North Edinburgh Drug and Alcohol Centre




image EU Drugs Agency publishes first European Guide on responding to drug problems

A new European guide published by the EMCDDA includes the agency's first overview of actions and interventions to address the consequences of illicit drug use.

Issues including how to respond to the problems of older heroin users, how to reduce potential harms from highly potent fentanyls and from drug and alcohol use at festivals and clubs, are all explored within the paper.

The guide is aimed at those approaching drug problems from a public health planning perspective as well as frontline workers and practitioners.

Scottish Drugs Forum and Greater Glasgow and Clyde Alcohol and Drug Services have contributed to the European guide by authoring a background paper on older people with drug problems.

Click here for more information


Harm Reduction on a Knife Edge

Disinvestment in harm reduction is hurting services and failing clients.


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There has been a steady erosion of vital aspects and knowledge about harm reduction approaches since 2010. Large cuts to funding have meant caseloads of increasing complexity and evidence-based practice being replaced by 'a mush of dubious interventions'. Significant numbers of drug-related deaths have not prompted a relevant response with the focus appearing to be more on data requirements rather than interventions around reducing risk.


The stuff we know works; assertive outreach, consistent and persistent support for treatment-resistant individuals has taken a back seat in favour of assessment, and group work. While this model may work for those who are highly motivated to change, there are so many of our most vulnerable that cannot or will not come into treatment to access potentially life-saving interventions. As well as not receiving the immediate help they need, these individuals are missing out on a much bigger opportunity to engage with healthcare. What about them? There's no time, no strategy, and yet again, these individuals fall through the cracks.


There is so much pressure on "positive outcomes" that ultimately very little energy is spent nailing the basics. Ultimately the pressure and expectations we have to impose on our clients is mammoth. We really need to take a step back and reduce the threshold for those accessing support, it can't be that we turn away the chaotic, dependent injecting drug user because they are ten minutes late for their appointment. The ease with which people who need these services are being dismissed is being compounded by a crisis in funding and staff morale. The system feels designed for the chaotic to fail and why wouldn't it be? Fewer chaotic clients in treatment means fewer drop-outs, fewer representations, and all of a sudden your positive outcomes and numbers are on the up.


Needle exchanges and harm reduction services for many people represent the first, and possibly only, engagement with a "professional" agency, this toe-hold in a service opens up routes to so many other interventions overdose prevention and naloxone, vaccines and BBV testing, wound care and treatment. It can be the first tentative step on a longer treatment journey. For many it will also offer the right environment to discuss substitute prescribing and life-changing options for stabilisation, steps that not only transform the individual's prospects, but also reduce the harm to their families and ultimately to society.


At the moment we are devaluing harm reduction services by failing to provide space, time, privacy and resources to make services excellent. Having 60 clients on your caseload and a mountain of admin on your desk translates to telling the client 'take your script and I will see you in two weeks', instead of giving them the time and energy required for a meaningful working relationship. These are people's lives we are dealing with. We underestimate the power that just sitting down and having a cuppa and a chat, with no expectations, can have. We need time and we need patience, and unfortunately there is no pot of funding for that,


Furthermore, we are seeing a slide towards a deskilled workforce. Within increasingly complex caseloads, 'much of this work is done by recovery workers who are relatively new to the field but have received little or no training other than shadowing colleagues'.


The government's drug strategy, which (while acknowledging that we should protect society's most vulnerable) only fleetingly mentions harm reduction and ignores the importance of outreach. The providers of treatment really need to start to use the language of harm reduction and be clear about a commitment to those approaches, rather than continuing with a culture of harm reduction by stealth. A creative pro active harm reduction approach might support a shift back to this kind of essential work.

 

Risks of pregabalin and gabapentin

Death rates have risen dramatically for prescription drugs pregabalin and gabapentin. Let’s be aware of the risks, says Clare Kingsbury-Bell.

Drug-related deaths linked to pregabalin and gabapentin have risen 2,675 per cent and 637 per cent respectively in just six years. Addaction believes the risk of addiction and overdose related to these two prescription drugs hasn’t been made clear enough, particularly where they are prescribed to people with a history of substance misuse. Death rates have risen even more rapidly than those related to new psychoactive substances (NPS), which in the same time period show an increase of 123 per cent.

The ACMD advised government that pregabalin and gabapentin prescribing in the UK has increased by 350 per cent and 150 per cent respectively in five years, and an increasing number are also being bought and sold on the streets. The government has just confirmed that they will become class C drugs, subject to consultation.

The medicines can depress the central nervous system causing sedation and reduced breathing. So if someone is already taking substances that depress the central nervous system, including alcohol, opioids like heroin, or benzodiazepines like diazepam, they will be more prone to overdose.

Addaction pharmacists and doctors are asking for more guidance to be given to prescribers, including GPs, about how the drugs can be prescribed more safely, particularly for people with a history of substance misuse. The drugs were first prescribed for the treatment of epilepsy. Their use was then extended to include general anxiety disorders and soon they were recognised as useful in the treatment of chronic and neuropathic pain.

 

 

 


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Hepatitis Scotland

HIV -HCV

Not only does a HIV co-infection with hepatitis C increase the risk of liver damage, it can also speed up its onset. As noted below there has been a rise in hepatitis C prevalence within the men who have sex with men (MSM) population, while HIV outbreaks across Europe amongst people who inject drugs (PWID) have been preceded by significant rises in hepatitis C infections.

Although new medications can now clear the hepatitis C virus, there are also potential drug-drug interactions to consider when used concurrently with HIV anti-retrovirals. A focus on prevention and on wider health issues must be maintained as recent spikes in HIV and sexually transmitted infections (STIs) amongst communities, including in Glasgow, show that prevention requires constant vigilance for and adjustment to new risks.

Access to pre-exposure prophylaxis (PrEP) for HIV, along with higher levels of effective testing and quicker access to treatment, appears to have decreased HIV incidence amongst MSM.

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