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Hepatitis C treatment access and uptake for people who inject drugs: a review mapping the role of social factors

Evidence documents successful hepatitis C virus (HCV) treatment outcomes for people who inject drugs (PWID) and interest in HCV treatment among this population. Maximising HCV treatment for PWID can be an effective HCV preventative measure. Yet HCV treatment among PWID remains suboptimal. This review seeks to map social factors mediating HCV treatment access.

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The National Drug-related Deaths Database (Scotland) Report 2011

In 2011, there were 438 cases identified as eligible for inclusion in the NDRDD cohort (an increase from 365 in 2010).

1. Over three quarters (78.3%) were males, over half (53.4%) had lived in the most deprived areas in Scotland and the 35-44 years age group accounted for the highest proportion of deaths (38.1%)
2. Over two fifths (44.5%) of the cohort, where known, were a parent or parental figure. A total of 331 children lost a parent or parental figure to a drug-related death.
3. Where known, nearly two thirds (63%) had a history of intravenous (IV) drug use, which is a lower proportion than in 2010 (70.8%). Over three quarters (77.4%) of the 2011 cohort had a medical condition recorded in the 6 months prior to death. IV drug users had a higher prevalence of medical conditions compared to those who were not known to have been an IV drug user.
4. The prevalence of Hepatitis C amongst the drug-related deaths cohort has steadily increased over the period 2009-2011.
5. Where known, almost two thirds of individuals (64.5%) had been in contact with a drug treatment service at some point in their lives.
6. Where known, in the 6 months prior to death, one third (34.3%) had been released from police custody and almost one fifth (18.1%) had been released from prison.
7. This year’s report includes data on drugs ‘present’ in the body and drugs ‘implicated’ in the death. The presence of a drug in toxicology of the deceased individual does not necessarily mean that the drug was implicated in (contributed to) the death.
8. The drug most frequently found to be present in the body at death was diazepam (81.4%) followed by methadone (57.3%), heroin/morphine (51.5%), anti-depressants (37.1%) and alcohol (37.1%). In 97% of cases there was more than one drug present. Opioids (methadone, heroin, morphine or buprenorphine) were present in 87.2% of cases.
9. The drug most frequently implicated in the death was methadone (53.4%), followed by heroin/morphine (38.6%), diazepam (23.1%) and alcohol (21.2%). More than one drug was implicated in the death in the majority of cases (68.9%).
10. In relation to drugs present, the proportion of deaths with heroin/morphine and alcohol has decreased over the period 2009-2011, while the proportion of deaths with methadone, diazepam and anti-depressants has increased over this period.
11. In 2011, the majority of individuals (150, 60.7%) with methadone found in their toxicology were not in receipt of a methadone prescription at the time of death.
12. Where toxicology information was known, a higher proportion of females (72.3%) had methadone present compared with males (53.1%). This pattern is similar to 2010, (56.6% and 41.8% for females and males respectively), although the gap between females and males has grown in 2011.
13. Where known, almost three quarters (73.8%) of individuals in the 2011 NDRDD cohort were not currently in receipt of a prescribed substitute drug.

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Green Apples WARNING- Fatal Overdose Co.Louth Ireland

I did not see these pills so I cannot say whether they were beveled, had a score line or their height/weight I have been told there identical to the batch that we all loved last year! These are NOT the same batch!!!

These pills have been reported to be everywhere!

Have heard these beans where doing the rounds for a while now and have been warning everyone off them after reading about the 2 lads in Cardiff.

Unfortunately a friend of a friend passed away on Wednesday after taking these at a rave on Saturday,
Avoid these like the plague!

Here’s a run down of what went down according to someone close to the girl.

” so she went to a rave on Saturday night with 4 green apples and had consumed them by 12:00 she was in good form all night dancing and joking but her feet kept going from under her, because of this she chose to spend her night sittin down Chatting with her mates. When they got the bus home to a house things took a turn for the worst when she began to over heat, she took off some clothes and went outside to cool down, shortly after she collapsed to the ground and began to fit and was foaming from the mouth. The ambulance arrived and she was rushed to the hospital. Her temperature spike to 160? Her head was reported to have swollen up along with her body which also turned black and blue. Her organs were reported to have started failing on Monday, on Tuesday a brain scan reported that she was clinically dead and her life support was turned off on wednesday”
I urge anyone who has these in there possession to flush them, get your money back and warn your dealer, from what I hear they are identical to the batch from last year that we all loved, therefore people will jump at the chance to buy them once more! STAY AWAY

I know the report lacks detail on the pill but I urge the Mods to keep this warning up as everyone loved the MDMA/MDA combo apples last year and these could be easy mistaken for them!

Taken from Pillsreports.com

A Harm Reduction Response to Media Reports of Needlestick Injury / Drug Related Litter (S. Parkin PhD)

Article written by Stephen Parkin PhD

In March 2013, Laurence Avis of UnitingCare ReGen, (the lead alcohol and other drug treatment and education agency of UnitingCare Victoria & Tasmania), wrote an open letter to members of a local community following an account of needlestick injury (involving a young child) that had been reported in a local newspaper (The Sunbury Leader, 26th March 2013). The letter was written in order to avoid hysterical, ‘kneejerk’ and stigmatising responses by local authorities and officials in matters relating to street-based injecting.

