Harm Reduction evidence, practice and improvements

What is harm reduction?

social policy that is embodied in some healthcare interventions
aims to benefit the individual, communities and society by protecting all from the associated negative effects and the social and financial costs of activities that present a (very significant) risk of harm

What does harm reduction focus on?

Intervention aim to shift risk behaviour down to less risk

When was first needle exchange in UK?

1985: First NSP in UK in Peterborough.

What is the biggest risk factor for infection of Hep C?

Injecting drug use

How long can it take for HEP C to show?

20+ years to have symptoms or complications

WHO goal to eliminate HCV by 2030, UK by 2025;

What is the state of NSP in UK?

Coverage is patchy and service provision variable

How could the NSP in the community be better?

• Reactive service - very commonly it is transaction focused. (NICE level 1 provision)

• Missed opportunity to be proactive

• Stigma and fear sometimes intersect

• Payment and support are variable, sometimes both are poor.

• Knowledge, capability and motivation can be low.

What are the 3 definitions of coverage WHO?

• percentage of injections administered 'covered' by sterile needles and syringes

• number of needles and syringes supplied to each injecting drug user per year

• percentage of injecting drug users in regular contact with NSPs

What are the key issues in NSP?

• Inadequate coverage*

• Convenience and accessibility

• Equipment quantities

• Relationship with supply & returns

• Confidentiality

• Staff attitude

• Provision of additional interventions

What factors increase the likelihood of a PWID to get Hep C

• New injectors

• Homeless

• Been in prison

• Crack cocaine use

What factors decrease the likelihood of a PWID to get Hep C

Being in drug treatment (OST)

What services can NSP get people involved in?

• Signpost into treatment when ready

• Early and crisis interventions

• Safer injecting and health protection

• BBV screening, HBV vaccination

• Social support and advice

• Naloxone supply

What can community pharmacist do to engage people with the service?

• Consider the key issues previously discussed:

• Staff attitude [reduce stigma]

• Confidentiality

• Coverage: Equipment quantities and provide the right equipment.

• Relationship with supply & returns

• Convenience and accessibility – located near to need, consider opening hours.

• Provision of additional interventions

What are some addition interventions?

• Reactive and proactive advice and services

• BBV screening (HCV testing from NSP pharmacies)

• SSTI care

• Naloxone