Edinburgh Drug and Alcohol Centre
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
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Harm Reduction on a Knife Edge
in harm reduction is hurting services and failing clients.
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
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. Lets be aware of the risks, says Clare
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 hasnt 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.
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.
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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