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PROFESSOR KATY HOLLOWAY, PROFESSOR
TREVOR BENNETT AND JASON EDWARDS
, from
the Centre for Criminology, carried out a unique
national survey exploring how many opiate users
experience a non-fatal overdose each year, the
causes of non-fatal overdoses and how they can
be prevented.
The academics were commissioned by the
Welsh Government to carry out a study of non-fatal
opiate overdose comprising two parts – a question-
naire of injecting opiate users to find out the
prevalence of non-fatal overdose, and interviews
with some of the respondents to find out the
nature and circumstances of overdose events.
The key findings of this research were that
almost half (47 per cent) of all opiate users said
that they had overdosed at least once in their
lives, and 15 per cent said that they had done
so in the past 12 months. There was little
difference in the prevalence of non-fatal
overdose among male and female respondents,
and no difference in the likelihood of non-fatal
overdose among younger and older users.
There were wide variations in the prevalence
of overdose across locations, ranging from 0 per
cent in one scheme area to 75 per cent of
respondents recruited from a city centre hostel.
On average, respondents who reported overdosing in the last 12 months
stated that they had overdosed twice in that time. Naloxone was administered
by one or more persons in 38 per cent of all cases of a non-fatal overdose.
These findings are unique because there is no equivalent information
available on this topic in Wales. The existing data which is available on drug-
related deaths, hospital admissions and patient episode only show the
numbers of those users who have come to the attention of the recording
agencies. The USW research project has sought to identify the dark figure of
non-fatal overdose that might not otherwise have been officially discovered.
‘We believe on the basis of this research that there are several actions
that could be taken that might reduce non fatal overdose,’ said Professor
Katy Holloway.
‘First, opiate users should receive more information on how to recognise
early signs of an overdose in themselves as well as others, through improved
training. Second, attention should be paid to the less common drugs
implicated in overdose, such as mephedrone, amphetamines,
benzodiazepines and anti-depressants, and third, attention should also be
paid to the effects of drug mixing, and appropriate advice should be given
through advertising campaigns or naloxone training programmes.
‘Fourth, the role of alcohol in drug misuse should be investigated more
closely and appropriate advice offered on safe levels of use. And finally,
some attempt should be made to identify the purity of current street heroin
and to devise an early warning system that could inform users when purity
levels are unusually high.’
October 2014 |
drinkanddrugsnews
| 9
Research|
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POST-ITS FROM PRACTICE
FOR THE PAST SIX MONTHS
my practice has
been providing the medical cover for some of
the homeless and vulnerable persons’ drug
service sessions in Birmingham. Because the
doctor who usually covers these clinics is on
sabbatical, it has been my privilege to do these
clinics for the last three months.
Most of the patients are IV poly-drug users,
many are rough sleeping, there are high rates of
hepatitis C, and much higher rates than usual of
HIV. A lot are groin injectors; DVTs and cellulitis
are common and we had one patient recently
who had a femoral artery pseudo-aneurysm
rupture but fortunately survived.
The police have started to clamp down on begging and many of the
patients have received criminal anti-social behaviour orders and are banned
from large chunks of the city centre, which makes collecting their prescriptions
and attending appointments a breach of their orders. There are no safe places
to inject, so under flyovers, on flat roofs and in bushes by car parks there are
needle litter and desperate people hurriedly injecting with all the risks that
entails. This may make grim reading and sound very negative, and indeed
much work is needed to change some of the attitudes within the authorities.
However my time there has felt incredibly positive, as despite these
problems the staff are highly motivated and committed to working with this
group, both through key working and support from the clinic, but also
outreach. I was buoyed by their resilience and enthusiasm and reassured to
see how individualised the care was for each and every client.
For me this has emphasised again the essential role the key worker has in
an individual’s treatment journey. For the first 12 years I attempted to treat
people with problematic drug use at my practice. They had to go elsewhere
for key worker support, and this disconnection meant much higher dropout
rates, difficulty in communication and multiple journeys and appointments
for the patients. The day when the shared care system in Birmingham
formally launched, and we had key workers in our GP surgeries, was probably
the most effective change that has happened in my career.
I have come to realise over the years that while a prescriber’s role is
important, what we do by providing a prescription for OST is to give people a
choice. Without a script they have little option but to use drugs. On a script
they have a choice to not use, however the confidence and ability to do that
comes from within them and is usually a result of the strong therapeutic
relationship that effective and caring key work brings.
Working with people who use drugs problematically needs a truly
multidisciplinary approach. The bedrock of this is carers, peers and social
support, but within treatment systems it needs doctors, nurses, pharmacists,
counsellors and key workers who care about their clients and who
communicate and work together to deliver the needs identified by the
individual patient across the whole spectrum of treatment – from harm
reduction to supporting abstinence.
Steve Brinksman is a GP in Birmingham and clinical lead of SMMGP.
www.smmgp.org.uk. He is also the RCGP regional lead in substance misuse for
the West Midlands
The golden key
Working with people who use drugs is a
multidisciplinary landscape with key workers
at its heart, says
Dr Steve Brinksman
‘Attention
should be
paid to the
less common
drugs
implicated in
overdose...’
Professor
Katy Holloway
A group of academics from the University of South
Wales has published research on the prevalence of
non-fatal overdoses among drug users in Wales