Substance use and misuse

Transcription

1 CENTRE FOR PHARMACY POSTGRADUATE EDUCATION Substance use and misuse A CPPE workshop to support local public health services Pre-workshop book PH/SUBSUSE14/PW August 2014

2 Substance use and misuse - Pre-workshop book Content development This CPPE workshop resource was developed from the CPPE distance learning programme, Substance use and misuse. CPPE recognises all those who helped with and supported its development, in particular Dr Jenny Scott, senior lecturer in pharmacy practice, University of Bath. CPPE programme developer Karen Wragg, local tutor and senior pharmacist, learning development Reviewer Dr Rhys Ponton, medicines management pharmacist, NHS Plymouth and member of PharMAG steering committee CPPE reviewers Christopher Cutts, director Sarah Ridgway Green, local pharmacy tutor Brand names and trademarks CPPE acknowledges the following brand names and registered trademarks which are mentioned in this learning resource: BluTack, PowerPoint, YouTube. Disclaimer We have developed this learning resource to support your practice in this topic area. We recommend that you use it in combination with other established reference sources. If you are using it significantly after the date of initial publication, then you should refer to current published evidence. CPPE does not accept responsibility for any errors or omissions. External websites CPPE is not responsible for the content of any non-cppe websites mentioned in this learning resource or for the accuracy of any information to be found there. All web links were accessed on 27 June Design and artwork: Outset Publishing Ltd, West Sussex Third edition published August Originally published in March 2011 by the Centre for Pharmacy Postgraduate Education, Manchester Pharmacy School, 1st floor, Stopford Building, University of Manchester, Oxford Road, Manchester M13 9PT. Copyright controller HMSO

3 Learning with CPPE The Centre for Pharmacy Postgraduate Education (CPPE) offers a wide range of learning opportunities in a variety of formats for pharmacy professionals from all sectors of practice. We are funded by Health Education England to offer continuing professional development for all pharmacists and pharmacy technicians providing NHS services in England. For further information about our learning portfolio, visit: We recognise that people have different levels of knowledge and not every CPPE programme is suitable for every pharmacist or pharmacy technician. We have created three categories of learning to cater for these differing needs: Substance use and misuse - Pre-workshop book Core learning (limited expectation of prior knowledge) Application of knowledge (assumes prior learning) Supporting specialties (CPPE may not be the provider and will direct you to other appropriate learning providers). This is a learning programme. Continuing professional development You can use this workshop programme to support your continuing professional development (CPD). Consider what your learning needs are in this area. You can record your CPD online by visiting: or use the CPD record sheets to plan and record the actions you have taken. Keeping up to date To ensure this learning resource is up to date we will review it every year. A CPPE programme manager will check through the material to ensure the content is current and relevant, and that the quality of the learning experience is maintained. You will find the latest version of this resource on the CPPE website. Feedback We hope you find this learning resource useful for your practice. Please help us to assess its value and effectiveness by completing the feedback form at your event, or by ing us at: feedback@cppe.ac.uk 3

4 Substance use and misuse - Pre-workshop book About this CPPE workshop resource You are about to take part in training so that you can gain the necessary skills to provide pharmacy services for substance misusers from your pharmacy. There are two parts to this CPPE workshop resource: 1. This pre-workshop book, which includes reading, information searches and activities that you need to complete before you attend the workshop. 2. The workshop itself, which is focused on the attitudes, knowledge and practical skills required to deliver successful services. This book gets you started, it provides key information and activities to help you to meet the learning objectives shown overleaf, but should also help you to identify your own learning needs in this area. We have included activities to stimulate your thinking and we will refer to these again at the workshop, so please ensure that you complete them before the event. We estimate that it will take you up to three hours to complete Tasks 1 to 3 in this book. You will also need to allocate time to complete Task 4 which involves completing the CPPE Substance use and misuse distance learning programme (2010 or 2012 edition) and e-assessment. These are both available from the CPPE website: To get the most from the workshop we recommend you work through as much of the distance learning programme as possible before attending the event. You should then aim to complete both the programme and its linked e-assessment within three months of attending the workshop. Notes 4

5 Declaration of competence The Declaration of competence (DoC) model has been designed to help pharmacy professionals assure their competence to deliver consistent and quality public health services. As a registered pharmacist or pharmacy technician you are professionally responsible for keeping your knowledge and skills up to date. If you are completing this learning programme in order to deliver a commissioned service, you must first check that the service commissioner has approved the use of the Declaration of competence model within the service specification and/or patient group direction. Alternatively, commissioners may specify their own routes of training for service delivery (which may also meet specific competencies within the DoC). Substance use and misuse - Pre-workshop book Working through this learning programme (ie, completing the pre-workshop reading and tasks, attending the workshop and completing the associated learning and assessment) will support you in meeting specific competencies within the DoC self-assessment framework for this service. If the service is not currently commissioned locally, then working through the learning programme will enable you to be service ready. To find out more about the DoC model visit: Overall aim The overall aim of this resource is to help you acquire the knowledge, develop the skills and demonstrate the attitudes necessary to offer pharmacy services for substance misusers. The focus of this resource is mainly on the provision of needle and syringe programmes (NSP), however, the content is also relevant to those offering supervised consumption services. Notes 5

