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National injecting conference
Annette Dale-Perera
Director of Quality
NTA
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Context: expansion in drug
treatment
 Rapid expansion in structured drug treatment
 Improvements in access: reduced waiting times, more
offenders
 Rapid increase in drug treatment workforce
 New NTA push on “Treatment Effectiveness” with service
users fully involved in care
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Most injectors in contact
with drug treatment ?
 Structured drug treatment: approx 160,000 people in 04/05 –
56% injectors – 90,000
 Needle exchange services: 105,000 people (overlap unknown)
 Estimates of injectors in England: 150-210,000 people
 New populations being drawn in via DIP & prison work
 DIP 3000 assessed per month, most not had treatment, 35%
injected in last month – high reported levels of sharing
 About 15,000 04/05 in treatment referred from CJ
 Prison work especially CARATS
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Harm
 Increasing infections (Nicolas Beeching)
 New, worrying patterns of drug taking: Nexus of Risk re crack
use in the context of injecting (Tim Rhodes)
 Increasing BBV (Viv Hope)
 Hep B
1: 5
 Hep C
2: 5 some areas higher - many unaware
 HIV
increasing
 More drug users with serious long term health problems
 But some good news …….Overdose Deaths are falling
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What are we trying to achieve ?
Harm reduction as core activity in
all drug treatment
 Injecting is high risk behaviour
 Interventions to reduce risk and improve health ie change behaviour
 Harm reduction interventions to help injectors reduce harm:
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Raise awareness amongst drug injectors
Safer injecting techniques to stop spread of Blood borne Virus’s, infection, etc
Injecting equipment dispersal and return
Overdose prevention inc alcohol treatment, naloxone, first aid etc
Reduce initiation into injecting
Opiate substitution treatment: at the right dose
Reduce and ideally stop injecting
Continuity of drug treatment
 Reduce risks to others from injecting eg disposal
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So why have we got an
increase in injecting
related harm ?
 Continued focus in national guidance on harm reduction,
Models of Care 2002, reducing drug related deaths 2004
 30% staff new: need better competence to work with
injectors ?
 Some work not monitored as structured treatment and
HR not stressed enough in structured treatment
 NX not proactive enough eg 80% pharmacy based
 Drug trends and trends in BBV ?
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National needle exchange
audit 04/05 Abdulrahim &Hunt
Key finding is VARIATION in range and type of NX
On the surface every DAT in country has some but
 10% rely on pharmacy based exchange only
 40%-60% have no on-site testing for BBV
Specialist NX initial assessment
 15% did not cover risks sharing injecting equipment
 25% did not cover OD risk
 Under 65% covered injecting hygiene, vein care
 Only 35% provided dressings/care for minor infections
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Improvement required in
commissioning & provision
 More testing and awareness of BBV status
 Better health care: Hep B vacs, check injection sites, abscesses
 More proactive NX and open access: pharmacy alone is not enough
 MORE COMPETENT STAFF: more training
 More work with injecting in structured drug treatment
 Getting the dose right in prescribing
 Greater users involvement in design and delivery of services
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NTA/HealthCare Commission
Improvement Review
National improvement review and inspection of
Harm reduction services 06/07
 National criteria (standards) and programme developed 05/6
 Every area screened against criteria and data: summer 06
 Every area receive a report Dec 2006
 10% “inspected” (inc peer review)
By March 2007
 Each area with an action plan to improve harm reduction
 Good practice “benchmarked” and identified
 Action to improve commissioning, monitoring and provision
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Conclusions
 Local drug treatment systems need to provide better
services to help injectors reduce harm
 We are already in contact with the majority: we need to
question whether we doing enough to reduce harm
THANK YOU
Conference organisers and attendees
Events like this will help
NTA
More treatment, better treatment, fairer treatment
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