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Delivering Effective Needle and Syringe Programmes

Delivering Effective Needle and Syringe Programmes. Working With and Providing Services for Performance and Image Enhancing Drug Users (PIEDs). Mark Harrison. Ralph Heron. County Durham Drug and Alcohol Action Team. DISCUS. D RUGS I N S PORT C LINIC and U SERS S UPPORT.

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Delivering Effective Needle and Syringe Programmes

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  1. Delivering Effective Needle and Syringe Programmes Working With and Providing Services for Performance and Image Enhancing Drug Users (PIEDs) Mark Harrison. Ralph Heron. County Durham Drug and Alcohol Action Team

  2. DISCUS DRUGSINSPORTCLINICandUSERSSUPPORT “The use of images in this presentation does not imply an individuals’ use of performance and image enhancing drugs, rather that they are used to depict the attainment of a desired physique and appearance of the individuals.”

  3. Why DISCUS • Need identified locally in 1993 • 50% of needle exchanges were for PIED users • April-Sept 07 43% all new registrations • Prevention of blood borne viruses • PIED users reluctant to approach existing “drugs” services • Experience within gyms • Gateway service focussing on harm reduction • Some users collecting for up to 250 users

  4. 15 years old this year Clinic Co-ordinator Nurse DISCUSService User Sports Massage Sports Dietitian Onward Referral R.M.O. The DISCUS Team

  5. Services Available 1 • 2 Hours per week • Over 1000 individuals registered • Informal and confidential • Full range of needle exchange services • Safer injecting advice • Responsible Medical Officer • Nursing assessment

  6. Services Available 2 • Specialist Dietician • Hepatitis A and B vaccination • Regular blood investigations • ECG • Body fat analysis • BBV testing • Referral on to other services if / when necessary

  7. Services Available 3 Regular blood investigations • FBC • LFT’s • Cholesterol • HDL/LDL • Testosterone levels • Thyroid Stimulating Hormone (TSH) • Hepatitis Titre

  8. DISCUS Activity 2008-2009 • Number of attendances 750 • Number of Individuals 198 • New Registrations 53 • Needle Exchanges 225 • Bloods Taken 154 Durham Harm Minimisation Services (April-September 07) • 43% of all new registrations to all Harm Minimisation services were for PIEDs users.

  9. DISCUS Gender Ratio Female 3% Female 3% Male Female Male Male 97% 97% DISCUS Gender Split

  10. Harm Minimisation • Start with lowest dose/stack possible • Optimise diet and training regimes • Use low androgenic initially • Regular investigations • Shortest cycle possible with max. time clean • Use your own, sterile injecting equipment • Correct injecting technique • Know your source of gear

  11. Creatine Monohydrate • Acts as muscle’s capacitor • Effective in 70% of users • 5-7lb of lean muscle • Each dose = 2lb steak • Take in warm drink with 100g of carbohydrate • Loading phase = 10g for 5/7 then 5g for 5/7 • Maintenance phase = 2g daily

  12. Style of PIED Use • Style of usage – stacking style of cycle duration of cycle time off cycle • Oral or I.M. ? 17 Alpha-Alkylation

  13. Rates of Performance and Image Enhancing Drugs Better than average Consistent with average Worse than average Indicator England North East North West Yorkshire & Humber East midlands West Midlands East England London South East South West Rate per 1000 population who have used anabolic steroids (2007-2008) 5.36 11.97 5.21 7.37 7.34 3.78 1.83 3.05 6.94 3.78 Indications of Public Health in the English Regions Association of Public Health Observatories (2009) (from British Crime Survey)

  14. Our Role (1) • Drug misusers have the same entitlement as other patients to the services provided by the NHS. • The General Medical Council has stated: “The investigations or treatment you provide or arrange must be based on the assessment you and the patient make of their needs and priorities, and on your clinical judgement about the likely effectiveness of the treatment options.” You must not refuse or delay treatment because you believe that a patient’s actions have contributed to their condition. Drug Misuse and Dependence: UK Guidelines on Clinical Management (2007)

  15. Our Role (2) The General Medical Council has stated: • You must treat your patients with respect whatever their life choices and beliefs. • You must not unfairly discriminate against them by allowing your personal views (including your views about a patient’s lifestyle) to adversely affect your professional relationship with them or the treatment you provide or arrange.” Where do PIED users fit into this guidance????

  16. Recognition • British Medical Association identified DISCUS as an “example of good practice”. (Pressure to Perform BMA 2001) • October 2008 DISCUS presented to Advisory Council on the Misuse of Drugs (ACMD) and contributing to national review of PIEDs. • Previous presentations at national injecting and PIED conferences.

  17. Mark Harrison Joint Commissioning Manager Office: 0191 3837800 Mobile: 07747475402 mark.harrison5@nhs.net Ralph Heron Development Manager Office: 0191 3837800 Mobile: 07884436320 ralphheron@nhs.net Contact Details

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