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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%)


2007 suite of evidence based clinical guidance
2007 suite of evidence based clinical guidance


Reducing drug related harm

Messages:

  • 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



Reducing drug related harm

I have a Reducing drug-related harm action plan


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 will do

Learning from the 2006/07 service reviews

Tim Murray


What s involved in the service reviews
What’s involved in the service reviews will do

  • 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 will do

  • 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 will doGood 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) will do

  • 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) will do

  • 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) will do

  • 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) will do

  • 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) will do

  • 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… will do

  • Echoes the points made at the NCIDU conference

  • Harm reduction across the treatment system

  • Revision and final publication

  • Poster at the IHRA conference


Reducing drug related harm
So … will do

  • 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 will do

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… will do

  • Harm reduction training for primary care

  • Campaign launch

  • Training DVD for those working with IDUs

  • Prisons training

  • Regional user champions