The newest one which is available on our website is from 2017, the 2018 one is coming out soon and so we do try to get some data from our folks but it is anonymous and so people come to us and you can refuse as well if you really, really don't even want a number that's okay, we'll serve anyone who wants to exchange and so when someone comes to us, we count how many syringes they have, ask which ones they want, exchange the dirty syringes for clean ones and then also other things they may need so we have other harm reduction tools, we have condoms, lube, we also give out things like pipe covers, a lot of folks actually smoke out of glass pipes and it's a hepatitis C risk. If you have an open sore blood on your lips and you share with somebody else, things and other things that go along with injection drug use that could get blood on them, we also give out snacks when we have water but also referrals to other services so if someone comes to the van and they want housing or mental health services, if they wanna know where to go to get their IDs, we talk story with folks and give them referrals to the other things. I think we have a picture of the van here that goes out and it's in Chinatown every day, you say, oh, in fact- Monday through Friday. Monday through Friday and this is a picture of the surgeon general Jerome Adams, I believe. Yes, Dr. Adams, yes. And what's he doing here? Just seeing how it works. So this was amazing. We actually were so blessed to have him come visit us a couple of weeks ago. So he was coming to the islands to do several visits. He went to the medical school to give a talk. He visited other services on the island but he is very supportive of syringe exchange. He was the state, oversaw the state Department of Public Health under Pence when they had that HIV and hepatitis C outbreak several years ago. And what happened there is we saw what really what happens when a state hasn't legalized syringe exchange and people are sharing syringes. So we had whole communities that were drug using that ended up HIV and hep C positive because they didn't have access to sterile syringes. I think one of that here, as I just Googled, when our current vice president was Governor of Indiana, we had a mass outbreak. And this is an interesting one because they went back and they did a statistical mathematical modeling of how many cases would have been prevented and they said it should, it would have been 10 cases or fewer if they had a syringe exchange program based on all the data that they could crunch and compare to this. Instead, 215 people became HIV infected and probably a lot more with hep C because it's a lot more infectious disease. Yeah, we saw a lot of co-infections there with hep C and HIV. And for us, because the people that came together and saw it was the governor's task force on AIDS, they came together, members of that, they really heard about syringe exchange happening other places and they really very quickly jumped on the bandwagon for that and were so lucky that they had the foresight to know that this would be a good prevention tool here in Hawaii because we actually have half the prevalence rates of HIV in our drug-using community, then there is nationally. And you can attribute that probably almost directly to needle exchange. And how many states do you have needle exchanges? I think right now it's legal in, I'm sorry if I'm wrong on this, 43 states. There's still some states that are, it's just becoming legal. There's places like Indiana where when they had the outbreak, it wasn't legal and then they legalized syringe exchange and some counties brought it in but it's still not fully legal. And a lot of states also, like they had issues in Indiana, aren't following best practices either. And so that's really important in terms of meeting people where they're at, having it run in a way that's user-friendly so that folks actually will come for the services, which includes things like they were doing when they first brought syringe exchange to Indiana. There were places where the police were present during syringe exchange, which made people afraid to come. And even with us, one thing that Dr. Adams was, I mean, it was an amazing visit because he asked us so many questions. I mean, he just, you saw from that picture, he just jumped right in the syringe exchange van and went through our things. He asked us a lot of questions about our syringe exchange and one thing is we are a one-for-one exchange. We have to get to get one back to give one out. Yeah, and many states, that's not the case. They give people what they need and ask for. So that's something we discussed with him. That's considered a best practice because a lot of things happen with our folks. They do, you know, their bags get stolen, you know, their homeless, their stuff gets stolen or maybe they got caught up in a sweep, in a park and their things got taken. And so a lot of times they don't have one to exchange. One thing we're lucky for is that we do have a law here that you can purchase syringes at a pharmacy without a prescription. But the only problem with that is it's not called this, but it's essentially a