Transcript Slide 1

Early Intervention with
Drug Injectors
Maureen Woods
NHS Lanarkshire – Harm
Reduction Team
Stirling Royal Infirmary 28/11/05
What Intervention
measures are we
providing to drug injectors
and are they EARLY
enough?
The Main Risks Associated with
Injecting Drug Use.
• Blood Borne Viruses (BBV’s)
• Overdose – Fatal and non-fatal.
• Injection Site Injuries/Other Bacterial
Infections.
Blood Borne
Virus
Prevention
Early Intervention – Harm
Reduction Measures
“1980’s/90’s – evidence that speedy
implementation of a range of public health
and treatment measures targeted at those
who inject can be effective in reducing the
number of infections and in some
instances has altered the projected course
of an epidemic”.
The Beckley Foundation Drug Policy
Programme 2005
The 3 Main Components of
Harm Reduction
• The widespread dissemination of information on
the risks of infection, and advice to drug injectors
on how they can avoid that risk.
• Accessible provision of clean materials for
injection that allows users to avoid re-using
infected equipment
• Easy access for drug injectors to treatment
services that help them move away from the
most risky behaviour
Hepatitis C
Often referred to as the “Silent Killer” because of
the chronic nature of the disease and absence
of symptoms.
• Recent evidence suggests that this is steadily
increasing in new injectors in Glasgow.
• Among 55 IDUs who had commenced injecting
in the previous 2 years, the prevalence rate was
51%; higher than that detected among
equivalent IDUs surveyed in 1999 (24% of 126)
and 2001 (43% of 120).
Shooting Up – HPA Updated Oct 2005
Evidence of Good Practice –
Lanarkshire Perspective
BBV Risk Reduction Outreach Post
• Dual funded post – Acute and Primary Care
• Initially 3 year funded – now substantive post.
• Hep B Vaccination given to over 1100 service
users from a range of locations.
• Provides Pre and Post Test Counselling for HIV,
HBV and HCV - tested over 400 IDU’s and
partners. Approx 100 +ve HCV, 1 with HIV.
• Provides Fast Track Referral to Treatment
Services
Evidence of Good Practice –
Lanarkshire Perspective
• 1-1 Advice and information on
transmission and associated risks
• Distribution of sterile injecting equipment
• Provides Safer Sex Advice and
Information/Condom Distribution and
testing for STI’s
Who needs Vaccination?
Current Injecting Drug Users
Those who inject occasionally
Partners of injecting drug users
Males who have sex with males
Needle Exchange
Needle Exchange
• Evidence suggests that transmission of BBV’s is
likely to happen within the first year of injecting
drug use:
• NSX should be offered from a range of premises
from appropriately trained staff:
• Pharmacy
• Fixed Sites
• Outreach
• Voluntary Agencies
• Addiction Services
Pharmacy Exchange
Lanarkshire 2004/05
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17 Pharmacies provide exchange
Total contacts 17,237
Gender – 13,590 Male: 3647 Female
Total Needles Distributed 262,245
Return Rates 40-82%
User Perspective on What a
NSX should offer.
• Information and advice on how
to use the service
• 1-1 confidential advice and
information on drugs and
related issues
• Provision of free
needle,syringe and
paraphernalia required for drug
use
• Awareness of cleaning
techniques of tools
• Safe disposal for used
equipment
• Assessment of risks
associated with drug use
• Safer injecting advice and
information
• Examination of injecting
practices for all injecting drug
users
• BBV Activities
• Access to treatment/support
services
• Access to overdose
training/information
• Peer education/user
involvement/consultation
Evidence of Good Practice –
Lanarkshire Perspective
A73 OUTREACH PROJECT
• 2-year funded Project set up in 2002 as a
result of DRD’s in the Rural area of
Clydesdale.
• Needs Assessment Survey using an action
research approach
• To engage with hard to reach drug users in
a rural setting.
