Reducing Drug related harm

1. Reducing Drug related harm Trevor McCarthy Paul Hammond & Tim Murray 4 April 2008

2. Harm Reduction isn’t new so …. • Why now? • What is being done? • What will be done? • Paul: NEXMS • Tim: Good Practice Guidance - forthcoming

3. 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%)

4. 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.

5. 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

6. 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%)

9. 2007 suite of evidence based clinical guidance

10. 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

11. I have a dream

12. I have a Reducing drug-related harm action plan

13. 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

14. Create New Service Provider/ Service Provider Maintenance (NEX Coordinator and National User)

15. 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

16. Good practice in harm reduction Learning from the 2006/07 service reviews Tim Murray

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

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