6 Substance use and misuse - Pre-workshop book Learning objectives Once you have completed the pre-workshop reading and activities, attended the local workshop, and worked through the other specified learning programmes and e-assessment, you should be able to meet the core objectives for both supervised consumption of opioids and needle and syringe programmes at Levels 1 and 2. The core competencies, are set out below. Supervised consumption of prescribed medicines for substance misusers (opioids) a) Understands the terminology and definitions of substance misuse, the theories of drug dependence and the concept and practice of harm reduction and recovery. b) Is aware of commonly misused substances. c) Understands the treatment of substance misuse, including multidisciplinary team working, assessment and care planning, pharmacotherapeutic and non-pharmacotherapeutic options. d) Can communicate appropriately and sensitively with the client group and their peers using discretion, privacy, respect and a non-judgemental approach, whilst applying conflict resolution skills when appropriate. e) Is able to counsel and advise individuals about their substance misuse and enable them to take their medication as prescribed and advise on safe storage whilst respecting their privacy and treating them with dignity. f) Can recognise the various symptoms and signs potentially displayed by this client group which may adversely affect their treatment and what actions to take (eg, intoxication). g) Knows how and when to refer/signpost clients regarding problems relating to their substance misuse (or general problems). h) Understands the legislation, ethics, duty of care and professional judgement for this client group and knows how and when to ask for support and advice. i) Is aware of the management, planning, and delivery of pharmacy services for substance misusers, including how to train and monitor staff to deliver these services to the required standard. 6

7 Needle and syringe programme: Level 1 This level covers distribution of basic injecting equipment, either loose or in packs, with written information on harm reduction (eg, safer injecting, overdose prevention) plus distribution of health promotion information and signposting. a) Understands the key aims of a needle and syringe programme are to: reduce the transmission of blood-borne viruses (BBV) and other infections caused by sharing injecting equipment reduce other harms caused by injecting drugs signpost to other services. Substance use and misuse - Pre-workshop book b) Is aware of issues relating to sexual health, sexually transmitted infections, BBV, HIV and hepatitis C transmission and promotion of hepatitis B immunisation. c) Understands the terminology; nomenclature of both official and street drugs; definitions of drug dependence. d) Is aware of the treatment/management of substance misuse and knowledge of commonly misused drugs, with particular reference to drugs liable to be injected. e) Can communicate effectively with drug misusers with discretion, respect their privacy and appreciate how to treat them in a non-stigmatising way. f) Supports pharmacy team members in the delivery of a safe, effective and non-judgemental service. g) Knows how to risk assess a client s situation; how to promote safer injecting practice and when to ask for support and advice and which related services to signpost to. h) Understands the legislation and parameters associated with the supply of injecting paraphernalia. i) Knows the sizes and uses of the various types of needles, syringes and other injecting equipment associated with illicit drug use to be made available and is able to provide the amount of equipment to meet the client s needs, ie, coverage. j) Understands the differences between the injection sites and equipment requirements for opioid, performance and image-enhancing drugs (PIED) and stimulants, etc. 7

8 Substance use and misuse - Pre-workshop book k) Understands the principles of risk minimisation to patients, staff and members of the public; use of appropriate protective equipment; safe disposal of used equipment; and how to deal safely and effectively with spillages, needle stick injuries or contamination with potentially infected blood or body fluids. l) Is aware of other related services and knows how and when to refer/signpost clients regarding problems relating to their substance misuse or general health and social problems. Needle and syringe programme: Level 2 This level covers distribution of pick and mix (bespoke) injecting equipment plus health promotion advice (including advice and information on how to reduce the harms caused by injecting drugs) or referral to specialist services and expands on the Level 1 competencies. General a) Is able to counsel and advise individuals about their drug dependence. b) Can proactively advise on health promotion specific to this client group, including sexual health, sexually transmitted infections, BBV, HIV and hepatitis C transmission, as well as hepatitis B immunisation. c) Understands the principles of, and is be able to deliver, a bespoke pick and mix distribution service, including the range of injecting paraphernalia to be available. Supports pharmacy team members to deliver the service safely and effectively. d) Understands comprehensive harm-reduction services, including advice on assessment of injection-site infections; advice on preventing overdoses; help to stop injecting drugs; and opioid substitution therapy services. e) Is able to encourage people who inject drugs to use less harmful methods of drug use. This includes moving away from dangerous practices such as long needles and femoral injecting and moving towards other routes of administration. Now let s move on to some reading and activities to get you thinking about what is needed to provide a successful service for substance misusers. 8