• Increase referrals to services
Evidence of Good Practice –
Lanarkshire Perspective
• Adopted a Combined approach to
accessing the client group
• Outreach/drop in facility at our base
• Fixed Site Exchange
• Pharmacy Exchange
• Multi-agency approach
• Snowballing Effect within the client group
A73 Outreach Activities
• Outreach and Drop In
– 2163 contacts
• Evidence of
Secondary
distribution of
Injecting Equipment
• Return Rates – 97%
• 48 Referrals to other
services
• BBV Activities – BBV
Counselling – 25
clients, 22 of which
were tested for BBV’s
– 2 of which were
HCV positive
• HBV – 37 (all 3) 6 (2),
4 (1). Boosters 45.
A73 Outreach
Risk Behaviours – BBV’s
• 106 Respondents – 83% were currently IDU’s.
• Age range for first injection 12-37 years
• 63/106 Reported Sharing of Equipment
-Needles – 38%
-Syringes – 28%
-Spoons – 78%
-Water – 49%
Filters – 36%
Comparisons between Outreach
NSX and Fixed Sites (3)
2000
1895
1800
1600 1473
1400
1200
Male
Female
Total Contacts
1000
800
600
400
422
251
200
319
68
0
Outreach
Fixed Site
A73 Outcomes
• Proven to be an effective
way of engaging with
service users.
• Model being adopted by
the JFIG as a Low
Threshold Service in
Lanarkshire
• Proven to provide early
interventions at any stage
in the addiction cycle
Overdose
Awareness
Fatal and Non Fatal Overdose
• Drug Related Deaths remain high –
National Figures for 2003 - 317
• Non-fatal overdose is common amongst
injecting drug users.
• A73 Needs Assessment – identified that
amongst 106 respondents:
• 94% (100) reported poly drug use
• 38% (40) reported to one or more previous
overdose.
Fatal and Non Fatal Overdose
Risk Factors
• Anyone who takes drugs and or alcohol
but in particular injecting drug use (Heroin)
• Previous overdose history.
• Reduction in tolerance.
• Poly drug use
• High levels of alcohol use
• Poor physical health
• Recent detox
Fatal and Non Fatal Overdose
Interventions
• Importance of obtaining a drug/alcohol history
during assessment and at NSX.
• 1-1 discussion around risk areas.
• Dissemination of factual information.
• Overdose Awareness Training which
incorporates Life Saving Skills.
• Consideration for Retox programmes prior to
release from Prison.
• Consideration for Naloxone Prescribing
Injection Site
Injuries
And other Bacterial
Infections
Injection Site Injuries and Other
Bacterial Infections
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Abscess
Vein Damage
Citric Burns
Leg Ulcers
Needle Stick Injuries
DVT
Hitting an artery
Granulomas
• Localised swelling
due to missed hits
• Botulism
• Tetanus
• Septicaemia
• Endocarditis
• Gangrene
Interventions
• Regular checking of
injection sites
• 1-1 advice and
information on safer
injecting practices
• Adequate provision of
injecting equipment
• Training on safer injecting
techniques
• Advice on routes of
administration for their
chosen drug and
alternatives
• Early notification and
awareness of
potential threats (ie
botulism)
• Poster campaigns in
designated areas (ie
chemist)
• Advice on wound care
and referral for
antibiotic therapy
Why early intervention
is important.
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Engage with the client group.
So the client can make informed choices.
Prevention/reduction of associated harm.
Reduce/prevent drug related deaths.
Dispel drug related myths and provide
accurate and up to date information.
• Identify treatment options and priorities
For Interventions to be effective
Service Users Suggest that:
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Services need to be easily accessible.
Offer a drop-in facility.
Non-judgemental
Provide a range of services and treatment
options (from Outreach to Aftercare)
Have access to/offer prescribing
Have credibility with the client group.
Short waiting times
Confidentiality
User Involvement Survey 2005
Lanarkshire’s Service Users
Perspective
Recovery does not finish when you
finish a detox, this is where the hard
work starts”
“
“ A drop-in would be good for people
who have finished rehab, just so you
can talk to someone who has been
through it and get some support”.
Where are the Opportunities for
Providing Early Intervention?
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Pharmacies
Needle Exchanges
Addiction Services
Police
Voluntary
Organisations
• User Involvement
Groups
• Health Promotion
• Housing
• Social Work
Resources
• Homeless Units
• Primary Care and
Acute Services
• Education Authorities
• Peer Education
• Prison