Harm Reduction – NHS Sexual Health & Blood Borne Viruses | Tayside

What is harm reduction?

 

Harm reduction is a set of practical strategies and ideas aimed at reducing the harms from using drugs. Harms include but are not limited to:

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

Harm reduction strategies include promotion of safer drug use such as alternatives to injecting and provision of clean equipment.

Harm Reduction Services

Cairn Centre Dundee

Harm reduction services recognise that management and reduction of drug-related harm is a more feasible option than efforts to eliminate drug use entirely. In Tayside we have a range of harm reduction services available including a specialist nursing team, access to opiate substitution therapy (OST) through Substance Misuse Services and Injecting Equipment Provision (IEP) also known as needle exchange.

 

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.

The team can be contacted on 01382 204248.

Please have a look at our Services & Contact list for more info.

 

Injecting Equipment Provision (IEP)

Injecting Equipment Provision (IEP) 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 are a number of health risks associated with injecting drug use:

  • abscesses
  • cellulitis
  • collapsed veins (injecting with a blunt needle, over use of injecting sites)
  • increased risk of getting a blood-borne virus (BBV), particularly Hepatitis C.

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.

 

Please have a look at our Services & Contact list for more info.

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
Davidsons Pharmacy 41 High Street, BRECHIN, DD9 6EZ
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
Drumhar IEP Service Drumhar Health Centre, North Methven Street, PERTH, PH1 5PD
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 & Alternatives

Safer Injecting Advice for Opiates

  • 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. These 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. Approved suppliers can include nurses, pharmacists and staff working in third sector (Gowrie Care and Addaction).

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 only certain staff can supply naloxone.

 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
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

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

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.