9 Task 1 - Engaging with clients and the dangers of social stigma To understand the impact your beliefs and behaviour can have on clients using your pharmacy, spend some time answering the questions set out below and make notes in the space provided. How are substance misusers referred to in your pharmacy? List all the words used by you, your team members and possibly even customers, when referring to substance misusers who access your services, as well as those who do not. Substance use and misuse - Pre-workshop book What specific procedures and agreements do you have in place for substance misuse clients using your pharmacy? For example, do you specify times at which they should come in or where they should wait before being served? 9

10 Substance use and misuse - Pre-workshop book Now have a look at the following article from the UK Drug Policy Commission: Getting serious about stigma: the problem with stigmatising drug users (summary). London: UKDPC; December (Further reading - The full report, Sinning and sinned against: the stigmatisation of problem drug users, published by the UKDPC in August 2010 can be found on the same web page.) Look back at your answers to the questions above and consider whether you feel that your clients are being treated in an appropriate way when they come into your pharmacy. What action do you need to take (if any) to address the issues raised in the article? 10

11 Task 2 - Providing advice on safer injecting Regardless of whether you provide a Level 1 or Level 2 needle and syringe programme, you need to have an understanding of the full range of injecting paraphernalia which your clients may be using, to be able to offer advice on safer injecting. Spend some time looking at the resources overleaf and consider what is available locally, before completing the table below. Substance use and misuse - Pre-workshop book Item Syringes Needles Variants / sizes available Available via needle and syringe programme? If not, where from? Prepacked Y/N Key piece of advice to provide Barrels Citric acid Ascorbic acid (vitamin C) Swabs Sharps bins Spoons/cookers Water Filters Condoms Foil Other 11

12 Substance use and misuse - Pre-workshop book If you are not able to cater for your clients requirements where would you signpost them to? Resources Your local service specification for needle and syringe programmes (NSP) Your local drug action team/drug and alcohol action team (DAT/ DAAT) or drug agency NICE public health guidance 52: Needle exchange programmes: guidance April How much citric? A short video highlighting the risks of using too much citric acid to dissolve heroin. Available on YouTube: watch?v=e_hlxbw1v20 Exchange Supplies The Exchange Supplies website provides information on all aspects of harm reduction; all of its documents are free to read online and many are available to order free of charge: 12

13 Task 3 - Preparing to offer a service To declare yourself competent to provide supervised consumption services and a needle and syringe programme (NSP) at Level 1, CPPE recommend you complete the following CPPE distance learning programme and linked e-assessment: CPPE Substance use and misuse distance learning programme (10 hours) To provide a needle and syringe programme at Level 2, you should also attend a workshop which contains assessed role plays. The distance learning programme was extensively revised and re-launched in December 2010, and was reprinted in 2012 as a second edition. If you have completed a pre-2010 edition you may choose to complete the new programme to refresh your knowledge. The current version of this programme is available to download from the CPPE website at: Substance use and misuse - Pre-workshop book The CPPE e-assessment can only be accessed and completed online via the CPPE website. Successful completion provides pharmacists and pharmacy technicians with a record of assessment which may be required by service commissioners before you can deliver these services locally. Assessments can be undertaken annually, if necessary, via the CPPE website. To get the most from the workshop we recommend you work through as much of the distance learning programme as possible before attending the event. You should then aim to complete both the programme and its linked e-assessment within three months of attending the workshop. Notes 13

14 Substance use and misuse - Pre-workshop book Checklist for action Now that you have worked through this pre-workshop book, take a moment to run through this checklist to make sure you are well prepared for the workshop. I have looked at the appropriate websites and references. I have completed Tasks 1 and 2. I completed this on: I have read all of this pre-workshop book. I have started to prepare for the workshop by downloading the CPPE distance learning programme Substance use and misuse. (To get the most from the workshop we recommend you work through as much of this programme as possible before attending the event.) I have started to prepare for the workshop by accessing the CPPE Substance use and misuse linked e-assessment. (You should aim to complete the e-assessment either before the workshop, or within three months of attending.) Signed: Date: Take this book with you to your local workshop. Make sure that you know when and where it is and what time it starts. Enjoy your learning. 14

15 Notes Substance use and misuse - Pre-workshop book 15

16 Contacting CPPE For information on your orders or bookings, or any general enquiries, please contact us by , telephone or post. A member of our customer services team will be happy to help you with your enquiry. info@cppe.ac.uk Telephone By post Centre for Pharmacy Postgraduate Education (CPPE) Manchester Pharmacy School 1st Floor, Stopford Building The University of Manchester Oxford Road Manchester M13 9PT Share your learning experience with us: us on feedback@cppe.ac.uk For information on all our programmes and events: visit our website Developed by: Funded by: