I attended a very interesting clinical update recently organised by the LPC in conjunction with First Contact Clinical - the local substance misuse team in South Tyneside. We had a really good overview of harm reduction and its place in substance misuse, followed by a case study and an overview of a pharmacy based project to improve uptake of blood born virus screening by positioning nurses from the team into a couple of community pharmacies. The latter may lead to a greater role for pharmacy via the development of a new service...

But by far the most exciting part of the evening was a demonstration of "how to inject heroin safely" and "how to smoke heroin" by a couple of Recovery Buddies. They used coffee granules for the demonstration. Everybody was fascinated by these demonstrations; we heard about chasing the dragon (Smoking heroin off of a piece of tin foil. As the heroin rolls across the tin foil, the smoke moves with it and looks like a dragon. The user follows the smoke with their straw, so chases the dragon), grafting (stealing), beetles (residue left on the foil), gouge (when you're high - the world is peaceful, everything is perfect, you're numb, but in the best way possible). Actually there's a whole new dictionary of terms!

We were told how vulnerable a person is when "gouging" - a person tends to drool, and can fall hurting themselves or be attacked/robbed by people around them.

One of the buddies described how it feels to use heroin..."you have a high and begin gouging, but soon, it starts wearing off. Your mind races, you're pulled out of your dream world. You crave the drug more and more, wanting to feel the same way as you did when high. You go to the dealer and buy the same amount you had the first time, and smoke. Still feels good, but not as good as first time. You go and buy more. Closer, but not quite there. You're stuck; you don't know what to do. You want to go back to that little dream world and stay forever, but your body is already developing a tolerance. You panic. You use all your money to buy more and more and more, but still, not the same as that first time. You realise that you have no more money, so you start selling your things, pawning whatever could get you that next bag. Still, nothing compared to what you had on that first, magical time. So, you're broke and own nothing. But you don't care; all you care about is getting back to the first high. You start stealing, doing "favours", whatever gets you the money for the attempt. Your life becomes a living hell, all in search of a repeat of the first high."

Another of the buddies explained how difficult it is to inject safely, how it's so easy to miss veins leading to infections, how it's so easy when desperate to share needles, how important needle exchange is, and what's in the needle exchange kit. The little pan, the citric acid, the syringe - in fact the whole ritual associated with injecting..."if it's red go ahead, if it's pink, stop and think (it's not the vein)."

Welcome to my blog…This month it’s all about harm reduction…

Last week, I attended a meeting of the South Tyneside drug related death
group - which I sit on as a representative of the LPC. The group consists of
representatives from all agencies involved in drug misuse in the area and
attempts to try and learn from these sad deaths to prevent future tragedies.

We had 3 cases to consider, quite a lot really considering we only usually
have 3 cases per year, and they were all very heartbreaking. Community
Pharmacy is well placed to help prevent drug related deaths by supervising
methadone and buprenorphine - supervision has been clearly identified
by NICE as a method for reducing drug related deaths. Logic dictates
that reduced collection of methadone (more supervision) equates to less
methadone in society, less chance it can be diverted, and consequently less
tragedy. In some areas of Scotland supervision is at the 98% level, which
is well above our own as an attempt to reduce diversion. Sadly in one of
the cases we looked at, Methadone overdose was the culprit, and the police
had stated that the patient’s house was “awash” with Methadone. The
case is complicated, and I’m not going to go into detail here as it would
be inappropriate, but I raised the issue of minimising the risk for patients
by more pharmacy supervision. Clearly there is a prescribing decision
to make allowing patients to take home methadone as an alternate to
supervision… One member of the group strongly agreed and said “it simply
isn’t appropriate for a substance misuser to complain about a daily walk to
a pharmacy in an attempt to take-home supplies, only to have him lazing
around in bed or playing on a computer – a brisk walk is therapeutic”

Another of the cases we reviewed involved the tragic death of a patient taking
his father’s medication to help him to sleep…Not much we can do here, but
I’m sure improved patient counselling, and reduced prescribing of potent
opiate drugs, would lead to less chance of such an appalling waste of life.

The final case involved an ex-addict being tempted by a dose he had used
frequently before, but which ended his life - as his tolerance had been
markedly reduced. Educating addicts who are weaning themselves off drugs
is essential to limit such events.

I left the meeting feeling really quite sad at the waste of life; but happy that
pharmacy is doing as much as it can to prevent other cases like this.