Improving Clinical Responses to Drug-Related Deaths. Presented by: Dr Prun Bijral Medical Director Date: 15 th November 2017

Transcription

1 Improving Clinical Responses to Drug-Related Deaths Presented by: Dr Prun Bijral Medical Director Date: 15 th November 2017

2 DRD are preventable Highest for E+W since records began 1993 Heroin deaths doubled between 2012 and 2015

3 5 Key Areas for Action 1. Identifying risk of drug-related death 2. Delivering safe, recovery-orientated drug treatment 3. Preventing overdose in people who use drugs 4. Meeting physical and mental health needs 5. Reducing the risk of DRD for people outside treatment What the relevant guidance has to say, possible barriers to implementation, and solutions Case examples not covered today, available in document

4 1. Identifying risk of drug-related death Evidence to support identification of risk factors to overdose Male, older Not in treatment Entry and exit from treatment Reduced tolerance when leaving a secure setting Concomitant use of other depressants, with heroin Previous history of overdose Unstable accommodation, especially street or hostel Variable engagement

5 Identifying risk of drug-related death Considerations Paper-based data Inconsistency in recording Lack of focus on the most relevant data Variable accuracy in reporting cause of deaths by coroners Complexity not always recorded effectively Solutions Maximise benefits of EHR through discrete data points Analysis of data to allow risk-profiling Consider use of data-analytics, combined with traditional good practice of in-depth analysis of root causes Recognise importance of identifying complexity

6 2. Delivering safe, recovery-orientated drug treatment Key points Critical to ensure treatment systems are balanced Opioid substitution treatment is protective Optimised interventions that are individualised Time-limited treatment increases risk Importance of maintaining therapeutic relationship (engagement)

7 Delivering safe, recovery-orientated drug treatment Considerations Those at highest risk often require a holistic plan Possible over-emphasis on progress to abstinence Retendering will certainly impact on continuity of care Ability of services to consistently deliver evidence-based interventions as resources are constrained Solutions Holistic plans and advocacy for equitable access to other services Informed consent and optimisation of dose Take-Home Naloxone Low-threshold offer Other options for those failing to benefit eg Heroin-Assisted Treatment

8 3. Preventing overdose in people who use drugs Current guidance Importance of Needle exchange Education around OD and risk reduction Staff awareness Rapid access to OST Addressing use of alcohol and other drugs Recovery check-ups and Rapid re-entry Seamless transfer of treatment on release from prison Multiagency collaboration to identify those most at risk

9 Preventing overdose in people who use drugs Considerations Can be hard to predict (unexpected life events eg bereavement) Optimisation of dose is not just when SU feels OK THN on release from prison not universal/core Needle ex engagement opportunities may be limited Availability of therapeutic options for those struggling to benefit Trauma-informed care is not widespread Solutions THN must be considered core element of treatment Dynamic risk approach Tenacious approach to re-engagement Improve staff competency in dealing with trauma

10 4. Meeting physical and mental health needs Current guidance All SU should have an assessment of general health needs Awareness of increased susceptibility to OD Recognise impact of smoking Awareness of appropriate pathways Staff should be able to recognise psychiatric crises

11 Meeting physical and mental health needs Considerations PWUD most in need, but least likely to receive help Homeless, mentally ill or in CJ system struggle the most Mainstream systems can be difficult to navigate Experience of prejudice in a healthcare setting Solutions Focus on developing robust pathways with senior-level oversight Improve staff competency Use of standardised assessments Empower SU to understand and support their access to services Co-location supports engagement Obvious cross-over with Hepatology and Respiratory Health

12 5. Reducing the risk of DRD for people outside treatment Current guidance Understand treatment penetration for all groups Treatment should be accessible and attractive Needle Exchange remains a crucial access point to treatment Services should be culturally sensitive Particular consideration for hard to access groups

13 Reducing the risk of DRD for people outside treatment Solutions Reduce waiting times Outreach is vital for hard to reach and engage Needle Exchange staff should have the appropriate skills Improve awareness of treatment amongst employers, first responders Support peers to promote treatment benefits Listen to SUs when developing services Widespread THN in high risk settings eg hostels Consider new initiatives such as Drug Consumption Rooms Excellent harm reduction may be enough for some Engage families and carers with THN, and support

14 Emerging issues Fentanyl and related analogues Fentanyl and related analogues North Americas opioid epidemic and task force report Reversal in mortality rates UK relevance Increasing number of deaths (60+) Largest share of darknet sales in Europe Local geography of trading Scale of problem and future risk unknown Opportunity to prepare is now prevent, detect, control Solutions as above Must keep an open-mind to national and international initiatives

15 Useful Links ACMD PHE CV/NHSSMPA Fentanyl round table report