National injecting conference

1. National injecting conference Annette Dale-Perera Director of Quality

2. Context: expansion in drug treatment • Rapid expansion in structured drug treatment • Improvements in access: reduced waiting times, more offenders • Rapid increase in drug treatment workforce • New NTA push on “Treatment Effectiveness” with service users fully involved in care

3. Most injectors in contact with drug treatment ? • Structured drug treatment: approx 160,000 people in 04/05 – 56% injectors – 90,000 • Needle exchange services: 105,000 people (overlap unknown) • Estimates of injectors in England: 150-210,000 people • New populations being drawn in via DIP & prison work • DIP 3000 assessed per month, most not had treatment, 35% injected in last month – high reported levels of sharing • About 15,000 04/05 in treatment referred from CJ • Prison work especially CARATS

4. Harm • Increasing infections (Nicolas Beeching) • New, worrying patterns of drug taking: Nexus of Risk re crack use in the context of injecting (Tim Rhodes) • Increasing BBV (Viv Hope) • Hep B 1: 5 • Hep C 2: 5 some areas higher - many unaware • HIV increasing • More drug users with serious long term health problems • But some good news …….Overdose Deaths are falling

5. What are we trying to achieve ? Harm reduction as core activity in all drug treatment • Injecting is high risk behaviour • Interventions to reduce risk and improve health ie change behaviour • Harm reduction interventions to help injectors reduce harm: • Raise awareness amongst drug injectors • Safer injecting techniques to stop spread of Blood borne Virus’s, infection, etc • Injecting equipment dispersal and return • Overdose prevention inc alcohol treatment, naloxone, first aid etc • Reduce initiation into injecting • Opiate substitution treatment: at the right dose • Reduce and ideally stop injecting • Continuity of drug treatment • Reduce risks to others from injecting eg disposal

6. So why have we got an increase in injecting related harm ? • Continued focus in national guidance on harm reduction, Models of Care 2002, reducing drug related deaths 2004 • 30% staff new: need better competence to work with injectors ? • Some work not monitored as structured treatment and HR not stressed enough in structured treatment • NX not proactive enough eg 80% pharmacy based • Drug trends and trends in BBV ?

7. National needle exchange audit 04/05 Abdulrahim &Hunt Key finding is VARIATION in range and type of NX On the surface every DAT in country has some but • 10% rely on pharmacy based exchange only • 40%-60% have no on-site testing for BBV Specialist NX initial assessment • 15% did not cover risks sharing injecting equipment • 25% did not cover OD risk • Under 65% covered injecting hygiene, vein care • Only 35% provided dressings/care for minor infections

8. Improvement required incommissioning & provision • More testing and awareness of BBV status • Better health care: Hep B vacs, check injection sites, abscesses • More proactive NX and open access: pharmacy alone is not enough • MORE COMPETENT STAFF: more training • More work with injecting in structured drug treatment • Getting the dose right in prescribing • Greater users involvement in design and delivery of services

9. NTA/HealthCare CommissionImprovement Review National improvement review and inspection of Harm reduction services 06/07 • National criteria (standards) and programme developed 05/6 • Every area screened against criteria and data: summer 06 • Every area receive a report Dec 2006 • 10% “inspected” (inc peer review) By March 2007 • Each area with an action plan to improve harm reduction • Good practice “benchmarked” and identified • Action to improve commissioning, monitoring and provision

10. Conclusions • Local drug treatment systems need to provide better services to help injectors reduce harm • We are already in contact with the majority: we need to question whether we doing enough to reduce harm THANK YOU Conference organisers and attendees Events like this will help