What is it?

 

Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Negative consequences include but are not limited to:

  • transmission of blood borne viruses
  • damage to veins and circulation
  • injecting wound
  • bacterial infections.

Harm reduction strategies include promotion of safer use such as alternatives to injecting, managed use through provision of clean equipment and abstinence (stopping drug use) to meet drug users “where they’re at”.

Harm Reduction Services

 

Harm reduction services are sensible and recognise that management and reduction of drug-related harm is a more feasible option than efforts to eliminate drug use entirely;

  • focus on risks and harms on the basis that by providing responses that reduce risk, harms can be reduced or avoided. Harm reduction interventions may target individuals, communities and wider society;
  • do not focus on abstinence, although harm reduction supports those who seek to moderate or reduce their drug use, it neither excludes nor presumes a treatment goal of abstinence;
  • are person-led, respecting the dignity and rights of individuals and services endeavor to be ‘user friendly’ in the way they operate
  • are low threshold and are often the first and only point of contact for people using drugs
  • can be the first step on a recovery journey

In Tayside we have a range of harm reduction services available including a specialist nursing team, access to opiate substitution therapy (OST) through Tayside Substance Misuse Service (TSMS) and Injecting Equipment Provision (IEP) also known as needle exchange.

Our focus is mainly on reducing the harms associated with injecting of opiates such as heroin but we also provide services for people using Image and Performance Enhancing Drugs (IPED) such as steroids or tanning products and to a lesser extent, harms associated with the use of other substances such as New Psychoactive Substances (also known as “legal highs”) and “Chems” used primarily by men who have sex with men to enhance sexual experiences.

Injecting Equipment Provision

Injecting Equipment Provision (IEP) is the name given to a service that provides people who inject drugs with clean needles, syringes and other injection paraphernalia such as water and citric acid. These services were previously known as Needle Exchanges.

There is a number of health risks associated with injecting drug use, such as bacterial infections.  Abscesses, cellulitis and collapsed veins can result from injecting with a blunt needle.  Injectors are also susceptible to a range of blood-borne virus (BBV) infections, the most prevalent of which is Hepatitis C infection.

There is sufficient evidence from around the world to show that IEP services are effective in reducing injection risk behaviours among injecting drug users (in particular, self-reported sharing of needles and syringes, and frequency of injection) and there is some evidence that IEPs reduce HIV infection among injecting drug users. IEP services are also cost-effective when compared with the lifetime cost of treating HIV infection. Distribution of sterile needles and syringes alone is not enough to reduce the transmission of blood-borne viruses (especially, HCV) among injecting drug users – education and health promotion is an essential part of an IEP service.

For many injectors, engagement with an IEP service is a first step towards recovery.

IEP services can be found across Tayside. Look for the symbol below in the window.

Site Address
Arbroath Minor Injuries Unit Rosemount Road, ARBROATH, DD11 2AT
Whitehills Minor Injuries Unit Station Road, FORFAR, DD8 3DY
Your Local Boots 10 High Street, KIRRIEMUIR, DD8 4EY
Well Pharmacy 112 High Street, ARBROATH, DD11 1HM
Well Pharmacy 9 Fisheracre, ARBROATH, DD11 1LE
Davidsons Pharmacy 98 East High Street, FORFAR, DD8 2ET
Lloyds Pharmacy 48 High Street, MONTROSE, DD10 8JF
Site Address
The Cairn Centre 12 Rattray Street, DUNDEE, DD1 1NA
Your Local Boots 94 Albert Street, DUNDEE, DD4 6QQ
Your Local Boots 79 Macalpine Road, DUNDEE, DD3 8RE
Your Local Boots 71 Lothian Crescent, DUNDEE, DD4 0HU
Richardsons Chemist 181 Blackness Road, DUNDEE, DD1 5PH
Lloyds Pharmacy 103 High Street, Lochee, DUNDEE, DD2 3BX
Site Address
Davidsons Pharmacy 12 Main Street, Bridgend, PERTH, PH2 7HB
Davidsons Pharmacy 21/23 Wellmeadow, BLAIRGOWRIE, PH10 6AS
Lloyds Pharmacy 115 Glover Street, PERTH, PH2 0JF
Right Medicine 56 High Street, CRIEFF, PH7 3BS
Rowlands Pharmacy 61 Hight Street, KINROSS, KY13 7AA

Safer Injecting

Safer Injecting Advice

  • Wash hands & injection site
  • Always use clean/new equipment
  • Never share any equipment including spoons, filters and water
  • Work from a clean surface to prepare your hit
  • Ensure you are using the right needle in the right place
  • Rotate your injection sites
  • ALWAYS INJECT TOWARDS YOUR HEART (up the way)
  • Do NOT inject if you can feel a pulse
  • Dispose of equipment in sharps bins and return to your IEP service

There are a number of useful short films produced by Harm Reduction Works that can be found on their You Tube channel

There are a number of alternatives to injecting that the harm reduction team can discuss.