The following ‘harm reduction response’ has been inspired by UnitingCare ReGen’s proactive response to negative media reports of needles/syringes in community settings. The following ‘letter’ provides a template for similar action by relevant bodies based in the UK (harm reduction agencies, drug and alcohol workers, drug users).

Where the letter has (brackets), individuals/correspondents using the template should insert the details relevant to their particular geographical location.

I advise and recommend using this letter as a template (adapt as required) to respond to press reports that seek to diminish and devalue the role of harm reduction in community settings and/or seek to over-sensationalise accounts of discarded paraphernalia in community spaces.

_____________________________________________________________________________________________

Dear (Journalist / Editor / Newspaper)

I am writing to you in connection with the recent story in your newspaper (online/print) regarding the incidence of (drug related litter / needlestick injury) in (name of town/area).

Although it is entirely natural for people to fear the consequences of needlestick injury (particularly in public spaces in community settings), the actual risk of serious harm to public/individual health from these types of injuries is relatively low. It is also important to emphasise that the epidemiological risk of contracting hepatitis C or HIV from these injuries is also very low (and no known incidence of serious blood borne infection from this form of injury exists in the research literature). Although I am not stating that there is completely ‘no risk’ of viral infection, you (as a broadcaster of information for public consumption) should be aware that research from the UK (Parkin and Coomber 2011) defined this ‘low risk’ as: ‘the odds of sero-conversion following community acquired needlestick injury ‘where the source is unknown but assumed to be an IDU [injecting drug user], is 12-31% for HBV, 1.62% for HCV and 0.003 – 0.05% for HIV’ (Blenkharn 2008, 727). As such, there is perhaps only limited rationality in fear associated with virally contaminated needle/syringes in community settings’ (Parkin and Coomber 2011, 1219)

All injuries involving sharp objects should be taken seriously (including blades, glass, razors and needles)and receive appropriate medical treatment. Injuries caused by needles however should not be a cause for panic or as a reason to mobilise discriminatory responses against people who inject drugs. The research shows that the chances of contracting a blood-borne virus like HIV or Hepatitis B or C from a used needle discarded inappropriately in community settings are minimal, as these viruses can only survive for a short time outside of the body. (That is why they are termed ‘blood borne viruses’; because they need ‘blood contact’ to stay alive). As with any puncture wound there would also be a low level risk of tetanus, but this can be remedied by arranging a booster shot at a local Emergency Room or community GP.

Needles and syringes are distributed each year to members of the public through the UK’s network of Needle and Syringe Programs (NSP), including the program run by (name of centralised agency) in (name of town/city/region/local authority) in your news story. NSP are regarded as an important part of public health policy in the UK and have been influential in reducing drug (and sex) related harms since their introduction to the UK in the mid 1980’s. These programs are a key part of assisting people with drug problems and assisting them towards recovery from drug dependency.

People who discard any form of litter are acting irresponsibly, especially when there is a social expectation that people will manage their ‘rubbish’ in a responsible manner. This is especially so when littering involves cigarette butts, chewing gum, glass, sharp items, dog faeces and needles attached to syringes. While the story contained within your newspaper involved sharp items discarded by (one/two) individual(s), the specific actions of (this/these) individual(s) should not be regarded as sufficient evidence to support the moral outrage aimed at injecting drug users (inferred/noted) in your news story.

The stigmatisation and discrimination of people who inject drugs in our community is not a helpful response to difficult and challenging problems surrounding their drug dependency. Newspaper articles such as yours (date/title) may only influence negative responses towards people who may be vulnerable and in need of assistance. Accounts such as that in your paper may only push these people further away from seeking help with drug dependency and exacerbate their related health and social problems.

If you do have to report on such issues, a better approach may be to write an article that emphasises the need for parents/teachers/children to provide some form of awareness and training on the harms attached to handling sharp items, dog faeces, broken glass, barbed wire etc. For communities to respond positively to community issues, there is perhaps an equal moral responsibility for broadcasters such as yourself to provide the appropriate awareness needed for more positive action (and not promote fear and loathing that is directed towards already vulnerable people).

I look forward to your response,
Yours
(Name)

Reference

Blenkharn, J.I., 2008. Clinical wastes in the community: local authority management of discarded drug litter. Public Health 122, 725–728.

Parkin S, and Coomber R. (2011) Injecting drug user views (and experiences) of drug-related litter bins in public places: A comparative study of qualitative research findings obtained from UK settings. Health & Place, 17, 1218–1227.

You can also read also read a case –  Irish Press Ombudsman upholds complaint from coalition of drug services

Criminalising Addiction: is there Another Way?

