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etting the psychological approach right was equally important to
tackling exclusion, and Roger Nuttall gave insight from his role as
nurse coordinator at Hastings Homeless Service.
He talked about Paul, a 42-year-old man who had gone to his GP
surgery with a wound from ‘skin popping’. He had disengaged too
early from treatment, but since starting to attend the homeless service he had
never missed an appointment.
So what had worked in engaging him? The holistic approach to building trust,
using counselling skills, respect and empathy, was just as important as the wound
care, said Nuttall. ‘Homelessness and addiction tend to rob people of their identity. By
listening to their background and history you can help them rediscover who they are.’
Healthcare environments
were often stressful, and
raised stress levels (shown
through levels of cortisol)
had been shown to slow
wound healing and impair
immunity, he explained. So a
little empathy and humility
could go a long way in
creating the right setting for
the transition into treatment.
Another dynamic
environment for interaction
was the pharmacy, and Kevin
Ratcliffe, CGL’s non-medical
prescribing lead gave insight into initiatives in Birmingham. Needle and syringe pro -
grammes (NSP) were being run out of 88 pharmacies in the city, many with extended
hours. Service users were actively involved in providing feedback on the quality of
services and a mystery shopper exercise had identified things that the community
pharmacies could be doing much better – including harm reduction advice.
The exercise also identified a weak link in the chain of Birmingham’s take-home
naloxone programme – that clients had to be already engaged with a drug
treatment service to receive kits. After a pilot phase (‘and a lot of learning!’) the kits
were given out through pharmacies, ‘reaching people that services weren’t’.
The other valuable role of NSP-commissioned pharmacies was to refer people
directly into treatment, and Ratcliffe announced that funding had been secured for
hepatitis C testing in the Birmingham pharmacies, with results given within the
hour. ‘In the city centre we want to get as many people through as possible and
refer them into treatment there and then,’ he said.
Dr Ahmed Elsharkawy, consultant hepatologist at the Queen Elizabeth Hospital
G
‘The aim of
everything should
be to reach and
engage people.’
Tony Mercer
AHMED ELSHARKAWY
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ZOE CARRE
LORETTA FORD
in Birmingham, said that community treatment was critical to NHS England’s
target of eliminating hepatitis C by 2025. There were no patients now waiting in
Birmingham and ‘we’re running out of people to treat’, he said. But the UK needed
to be far more proactive in finding people with hep C as there were still more
people becoming infected than being cured.
NHS England now needed ‘to put their money where their mouth is and stop
the rhetoric’ on eliminating hep C, he said – particularly as the highly effective new
oral treatments represented a cure within eight weeks.
hile the route map for hep C seemed clear, it was as important as
ever for workers to stay informed of the latest drug trends. CGL’s
medical director, Dr Prun Bijral, explained some important (yet still
widely misunderstood) risks of fentanyl – that potency varied
widely, leading to uncertainty around consistency and dosing.
When pressed with a bulking agent, ‘hotspots’ could occur, with pills containing
dangerous levels of this potent painkiller.
Improving access to medically assisted treatment (MAT) was vital to keeping
people safe, in accordance with the Orange Guidelines, he said. The other essential
strand of overdose prevention was giving out take-home naloxone kits, as ‘the
whole community is at risk, not just those in treatment’.
Dr Loretta Ford of the West Midlands Toxicology Laboratory added to the
discussion of changing drug trends and explained that toxicology services had to
constantly rise to the challenge of detecting new compounds. The ‘classic’ drugs of
misuse had been joined by rising trends in NPS, prescription medication (notably
pregabalin and gabapentin), steroids, and over-the-counter meds such as anti-
histamines – drugs that had opened up a whole new world of varying potency and
uncertainty for the user.
This uncertainty meant that the take-home naloxone programme had an
invaluable place in reducing drug-related deaths. Zoe Carre, policy researcher at
Release, said that while there had been a significant increase in areas providing
naloxone, it was shocking that some local authorities were commissioning drug
services without monitoring whether it was being distributed.
Coverage of kits was still not wide enough, and was not reaching the people
who needed it. In many areas they were not provided to NSP clients, OST patients or
to family, friends and carers of people considered to be at risk. Needless barriers
included people having to be assessed or referred before getting a kit, or having to
wait for training when the kit contained detailed instructions.
‘We recommend that England implements a take-home naloxone programme as
a matter of urgency,’ she said, and Release was setting up a steering group to
develop national guidelines to improve coverage and remove barriers. ‘All local
authorities should be providing take-home naloxone and every person who uses
W
ROGER NUTTALL
PRUN BIJRAL
KEVIN RATCLIFFE
May 2018 | drinkanddrugsnews | 9