Transcript Slide 1
Delivering Effective Needle and Syringe Programmes Working With and Providing Services for Performance and Image Enhancing Drug Users (PIEDs) Mark Harrison. Ralph Heron. County Durham Drug and Alcohol Action Team Adding life to years and years to life DISCUS DRUGS IN SPORT CLINIC and USERS SUPPORT “The use of images in this presentation does not imply an individuals’ use of performance and image enhancing drugs, rather that they are used to depict the attainment of a desired physique and appearance of the individuals.” Adding life to years and years to life Adding life to years and years to life Adding life to years and years to life Adding life to years and years to life Why DISCUS • • • • • • • • Need identified locally in 1993 50% of needle exchanges were for PIED users April-Sept 07 43% all new registrations Prevention of blood borne viruses PIED users reluctant to approach existing “drugs” services Experience within gyms Gateway service focussing on harm reduction Some users collecting for up to 250 users Adding life to years and years to life The DISCUS Team 15 years old this year Clinic Co-ordinator Nurse DISCUS Service User Sports Massage Sports Dietitian Onward Referral Adding life to years and years to life R.M.O. Services Available 1 • • • • • • • 2 Hours per week Over 1000 individuals registered Informal and confidential Full range of needle exchange services Safer injecting advice Responsible Medical Officer Nursing assessment Adding life to years and years to life Services Available 2 • • • • • • • Specialist Dietician Hepatitis A and B vaccination Regular blood investigations ECG Body fat analysis BBV testing Referral on to other services if / when necessary Adding life to years and years to life Services Available 3 Regular blood investigations • FBC • LFT’s • Cholesterol • HDL/LDL • Testosterone levels • Thyroid Stimulating Hormone (TSH) • Hepatitis Titre Adding life to years and years to life DISCUS Activity 2008-2009 • • • • • Number of attendances Number of Individuals New Registrations Needle Exchanges Bloods Taken 750 198 53 225 154 Durham Harm Minimisation Services (April-September 07) • 43% of all new registrations to all Harm Minimisation services were for PIEDs users. Adding life to years and years to life DISCUS Gender Split DISCUS Gender Ratio Female Female 3% 3% Male Female Male 97% Male 97% Adding life to years and years to life Adding life to years and years to life Harm Minimisation • • • • • • • • Start with lowest dose/stack possible Optimise diet and training regimes Use low androgenic initially Regular investigations Shortest cycle possible with max. time clean Use your own, sterile injecting equipment Correct injecting technique Know your source of gear Adding life to years and years to life Creatine Monohydrate • • • • • • • Acts as muscle’s capacitor Effective in 70% of users 5-7lb of lean muscle Each dose = 2lb steak Take in warm drink with 100g of carbohydrate Loading phase = 10g for 5/7 then 5g for 5/7 Maintenance phase = 2g daily Adding life to years and years to life Style of PIED Use • Style of usage – stacking style of cycle duration of cycle time off cycle • Oral or I.M. ? 17 Alpha-Alkylation Adding life to years and years to life Indications of Public Health in the English Regions Rates of Performance and Image Enhancing Drugs Better than average Indicator Rate per 1000 population who have used anabolic steroids (2007-2008) England 5.36 North East 11.97 Consistent with average North West Yorkshire & Humber 5.21 7.37 East midlands 7.34 West Midlands 3.78 Worse than average East England London 1.83 3.05 South East 6.94 South West 3.78 Association of Public Health Observatories (2009) (from British Crime Survey) Adding life to years and years to life Our Role (1) • Drug misusers have the same entitlement as other patients to the services provided by the NHS. • The General Medical Council has stated: “The investigations or treatment you provide or arrange must be based on the assessment you and the patient make of their needs and priorities, and on your clinical judgement about the likely effectiveness of the treatment options.” You must not refuse or delay treatment because you believe that a patient’s actions have contributed to their condition. Drug Misuse and Dependence: UK Guidelines on Clinical Management (2007) Adding life to years and years to life Our Role (2) The General Medical Council has stated: • You must treat your patients with respect whatever their life choices and beliefs. • You must not unfairly discriminate against them by allowing your personal views (including your views about a patient’s lifestyle) to adversely affect your professional relationship with them or the treatment you provide or arrange.” Where do PIED users fit into this guidance???? Adding life to years and years to life Recognition • British Medical Association identified DISCUS as an “example of good practice”. (Pressure to Perform BMA 2001) • October 2008 DISCUS presented to Advisory Council on the Misuse of Drugs (ACMD) and contributing to national review of PIEDs. • Previous presentations at national injecting and PIED conferences. Adding life to years and years to life Adding life to years and years to life Contact Details Mark Harrison Joint Commissioning Manager Office: 0191 3837800 Mobile: 07747475402 Ralph Heron Development Manager Office: 0191 3837800 Mobile: 07884436320 [email protected] [email protected] Adding life to years and years to life