DDN June 2023 DDN June_2023 | Page 10

WIDER HEALTH

HEALTH MATTERS

P eople who use drugs and alcohol are dying prematurely of diseases that could be prevented or treated .

Dame Carol Black ’ s drugs review found that ‘ many drug users have poor overall health ’ and that the NHS is ‘ poor at engaging with the wider health needs of drug users with medical co-morbidities ( for example , hepatitis C , HIV , heart and lung disease ), many of whom are ill-equipped to navigate complex pathways , and feel stigmatised ’. The issue is equally pressing for those using alcohol . They suffer many of the same conditions but we are particularly concerned about a continued rise in liver disease .

Smoking , meanwhile , is probably the single biggest contributor to premature mortality for people who use drugs and alcohol . The review also found that for many people , ‘ mental health problems and trauma lie

There ’ s much more that services could be doing to increase the focus on health , says Steve Taylor , including raising awareness , making referrals and offering simple tests like blood pressure checks

WHAT YOU CAN DO ...

Talk to service users about their health . Assess people when they enter treatment and regularly throughout – healthcare assessment for people who use drugs is detailed in the clinical guidelines ( CG 2.5 [ https :// assets . publishing . service . gov . uk / government / uploads / system / uploads / attachment _ data / file / 673978 / clinical _ guidelines _ 2017 . pdf # page = 34 ]). Later this year OHID will publish the UK clinical guidelines on alcohol treatment which will include healthcare assessment for people with alcohol-related health conditions .

at the heart of their drug and alcohol dependence . However , they are too often excluded from mental health services until they resolve their drug problem and excluded from drug services until their mental health problems have been addressed .’

The drug strategy commits government to work with the NHS to improve the provision of physical healthcare and mental health treatment through better care pathways , targeted and colocated interventions , and more joined-up service planning and commissioning .

The Office for Heath Improvement and Disparities ( OHID ) is working at national level on ways to improve integration between NHS specialist care and drug and alcohol treatment – including actions to reduce drug and alcohol-related deaths , and work on specific health topics such as respiratory health and hepatitis . Tackling stigma cuts across much of this work , and ADDER sites will be piloting a programme to measure and reduce stigma in healthcare settings . But there is much more that can be done to increase the focus on health .

As part of all this , the Press Partnership is a collaboration between government and the country ’ s news publishers . It raises awareness of the prevalence and risks of diseases that are preventable or treatable and encourages people to take the first step to get checked or get help . It covers 350 national , regional , local and multicultural publications reaching 28.6m adults daily . It has covered mental health and cardiovascular disease already and will move onto other topics . It targets the general population who read mainstream media , which might include some drug and alcohol service staff , but it will inevitably miss many people who use drugs and alcohol and who are at greater risk from some

Be wound aware [ https :// www . gov . uk / government / publications / wound-awarea-resource-for-drug-services ] so that injection infection is spotted early and treated before it leads to complications .

Prescribe thiamine to people drinking at harmful and dependent levels to prevent alcohol related brain damage caused by Wernicke Korsakoff syndrome .

Work with primary and secondary care , and through Combating Drugs Partnerships , Integrated Care Partnerships and other mechanisms , to better integrate care . This might include bringing secondary care services on site into alcohol and drug treatment services to screen and treat people . of these conditions .

Cardiovascular disease ( CVD ) is one condition covered recently in Press Partnership articles , which all echoed the message that the first step in preventing and treating CVD is to check for high blood pressure . That ’ s a simple , regular step in the healthcare assessment that every drug and alcohol service should be offering . Other conditions with high mortality rates – and often simple tests – in people who use drugs or alcohol include : liver disease – both hepatitis C in

• people who have injected drugs and alcohol-related liver disease in people who drink at harmful or higher-risk levels respiratory disease – smokingrelated ( primarily tobacco but also

• cannabis , crack and heroin ), TB ( especially in those sleeping rough ) bacterial infections in those who

• inject drugs cancers , especially those related

• to smoking and alcohol

Make supported and active referrals for lung , liver and breast cancer , alcoholrelated brain damage , and other screening and treatment , using peer supporters wherever possible .

Refer people to IAPT [ https :// www . england . nhs . uk / wp-content / uploads / 2018 / 06 / thenhs-talking-therapies-manual-v6 . pdf ] if they need help with depression or anxiety .

Spend more on making these things happen – the menu of interventions for the Supplemental Substance Misuse Treatment and Recovery Grant includes a whole section on better and more integrated responses to physical and mental health issues .

And , last but by no means least , offer smoking cessation , including switching to vapes , for services users AND staff .

Steve Taylor is programme manager , addiction & inclusion at OHID

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