including on occasion sharing needles and equipment, but later
– when in a more stable situation – she
started to ‘understand the long-term
implications’ of living with the virus.
She began treatment with interferon, but
experienced a range of unpleasant side effects,
the worst of which was the profound effect on
her mental health. ‘I had extreme mood
swings, hallucinations, suicidal thoughts,’ she
told the conference. ‘The treatment was painful
and took a huge toll on my body.’
However, thanks to connecting with a new
consultant, in 2016 she was approved for the
recently launched 12-week treatment
programme using oral medication. ‘There were
no injections and no physical or mental side
effects. After seven years of having hepatitis C I
stand here today free of any virus, and my
future is as bright as it’s ever looked.’
T
‘you have to
take healthcare
out on to the
street.’
he session then moved on to looking
at connecting those populations
traditionally be seen as ‘hard to
reach’ with effective healthcare, and
sUe mCCUtCheon
heard from Sue McCutcheon, an
advanced nurse practitioner with
the homeless primary care team in Birmingham. ‘The people I encounter have
multiple significant health concerns,’ she told delegates. These included liver disease,
respiratory problems, infections and mental health issues, while problems that could
affect anyone, such as epilepsy or diabetes, were obviously far more difficult to
manage for people who were both homeless and had substance use issues.
Many clients had an intense mistrust of services, which meant that they tended
to present very late in the pattern of illness, she said, often ‘at the point where it’s
life-threatening’, while some would not even present then. ‘They have different
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priorities, as well as concerns about being
admitted to hospital if they’re not on OST. So
it’s about working with that – sitting down
with the client and getting a plan togeth er,
and supporting them in realising that goal of
accessing health care.’ She would offer to take
people to hospital herself, she said, acting as
an advocate and staying with them until they
had been prescribed methadone. ‘But
obviously I shouldn’t have to do that,’ she said.
One frequently quoted reason for not
accessing services was that there was nothing for synthetic cannabinoids such as
‘mamba’, she pointed out. ‘Or people might say “I want a script today, not in two
weeks,” or “I need a detox now, not in four months”.’
Some of the most entrenched individuals were not on benefits and not
accessing healthcare, although they had the highest levels of need, she said. ‘So you
have to take healthcare out on to the street – attending to their immediate health
needs, supporting them to attend GP, nurse and hospital appointments, referring
them to hospital specialists and giving them naloxone training. The highest
percentage of people dying through overdose are those not accessing services, so
that training can be vital.’
It was also important not to overlook wider screening, she stressed, whether
blood pressure, breast, or BMI checks, or cervical smears, ECGs or vaccinations. ‘The
whole point of screening is to pick up things early, and oral health checks are also
important. We know that alcohol and smoking raise the risk of mouth cancer but
many of these clients won’t have seen a dentist in five or ten years, or longer.’ Other
issues faced by her clients included respiratory problems such as COPD, emphysema
or TB, infections linked to street injecting and sepsis, which carried ‘a real risk of
death but which is an easy diagnosis to miss because the symptoms can be so
vague’. The risk of infection could be reduced by clean kit, good lighting, a clean and
March 2018 | drinkanddrugsnews | 7