Transcript Document

Drugscope Harm Reduction Workshops
Overdose
Prevention
Dr Linda Harris
Clinical Director
Wakefield Integrated Substance Misuse Service
7/18/2015
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What we will attempt to cover
Overview of overdose – what do we know about
it and who is at risk
Policy and guidance in relation to overdose and
the prevention of drug related deaths
The responsibilities of commissioners and
service providers in reducing deaths from
overdose
Overdose training initiatives
A look at how to apply learning from the study of
actual cases
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Overdose is the largest cause of death
amongst injecting drug abusers
People who inject heroin are 14x more likely to
die than their peers
About a third of injecting heroin users report
having experienced an overdose
Drug users (many of them in contact with
services) are often present at fatal overdoses
Deaths would be prevented if drug services
provide appropriate information, training and
support on how to respond to an overdose
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Dispelling Myths
Patients who OD from
opiates have used an
excessive amount of
heroin
In the case of heroin
OD death is shortly
after the drug is
injected
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WRONG - Blood
levels of opiates in
those who die is often
less than that of a
person who is not
used to taking heroin
WRONG – in many
cases death is more
than 3 hours after the
heroin is injected
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Getting the message across
Stop injecting
Don’t mix drugs and alcohol
Don’t mix opiates with other drugs
Avoid using opiates when tolerance is low,
after a break in use e.g. on release from
prison
Encourage people who might witness an
overdose to give appropriate first aid and
call an ambulance
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Causes of overdose
Only a minority are reported as heroin
overdose or methadone overdose
The majority of deaths are opiates in
combination with other CNS depressants
(especially alcohol and benzodiazepines)
Failure to recognise the signs and act
quickly to give first aid when someone is
suspected to have “gone over”
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Risk factors and behaviours that
are linked to OD
who is most likely to be at risk of OD?
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Injector
< 30 years
History of previous nonfatal overdose
Longer history of injecting
High levels of drug use and presentations of intoxication
High levels of alcohol use
Low tolerance
Depression feelings of hopelessness and suicidal ideation
History of one additional mental disorder ( mainly depression)
History of using drugs in combination
Higher risk injecting behaviours
Out of treatment – not on a methadone
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Policies and guidelines
2000 - Advisory Council on Misuse of Drugs
(ACMD) report – “Reducing Drug Related
Deaths” 1
2001 - DoH publish their response to the ACMD
report 2
2002 - DATs receive guidance on providing
resuscitation for overdose from DoH 3
Publication of guidance for DATs on the
development of local confidential enquiries 4
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Mortality surveillance
Three main sources of information:National Programme on Substance Abuse Deaths (np – SAD)
Based on reports from coroner ( form F97) taking into account both the verdict
and the cause of death
Office for National Statistics (ONS)
Publishes annual mortality figures in February of each year for the year
ending 14 months earlier.
Includes all deaths in England and Wales where the underlying cause of
death is assigned to a given criteria of ICD 10 code using the cause of death
reported on death certificates
Home Office Bulletin
Derived from Deaths reported to Coroners in England and Wales. Based on
inquests where verdict on cause of death recorded as drug dependence or
non dependent abuse of drugs
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The important role of the coroner
Establish the circumstances and cause of death
Investigate any possible criminal involvement
To order a post mortem and include a request
for toxicology when indicated
To conduct an inquest where reports from
police/GP/hospital are considered to decide the
cause of death and give a verdict
Complete the relevant mortality surveillance
forms
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The importance of mortality studies
Informing treatment provision, and commissioning
E.g. evidence to back the role diverted methadone plays in drug
related deaths 10
higher death rate from methadone overdose noted over weekend
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CARATS team activities – prison discharge
Used to identify at risk population and lifestyles
Used to influence national and local harm reduction
interventions
Used by drug prevention organisation and charities in
drugs awareness campaigns
Inform the NTA and DoH in policy initiatives and
influences resource allocations
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Drug related deaths in Britain
Britain has highest rate of drug related deaths in
Europe 5
Newly released offenders 40X more likely to die
from a drug related cause than the general
population 6
40% of the deceased have suffered from at least
one additional mental disorder 7
Deceased 60% more likely to have a history of
use of concomitant drug of misuse - most
commonly benzodiazepines and/or alcohol 8
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Drug related deaths in Britain
(ONS database 1998 – 2002 9)
In the period 1998 – 2002 around 30% of deaths
were due to a multiple drug overdose – (ONS
2004)
¼ of drug related deaths included alcohol +
another drug
Deaths involving heroin are decreasing but
deaths involving cocaine have risen to their
highest level ever
Deaths involving amphetamine and
benzodiazepine increased during this period
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Govt supports local action on
preventing DRDs
Increasing concern at the rising numbers of
preventable drug related deaths
Almost as many life years are now lost due to
drug-related deaths, as are lost from all road
traffic accidents
DoH Action Plan(2001) sets target of 20%
reduction in drug-related deaths by March
2004 (N.T.A, 2004)
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Performance monitoring the
reduction of drug related deaths
The NTA looks for evidence of prioritisation of
the monitoring of drug related deaths in the DAT
Treatment plan
DATs are tasked with setting up local confidential
enquiries into drug related deaths
DRD audit along with recommendations to be
published and disseminated
Evidence of service user involvement crucial
throughout the process
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DRD monitoring in Wakefield
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DAT priority area.
Work picked up by the harm minimisation task group to look at
local issues
Work with local paramedics (WYMAS) and police to develop a
relevant OD policy
Establish DRD working group specifically to identify and audit
those who die as a result of taking illicit drugs
Purchase videos ‘Going Over’ which are run in the waiting rooms
of street agencies
Design and display leaflets to promote key messages around
OD
Develop a training module on Overdose for service users and
project workers
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Why Overdose Training?
Evidence to suggest most overdose
deaths preventable
Needs assessment research in this area
has demonstrated poor levels of basic
first aid knowledge amongst service
users
Many misconceptions
A way of getting the message directly to
the service using community
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Overdose training in
Wakefield
Follows national guidance (DOH,
mainliners and other leading groups)
Aims to give users the information they
need to respond to overdose situations
Training used as a vehicle to discuss
experiences and dispel myths
Provides basic first aid training
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The Session
Three hours with refreshments
Key messages: Dial 999, recovery
position, principles of CPR
Delivered in partnership with WYMAS,
with help from Turning Point to recruit
participants
Neutral, local venues
Some incentives to attend
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Feedback/evaluation
I think it is far better to let the participants
speak for themselves………….
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A case study
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Learning Lessons
Users and carers need to know what to do in the
case of an overdose
Overdose training needs to be accessible and
skills updated regularly
Specific advice and prioritisation should be
made in the case of prison releasers, dual
diagnosis, young people
Steps taken to reduce poly drug misuse
There is a case for training service users and or
carers to carry and use naltrexone
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The future
Recruit and support users to be involved in
delivery of sessions and cascading of key
messages
Identify ‘at risk’ groups to target
Develop training modules to incorporate
lessons learnt from case studies
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