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Reducing Drug related harm. Trevor McCarthy Paul Hammond & Tim Murray 4 April 2008. Harm Reduction isn’t new so …. . Why now? What is being done? What will be done? Paul: NEXMS Tim: Good Practice Guidance - forthcoming. Harm reduction: a fresh impetus.

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reducing drug related harm

Reducing Drug related harm

Trevor McCarthy Paul Hammond & Tim Murray

4 April 2008

harm reduction isn t new so
Harm Reduction isn’t new so ….
  • Why now?
  • What is being done?
  • What will be done?
  • Paul: NEXMS
  • Tim: Good Practice Guidance - forthcoming
harm reduction a fresh impetus
Harm reduction: a fresh impetus
  • Reducing drug related harm: an action plan
  • Health Care Commission Improvement Review
  • Clinical guidelines
  • NICE clinical guidelines, technology appraisals & public health intervention guidance
  • Target to reduce deaths by 20% 1999-2004 not met (9%)
bbv blood borne viruses
BBV [Blood Borne Viruses]
  • Hep C: 90% in England associated injecting drug use. 40%+ of injectors in treatment are HCV +ve
  • Hep B: 34% associated with IDU. 32% of injectors in treatment HBV +ve. Vaccinate against Hep B
  • HIV: est. 1 : 50 IDUs in UK living with HIV – 1 : 20 injectors in London (one in 150 outside London)

Around ⅓ of IDUs inject Crack. Increase in HCV among injectors associated with homelessness, groin injecting & crack injection.

Shooting Up. Infections among injecting drug users in the United Kingdom 2006. An update: October 2007. HPA.

Testing Times. HIV and other Sexually Transmitted Infections in the UK 2007. HPA.

from the nta 2007 user satisfaction survey 1
From the NTA 2007 user satisfaction survey 1

Users significantly more likely to have received harm reduction advice & interventions in past 3 months if:

  • Report ‘current’ injecting
  • Had a care plan esp. if reviewed in past 3 months
  • On an opiate substitution programme
  • Have regular contact with a keyworker
from the nta 2007 user satisfaction survey 2
From the NTA 2007 user satisfaction survey 2

Their unmet harm reduction needs included:

  • Training in overdose management and prevention (33%)
  • General health assessment (27.7%)
  • Checking injecting sites (24.3%)
  • Hepatitis B immunisation (20.5%)


  • Reducing harm should be part of all patient care.
  • All drug misusers should be offered hepatitis B and A vac
  • All drug misusers should be offered testing & if required, treatment for hepatitis C and HIV infections (inc. prisons)
  • Retaining patients in optimised treatment is protective against overdose.
  • This protection may be enhanced by other interventions including training drug misusers and their families / carers in the risks of overdose, OD prevention and how to respond in an emergency.
  • Alcohol treatment & smoking cessation for those who need it
new reducing drug related harm action plan
New Reducing Drug-related harm action plan
  • Increase surveillance and monitoring
  • Improving Needle Exchange and drug treatment delivery
  • Public Health campaigns focusing on those most at risk
what the national needle exchange monitoring system nexms will do
What the National Needle Exchange Monitoring System [NEXMS] will do
  • Facilitate the collection of data that will support:
    • Identification of trends in hepatitis C transmission
    • Better estimates of prevalence and incidence
    • Ability to measure the effectiveness of prevention measures, such as NEX and related HR interventions
    • Provide information to inform needs assessment
  • The system goes live in April 2008
good practice in harm reduction

Good practice in harm reduction

Learning from the 2006/07 service reviews

Tim Murray

what s involved in the service reviews
What’s involved in the service reviews
  • Healthcare Commission and NTA
  • Reviewing all DATs
  • Assessment against the assessment framework
  • Targeted follow-up in poor performing areas
  • Commissioning and harm reduction
the review criteria
The review criteria
  • 10 criteria in total
  • Four for harm reduction
  • Harm reduction embedded in the whole system
  • Service users have good access to harm reduction services
  • Action taken to reduce drug-related deaths
  • Staff are competent to deliver harm reduction
process for producing the good practice in harm reduction report
Process for producing the Good practice in harm reduction report
  • Identify the areas that scored well in the review
  • Select a number of these areas to interview
  • Range of different types of DATs
  • Spoke to a range of stakeholders in these areas
  • Identified common themes across the interviews
factors influencing good practice 1
Factors influencing good practice (1)
  • Criterion 7:Harm reduction is embedded in the whole system
  • Drug treatment seen as harm reduction
  • Good co-ordination of harm reduction interventions
  • How the DATs use resources and contracts
factors influencing good practice 2
Factors influencing good practice (2)
  • Criterion 8:Service users have prompt and flexible access to needle exchange services, vaccination, testing and treatment for BBV
  • Access to services – out of hours, outreach
  • Wide range of interventions available
  • Distribution and return of injecting equipment
  • Good use of pharmacy needle exchange
  • Range of BBV interventions and treatment pathways
factors influencing good practice 3
Factors influencing good practice (3)
  • Criterion 9:Action is taken to reduce the number of drug-related deaths
  • Serious incident investigations
  • Campaigns
  • Work with people leaving prison
  • Ambulance protocols
  • Relationship with local coroners
factors influencing good practice 4
Factors influencing good practice (4)
  • Criterion 10:Staff are competent to deliver effective harm reduction services
  • Drug treatment and specialist harm reduction staff
  • Pharmacists and pharmacy support
  • Non-treatment workers
  • Consistency of staffing
factors influencing good practice 5
Factors influencing good practice (5)
  • Other relevant factors
  • having a harm reduction strategy
  • Harm reduction data collection and use
  • Harm reduction services co-ordination
  • Service user and carer involvement
and finally
And finally…
  • Echoes the points made at the NCIDU conference
  • Harm reduction across the treatment system
  • Revision and final publication
  • Poster at the IHRA conference
So …
  • Now is the time for a renewed focus on harm reduction
  • Enhancing whole treatment systems

The wider environment:

  • The new drug strategy
  • Clinical governance
  • Value for money
key messages
More equipment

Change behaviour

Competent staff

Target OD training

Improve general health

Reduce Hep B

More access to Hep C / HIV testing and treatment

Target those most at risk

Treatment is protective

Better understanding of drug related deaths

Key messages
and it continues
And it continues…
  • Harm reduction training for primary care
  • Campaign launch
  • Training DVD for those working with IDUs
  • Prisons training
  • Regional user champions