By Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD
An interview with Adriane Apicelli, MSW, Project Manager, Harm Reduction Projects, University of New Hampshire, College of Health and Human Services.
Tags: Harm Reduction, Detailing Visits, Evidence-Based Medicine
Anna: Hi, Adriane. Harm reduction is deeply meaningful to many individuals – can you share why harm reduction is meaningful to you?
Adriane: The core principles of harm reduction, such as self-determination, mutualism, and self-advocacy, resonate with my personal and professional values. I firmly believe that individuals are the experts in their own lives, and it’s essential that people have access to the necessary resources, materials, and support systems to ensure their safety and well-being.
Harm reduction also offers a powerful framework that facilitates a shift within communities that moves away from moralization and stigmatization of individuals who use drugs. It’s easy to blame individuals for their behavior, but it’s far more challenging to critically reflect on how systems and decisions put people in those circumstances in the first place.
Anna: By embracing harm reduction principles, people within our communities can foster empathy and understanding for those facing challenges with substance use. Everyone deserves the same dignity, respect, and access to necessary resources.
Can you tell me about the harm reduction detailing project you’ve been working on in collaboration with the National Association of County and City Health Officials (NACCHO)?
Adriane: We’re currently focused on detailing elected officials in the State of New Hampshire, including city counselors, mayors, and senators. The opinions and decisions of elected officials shape the harm reduction service landscape – they make decisions that either enable or constrain available resources.
Anna: Recognizing the influential role of elected officials is crucial when working on public health initiatives, including harm reduction. What is the overall goal of your current detailing project?
Adriane: We want to empower elected officials to make informed decisions that increase capacity of harm reduction services based on the needs of their communities.
We’re currently encouraging elected officials to establish direct connections with individuals who use drugs so they can integrate the expertise from those with lived and living experience into decision-making processes regarding laws, policies, and resource allocation.
Anna: Actively listening to those with lived and living experience helps to better understand how to support specific populations. How did your team decide to focus on encouraging elected officials to directly connect with people who use drugs?
Adriane: During the development of our detailing project, we consulted with local syringe service program (SSP) participants and asked them how they think elected officials can better understand substance use and harm reduction. The overwhelming response was for direct communication between individuals who use drugs and elected officials, or having elected officials spend the day with them to understand their experiences firsthand.
We’re trying to figure out how we can facilitate these approaches to ensure the safety and ethical treatment of SSP participants. We’ve also been exploring the possibility of forming advisory committees to incorporate the perspectives of individuals who use drugs in the decision-making process in a safe and supportive environment.
Anna: Advisory committees certainly help to ensure that voices and perspectives are heard and valued.
Let’s transition to thinking about all of your detailing work to date – what makes you most proud to be a harm reduction detailer?
Adriane: The people I detail. We shouldn’t underestimate how hard it is to change our minds, our attitudes, or our behaviors. It takes so much humility and effort to receive and integrate new information, especially when it counters your social values and beliefs. It’s an honor to work through that learning process with those that I detail.
Anna: Do you have a specific example of that learning process that you can share?
Adriane: I detailed someone who was initially hesitant to publicly announce that she prescribes buprenorphine because she was worried how that information would affect her patient panel. We ended up having a conversation about substance use stigma and its implications.
We discussed that openly sharing that she prescribes buprenorphine serves as a powerful signal to patients, assuring them that she provides a safe environment to seek treatment. It also sends a message to other clinicians about the importance of prescribing this medication to patients who need it.
Anna: Having those types of honest conversations with people you detail is imperative to changing behaviors and reducing stigma at the individual and community level. Is there anything else you’d like to add before we wrap up today?
Adriane: Remember that it’s much easier to build harm reduction capacity in collaboration with others. Last year, I collaborated with individuals from the public health department, a local hospital, the New Hampshire Harm Reduction Coalition (NHHRC), and a community volunteer to address a concern raised by a business owner regarding improperly discarded sharps on their property.
We formed an informal work group and created a proposal aimed at piloting an anonymous syringe disposal project, installing two disposal units in the community. The disposal units were proposed to be on city property, so we needed buy-in from City Council to be able to do this. We recognized the power of engaging elected officials and presented our proposal to the City Council. Our proposal received unanimous support and it’s currently being piloted in the community. Collaborative advocacy and engagement with members of the community and elected officials can bring about positive change and enhance the health of all.
Anna: We often have more power than we think when we collaborate with others who have similar goals. Detailing is an effective approach for encouraging collaboration and connection with experts in the community, including experts with lived and living experience.
Thanks for joining us today, Adriane! We look forward to continuing to hear about your inspiring harm reduction work in New Hampshire.
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Biography. Since 2020, Adriane Apicelli has served as the Project Manager and primary academic detailer of the University of New Hampshire (UNH), Department of Nursing’s Harm Reduction Education and Technical Assistance (HRETA) project. She holds a Master of Social Work (MSW) from Boston College, where she also earned a Certificate in Management. In addition to her role with the HRETA project, Adriane serves as a nonprofit strategic planning consultant and has previously served as an adjunct professor for the Department of Social Work at UNH.
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