Basic HTML Version
October 2013 |
drinkanddrugsnews
| 13
www.drinkanddrugsnews.com
Harm reduction |
National Needle Exchange Forum
percentage of people needing hep C testing higher than normal in this client
group, it was a good idea to partner with a BBV project, he said. Needle
exchanges represented a good opportunity to make contact with clients that
didn’t present to other agencies.
The meeting brought in expertise from frontline workers in other areas of the
country. Philippe Bonnet, an outreach drug worker in Birmingham talked about
his work with chaotic clients – people who had become regarded as ‘problem
people’ rather than ‘people with problems’.
Working in pharmacies in the centre of Birmingham had convinced him of the
need for drug consumption rooms (DCRs) in the city, he said. Injecting in cold dark
conditions often led to hurried injecting into cold veins, resulting in a high
incidence of venous ulcers and abscesses.
Drug consumption rooms reduced deaths, as well as saving money for the NHS
and reducing needle litter – apart from which, he pointed out, human beings
should not be injecting in such circumstances. There were now 90 DCRs around
the world, with the 91st opening in Paris next month. ‘The drug strategy says we
are committed to learning from what works in other countries and an evidence-
based approach,’ he said. ‘So how much evidence do you need?’
*****
Next up to talk about frontline action, Nigel Brunsdon of HIT and the NNEF
explored the potential of harm reduction cafes in sharing ideas.
‘It’s a return to the grassroots idea of small stuff that led to bigger action,’ he
said. The internet offered a way to share resources and ideas: ‘Use the tools and
adapt them, even if you’re in the recovery movement.’ Get active, piggyback events,
choose the right venue and time (late afternoon or early evening) and think about
involving speakers – ‘but above all, don’t wait for others to do it,’ he said.
Moving on to the key developments for needle exchange, trainer and
consultant Stephen Molloy wanted to know why all commissioners were not fully
aware of the benefits of supplying naloxone.
‘How can we prevent people from standing beside the graves of their loved ones
who have died needlessly?’ he asked, before giving a detailed reminder of the
world’s first licensed kit. Although recommended by the ACMD’s naloxone report, it
was still batted away by many politicians who said the decision lay with local areas.
‘We know kits are used and we know lives are saved – so why wait?’ asked
Molloy. ‘There are more than 1,700 deaths every year in the UK from accidental
overdose. Why is this allowed to happen when naloxone works?’
Changing behaviour would mean having to talk to people about the potential
of death – not a comfortable subject, he said. ‘But we need to change attitudes –
an opiate-related overdose death doesn’t have to happen.’
The practical knowledge-sharing continued with Andrew Preston of Exchange
Supplies explaining latest developments with low ‘dead space’ syringes – a design
shown to have a much lower viral burden of HIV. Exchange were now working with
Bath University to see if they could further improve the dead space measurement
without compromising the fit of the needle.
The meeting then moved on to review changing trends, starting with trainer
Danny Morris’s look at mephedrone (MCAT) and methamphetamine (crystal
meth). ‘There have been changing trends in drug use that suggest progress in the
work we do,’ he said, but the rise in MCAT and crystal meth use among some
groups – primarily MSM – bucked this trend. With the former drug massively
cheaper than the latter, ‘if gay men can’t get hold of meth, MCAT will do,’ he said.
The resulting extreme behaviour, which could include sex sessions of up to
four days with different partners, meant the need for greater knowledge and
understanding among drug workers, as well as expertise relating to possible
complications including mental health problems.
As well as ‘getting kit out there’ it was important to engage and work in
partnership with services including sexual health clinics, who were ‘ill-equipped
to give any advice’, said Morris. He also advised the drug and alcohol field to ‘de-
emphasise recovery’ in this context. ‘If you have a recovery service, the door’s not
going to be open to them,’ he said.
*****
Josie Smith of the Welsh Needle Exchange Forum, added her knowledge from the
2013
Steroids and image enhancing drugs survey
(SIEDs) – an online survey from
harm reduction databases in Wales.
It was found that many needle exchange workers felt ill-equipped to deal with
the problem of steroids, which were distributed by coaches and increasingly used
in bodybuilding. The majority of steroid injectors were between 18 and 22 years
old – ‘an age where you shouldn’t be injecting these, as they interfere with
natural hormones. A lot of younger users think you don’t have to train or eat
properly – you just bang the steroids in,’ she added.
Needle sharing had increased as this population did not see itself as at risk, so
they needed to be offered hepatitis B vaccinations and warned about the dangers.
There were many risks and complications from a public health point of view,
‘because we know so little about this population,’ she said.
An online survey (at www.siedsinfo.co.uk) would help workers and pharmacists to
learn more about this population, she added. Another initiative inWales was to go
out to gyms – ‘the ones who are providing the gear’ – but it was a constant battle to
distribute information and posters, as gyms did not want to be associated with it.
With so much information-sharing taking place throughout the day, it was up
to Mat Southwell of Coact to comment on the value of needle exchange in the
past, present and future. Telling the story of one of the early drug user activists
from the Italian drug using community in London, he highlighted the need to
protect harm reduction, while emphasising how far we had come from the early
dark days of the HIV response. ‘This field has to be commended for its positive
progress and culture of collaboration,’ he said.
DDN
See profile of Philippe Bonnet, page 16
‘Harm reduction and public health
interests align in a way that they
didn’t when the NTA had to be seen
to be aligning with the
government’s recovery strategy.’
STEVE TAYLOR, PUBLIC HEALTH ENGLAND
XCHANGE