NTA

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 Viruss, 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