Drink and Drugs News DDN 1805 | Page 9

More conference pictures at: www.drinkanddrugsnews.com 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 www.drinkanddrugsnews.com 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