Break the Cycle is a tool used with people who inject to encourage them not to initiate new injectors.

There are a number of alternatives to injecting that the harm reduction team can discuss.
Break the Cycle is a tool used with people who inject to encourage them not to initiate new injectors.

Remember what influenced you to begin injecting and if you don’t want to encourage non-injectors to start then;

• Don’t talk about injecting to them or in front of them
• Don’t inject in front of them
• Think about the risks to them such as overdose, hepatitis and HIV

Other alternatives include:

  • Smoking heroin
  • Snorting
  • Up yer bum!

 

Signs of Overdose

  • Pinpoint pupils
  • Pallor (pale skin colour)
  • Cyanosis (blue tinge to lips, finger nails)
  • Breathing problems e.g. slow/shallow breaths, not breathing
  • Snoring deeply – this is often and understandably mistaken for sleeping
  • Unconsciousness

Overdose can be described as a process and therefore it is important to be aware that the effects can kick-in hours after the initial hit.

What to do

Useful life-saving action you could take if you think someone has overdosed:

If casualty is breathing normally:

  • Put in recovery position – see images below
  • Dial 999
  • Stay with them and monitor their condition until help arrives

If casualty NOT breathing normally:

  • Dial 999
  • Perform CPR – if able
  • Stay with them until help arrives

If you or the person has naloxone, you can give them this to buy time until the Emergency Services arrive.

What is Naloxone?

Naloxone is an opioid antagonist; a drug which can temporarily reverse the effects of a potentially fatal overdose involving opioid drugs such as heroin, morphine or methadone. 

Why is it important?

Intramuscular injection of naloxone is a first aid emergency response to overdose and provides more time for emergency services to attend and medical care to be given. Supplies of ‘take home’ naloxone (THN) kits are made, along with training on overdose awareness, to people at risk of opioid overdose in order to reduce the risk of death. 

Legal bits

In an emergency ANYONE can legally administer Naloxone to save a life.

However, to supply the naloxone (supplying in advance when there is no emergency but this person is at risk of an opiate overdose) you must attend Naloxone T4T (training for trainers) training programme and also be an approved supplier e.g. a registered nurse or pharmacist operating the Patient Group Direction (PGD).

Please note that ANY staff member can train someone on the signs of overdose and how to use naloxone after they have attended the Naloxone T4T training, however, currently in Tayside we can only supply naloxone on prescription or via a Patient Group Direction (PGD) and only registered nurses and pharmacists can use a PGD.  Work is currently underway to allow others to supply naloxone but at the moment it remains the case that the PGD must be operated.

 Key Points

  • Naloxone counteracts opiates for around 20-30 minutes
  • It does not rid the body of opiates
  • It has no effect on alcohol
  • It does not reverse the effect of non opiate drugs, although they can contribute to overdose in combination with an opiate
  • It will buy time until an ambulance arrives

Contact Information
For further information please contact

Pauline Cunningham
Administrator – Harm Reduction/BBV Team
(For paperwork, Naloxone kits, to book training)

The Cairn Centre
12 Rattray Street
Dundee
DD1 1NA

Telephone Direct: 01382 204248
Internal Extension: 53450
pauline.cunningham@nhs.net


Sarah Donaldson, Specialist Pharmacist in Substance Misuse
Naloxone Lead for Tayside

Constitution House
55 Constitution Road
Dundee
DD1 1LB

Telephone: 01382 660 111 (ext 22596)
sarahrdonaldson@nhs.net


Helpful websites

Martindale are the manufacturers of Prenoxad, the licensed product used in the Take Home Naloxone programme
http://www.prenoxadinjection.com/drug/use_naloxone.html

Scottish Drugs Forum
http://www.sdf.org.uk/what-we-do/reducing-harm/take-home-naloxone/

British National Formulary (BNF) naloxone information (please ensure you are looking at the correct section for overdose of opiates in non-medical setting for dosage information)
https://bnf.nice.org.uk/drug/naloxone-hydrochloride.html

UK Government publication for the widening the availability of naloxone.
https://www.gov.uk/government/publications/widening-the-availability-of-naloxone/widening-the-availability-of-naloxone

ODnotMe campaign posters for printing/email

Safer Injecting (non-opiates)

 

“Legal Highs” as they used to be called, are now covered by The Psychoactive Substances Act. It was introduced in the UK on the 26th May 2016 and it makes it an offence to manufacture, export/import.