Citywide are holding a conference on 21st May  to discuss the impact of current Irish Drug Policy and look at possible alternative policies. There is an international push to review the ‘War on Drugs’ and consider alternative drugs policies, it is therefore important to examine the evidence that informs these policies in order to participate in the debate.

The conference will cover:

• The difference between decriminalisation and legalisation of drugs
• The purpose of criminalisation and drug law enforcement
• The  impact of drug related convictions on the prison population and the drugs trade
• Drug decriminalisation practiced around the world
• The impact of criminal records  for minor drug offences
• The UN General Assembly Special Session on International Drug Policy 2016 to review the ‘War on Drugs.’

Participants will be given an opportunity to discuss their views and there will be presentations on the day by:

Niamh Eastwood, Director of Release, the national centre of expertise on drugs and drugs law in the UK

Johnny Connolly, Research Officer, Health Research Board

Liam Herrick, Executive Director, Irish Penal Reform Trust

Brigid Pike, Researcher, Irish Focal Point for the European Monitoring Centre for Drugs and Drug Addiction, Health Research Board

Venue: Royal College of Physicians, Kildare St, Dublin 2 Time: 10.30am to 3pm with lunch and refreshments provided. To book a place for this event please e-mail Lisa atlisa@citywide.ie or call 01 8365090. 

Prevalence of, and risk factors for, human immunodeficiency virus, hepatitis B and hepatitis C infections among men who inject image and performance enhancing drugs in England & Wales.

Dr Vivian Hope of Public Health England told the British HIV Association conference yesterday that injection of image- and performance-enhancing drugs is rising in England and Wales. Moreover, his research suggests that men may be acquiring bloodborne viruses through this route – 1.5% had antibodies to HIV, 8.8% had antibodies to hepatitis B and 5.5% to hepatitis C.

Dr Hope said that across the world, only three previous studies have been conducted on HIV prevalence among people who inject drugs which are taken to enhance body image, physical strength or performance. One of these three was conducted in the UK in the mid-1990s and did not find any HIV infections in those surveyed.

There are reports of increased numbers of people injecting these drugs who present to needle and syringe exchanges. However, not all syringe exchanges have the skills and experience to meet their needs. The injecting process is different to that of opiates ­– these drugs are normally delivered in a sealed vial, and are not usually injected into a vein, but into a muscle or beneath the skin.

Moreover, the social profile of injectors of image- and performance-enhancing drugs is different to that of opiate injectors – younger, more likely to be employed, less likely to have had problems with the criminal justice system.

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Dr. Stephen Parkin A ‘Harm Reduction’ Response to Drug Related Litter in Community Settings.

Part 1 Drug Related Litter

Part 2 Responses to Drug Related Litter

In the video the report by DEFRA is mentioned Tackling drug related litter this can be downloaded 

Cannabis drug debts leading to suicide

Drug debts are leading to suicides in parts of Dublin amid warnings that increased use of cannabis weed has led to some young people owing thousands of euro.

Dr Bobby Smyth, consultant child and adolescent psychiatrist in south Dublin said spiralling levels of cannabis use had now led to a growth in drug debts, ultimately leading to suicide in a small number of cases.

Dr Smyth said the most significant change was the usage of cannabis and the associated change in the way it is sold.

He said it was now not uncommon for people to smoke up to €50 worth of cannabis a day — a spend comparable to someone with a heroin addiction.

However, cannabis dealers are allowing clients to build up debts of hundreds of euro, which they then struggle to pay, often leading to the debt increasing while usage continues.

“They are spending the sort of money on cannabis now that we would associate with heroin four or five years ago.

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Calls for radical change to chaotic addiction services across Ireland

Existing guidelines for those working with opiate users are controversial and heavily criticised, and a report seen by MI recommends a radical overhaul of how services are delivered. James Fogarty investigates

The struggle to both balance the books and keep the health services afloat is an all consuming one. Drug addiction services are perhaps one of the casualties of this focus. Although recent figures compiled by the Health Research Board (HRB) said the annual number of drug-related deaths and deaths among drug users in Ireland decreased from 652 in 2009 to 575 in 2010, problems remain. Budget reductions, a continued scarcity of services outside the capital, and concern over the ICGP’s opiate treatment guidelines have combined to make a difficult area of medicine even more challenging.

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Suffolk (UK) patient with anthrax takes total in England to five cases

The Health Protection Agency (HPA) is aware that a person who injected heroin has been diagnosed with anthrax infection in Suffolk and has died.

There is an ongoing outbreak of anthrax among people who inject drugs in a number of countries in Europe with 13 cases now identified since early June 2012. The latest case in Suffolk brings the total number affected in the UK to seven – five in England (including four fatalities), one in Scotland and one in Wales. The source is presumed to be contaminated heroin.

It is unclear as yet whether these recent cases are linked to the cases in Europe (four in Germany, two in Denmark and one in France) but the HPA is continuing to monitor the situation.

The European Centre for Disease Prevention and Control (ECDC) and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) have concluded that heroin users in Europe are still at risk of exposure to anthrax.

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