morality clause where the individual pharmacist working at the time can refuse to serve you. And so unfortunately, that's something we need to look at changing for sure in the future, but it also means that we don't have true, full access for folks who need a syringe. Hopefully you're getting a pharmacist who is actually moral and realizes that he or she is doing the best thing for the patient. Now, I saw that like when you were saying the needle exchange is here, there's a 2012 study published in the journal Drug and Alcohol Dependence Comparing San Francisco, a city with needle exchange to Miami, a city without needle exchanges and more than eight times as many syringes were found on the streets of Miami because, and drug users were just throwing the needles everywhere compared to San Francisco. We got a couple more slides I did want to cover just to touch on these because this is the naloxone kit that you will have available on Thursday. So that is what we give to folks for free. We just train you how to use it. To prevent an overdose. To prevent an overdose. Or to help prevent. Or to help prevent an opioid overdose. It's an opioid overdose reversal drug. Okay, and we got another couple slides here, which is the pros of needle exchange. We'll just quickly read on these. There's lower numbers of contaminated needles in the community. Reduced drug related behavior. Reduced sexual risk behavior. Increased access to drug treatment referral services. Increased access to testing and diagnostic services. Increased access to education, substance abuse and increased communication with hard to reach population. And reducing the prevalence of new infections. A lot of people will say, this is immoral to do this. We're not going to give them the time of error today. They can Google that and decide that this isn't, okay. But we've got a couple more slides on here. Because this is international overdose awareness. Let's call it weak. But you can see the number of deaths per 100,000 went from three in this nation to about 14 per 100,000 just in the span of 20 years, which is incredible. That's opioid deaths alone. This is not the other overdoses. But we've got another slide that does talk to us about the other overdoses. We have alcohol overdose, which is a major, probably the major drug in our society that happens. For sure, alcohol is the drug of choice here. Much more people are drinking alcohol than using opioids. And in the toxic levels. Depressant overdoses, you mentioned were things like. Benzodazepine, other types of sleeping pills that aren't opiates. Sleeping pills. And opioids are heroin. Oxycontin. Oxycontin. Basic methadone, anything that's opiate derived from the poppy plant. And psychoactive, we won't get in too much in that. And stimulant overdose is the methamphetamine, crystal meth, ice. But, and you said also earlier when we were talking, the alcohol and the depressants. So people taking alcohol and then maybe shooting up. So mixing alcohol or other depressants with an opiate is one of the main ways people can overdose. Heroin and other opiates are already depressants. And so if you just, if you add more depressants into the mix in your body, your heart rate, your breathing goes down. So it's a, you know, we really recommend to folks not to mix those things if possible. Don't mix it. And we've got one final slide, if we can come up with there is that here it is. Time to remember, time to act. And I like this slide because it shows, you know, a man and his kid probably. And because this is affecting all members of our community. We have a lot of work to do here, but it sounds like Hawaii has a model program and with wonderful people like you that are in charge of this thing and all of the wonderful co-workers that you have who are right on the front lines of our society. I think you personally for the work that you do, it's so important, so critical. Thank you, thank you. And I really just respect your career choice and the choice of the great people that you work with at the Hawaii Health and Harm Reduction Center. Thank you so much. Unfortunately, we are out of time. Will you come back again and maybe we can talk some more on this? I would love to. Okay, that would be my great pleasure because you are inspiring to me and a lot of people that are out there today. So they can go to hhhrc.org for more information. Yes, and we'd love it if they came to our event on Thursday, August 29th, 11.30 to 2 p.m. at Harris United Methodist Church. Okay, and that's on Niuwano and Vineyard roughly. Well, sadly, this is another wind-up of out and about. We have been talking with Leilani Maxara, the overdose prevention manager from Hawaii Health and Harm Reduction Center and the very great work that they do for our community. Thank you again, Leilani. I look forward to you coming back. We thank you, our guest, for tuning in every week and we welcome your feedback. Thanks to our broadcast engineer who wore many hats today, Mr. Robert McLean and our executive producer, Jay Fidel, who puts it all together. I'll see you every other Monday here on Out and About. Be well, be happy, get involved with your community. Aloha.