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treatment services, residential or community based, should provide as part of core treatment, distinct harm reduction interventions aimed at reducing the spread of BBVs and risk of drug-related deaths.

Specific harm reduction interventions to reduce the spread of blood-borne viruses and reduce overdose include:

  • Needle exchange services – the provision and disposal of needles and syringes and other clean injecting equipment

    • (e.

      g. spoons, filters, citric acid) in a variety of settings

  • Advice and support on safer injection, on reducing frequency of injecting and on reducing initiation of others into injecting

  • Advice and information to prevent transmission of BBVs (particularly hepatitis A, B and C, and HIV) and other drug misuse-related infections

  • Availability of advice, information and counselling, as appropriate, for viral hepatitis and HIV testing (pre and post test)

  • Access to testing for blood-borne viruses

  • Provision of hepatitis B vaccination

  • Provision of hepatitis A vaccination if appropriate

  • Access to assessment and treatment for hepatitis B, C and HIV infection

  • Counselling relating to HIV testing (pre and post test)

  • Advice and support on preventing risk of overdose and drug- related death

  • Risk assessment and referral to other treatment services.

Harm reduction interventions such as needle exchange, advice and information on safer injecting, reducing injecting and preventing overdose should also be available as open-access services in each local area. These are available as part of specialist statutory sector drug treatment services, voluntary sector services and pharmacy needle exchanges. Needle exchange services often have contact with drug misusers who are not in touch with structured drug treatment services. Guidance on what services should be available from pharmacy needle exchanges is available in Best Practice Guidance for Commissioners and Providers for Pharmaceutical Services for Drug Users (NTA, 2006).47 Advice and information on harm reduction should also be available to carers of drug users, as appropriate.

The Department of Health has recently done work on raising the awareness of risks, detection and treatment of hepatitis B and C. In 2004, primary care trusts were required to use, as standard, a combination of treatments for hepatitis C with fewer side-effects than older treatments, which has been found to be effective in clearing the infection in a substantial proportion of cases. See the Chief Medical Officer’s Update Number 39, August 2004.48


Models of care for treatment of adult drug misusers: Update 2006

The National Institute for Health and Clinical Excellence (NICE) has produced a guidance document on treatment for people with hepatitis C: Guidance on the Use of Ribavirin and Interferon Alpha for Hepatitis C (NICE, 2000).49

The Department of Health has published Hepatitis C: Guidance for Those Working With Drug Users (2001),50 which gives information on hepatitis C and on approaches to prevention and management that is of relevance to provider services and commissioners, and which is due to be updated in 2006.

Drug treatment commissioners should liaise with hepatitis C treatment commissioners to ensure adequate provision of Hepatitis C treatment for drug misusers. Drug treatment commissioners should also liaise and develop agreements with mainstream non-specialist services (e.g. A&E, liver disease units, HIV services), to ensure that people who have been at risk of exposure to hepatitis B through injecting drugs have access to testing, and arrangements are in place within the PCT area for the immunisation of drug users. Immunisation programmes should be targeted and need to be accessible to current injectors, those at risk of becoming injectors and close contacts (e.g. sexual partners), who may be at risk.


Community prescribing interventions: GP prescribing and specialist prescribing

Community prescribing involves the provision of care-planned specialised drug treatment, which includes the prescribing of drugs to treat drug misuse. The range of community prescribing interventions can include the following:

  • Stabilisation on substitute opioids, including dose titration

  • Prescribing for a sustained period to substitute illicit drugs, such as methadone and buprenorphine (maintenance prescribing)

  • Prescribing for withdrawal from opioids with opioid or non- opioid medications such as buprenorphine or lofexidine (community detoxification)

  • Prescribing to prevent relapse

  • Stabilisation and withdrawal from sedatives, such as benzodiazepines

  • Prescribing for assisted withdrawal from alcohol where appropriate

  • Treatment for stimulant users, which may include symptomatic prescribing

  • Non-medical prescribing (by nurses or pharmacists).

All prescribing interventions must be carried out in line with Drug Misuse and Dependence – Guidelines on Clinical Management (DH, 1999),21 also known as the “clinical guidelines” or the “orange book”. Attention should also be paid to the forthcoming (2007) NICE guidelines on opiate detoxification, and the NICE

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