Under the new regulations, possession with intent to supply is an offence. Possession is not an offence, except in a ‘custodial institution’.

Injecting carries the risk of Blood Borne Viruses such as HIV and Hepatitis C, risk of vein damage and overdose. Snorting of these drugs is likely to be less risky but still may expose to BBVs and corrosive damage.

HARM REDUCTION ADVICE

  • Use clean needles for every new injection and never share!!!
  • Dispose of needles and other equipment safely following use
  • Make smaller joints/lines/bongs
  • The purity and strength of legal highs can vary from what you are used to, start with a smaller dose
  • Avoid mixing drugs as this can greatly increase the chances of cardiac arrest and overdose.

Useful Websites:

NPS Hub (Gowrie Care):

Local hub for workers to share expertise on drug trends.

Crew 2000

Edinburgh based harm reduction and information service.

Pill Report

Extensive information on “lived experiences” of substance use.

IPEDs are substances that are taken by people with the intention of improving their physical appearance and/or to enhance their sporting performance.  For the most part body image, physical strength and size is the main motivation to use IPEDs.  IPEDs can be taken by injection or orally (swallowed).

Risks are particularly high for young people.  If IPEDs are taken while a person is still growing they can cause a number of serious problems included stunted growth.

If a person is injecting they also carry the risk of transmission of HIV and other blood borne viruses (BBVs) such as Hepatitis B and C.  Injecting can also cause muscle damage, scarring and infections at the site of injection.

Anabolic steroids and other similar IPEDs are now considered Class C in the Misuse of Drugs Act 1971.

Before taking steroids, people should consider the alternatives such as:

  • a better, healthy diet
  • protein and vitamin supplements

If you are planning to inject, please visit the harm reduction team to ensure you have enough clean equipment for your cycle. 

Useful Websites:

Wedinos-

Welsh drug information website

NHS UK-

Anabolic Steroids

Crew 2000-

Edinburgh based, training and support organisation

 

Chemsex refers to the use of any combination of drugs that includes crystal methamphetamine, mephedrone and/or GHB/GBL by men who have sex with men (MSM) before or during sex.

Although drugs and alcohol have often been used in sexual contexts throughout history, crystal methamphetamine, mephedrone and GHB/GBL provide a particular sexually-disinhibiting “high”, which represents a different public health concern than that associated with other drugs more commonly used in the past.

Their use has been accompanied by higher-risk sexual activity than has ever been observed or associated with any other kind of drug use. Users of these drugs can feel invulnerable to harm, supremely confident, dismissive of consequences, sexually adventurous, experience a heightened sense of pleasure, and can possess a stamina and endurance that may keep them awake for many days. When used in sexual contexts, this can translate into a reduced concern for safer sex practices and contact with a higher number of partners during a short, concentrated period of time. Unwanted side effects while under the influence can include aggression, paranoia, hallucinations/perceptions of persecution, overdose and more.

Chems use is relatively low in Scotland however the risks and harms from using chems can be significant particularly if crystal methamphetamine and mephedrone are injected (known as “slamming”). If you are injecting, please visit one of our IEP sites to collect clean equipment.

If you are involved in chemsex, it is important that you know how to keep you and your partners as safe as possible. Come along to MOT or sexual health clinic for more information.

Understanding Chemsex by THT gives practical advice about safer drug taking, and how to lower the chance of sexual health risks when mixing drugs and sex.
More information on drugs and sex can be found on THTs Friday/Monday website.

Services

Tayside Harm Reduction/BBV Nursing Service provides specialist nursing input and support to people who inject drugs (PWID) across Tayside.  The team are based in The Cairn Centre, Dundee but deliver clinics across Dundee, Angus and Perth and Kinross.

The service plays an integral role in reducing the harms associated with injecting drug use for people.  The aims of the specialist service are to:

  • Reduce and prevent blood borne virus (Hepatitis C, Hepatitis B and HIV) transmission
  • Reduce injecting site infections and treat injecting wounds
  • Reduce hospital admissions related to ulcerated wounds
  • Support individuals into BBV and drug treatment
  • Reduce drug related deaths and near fatal overdose

The specialist nurses undertake assessments of individuals’ risk, advise on safer injecting techniques, discuss alternatives to injecting, provide overdose awareness training to staff and clients and provide naloxone.  They also provide screening for sexually transmitted infection and pregnancy testing, emergency hormonal contraception, hepatitis B vaccination, antibiotic prescribing and assessment for hepatitis C treatment.