1. j. smith - the impact of and responses to injecting new ... · the impact of and responses to...
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Reversing the tide: The impact of and responses to injecting New Psychoactive Substances in South Wales
Josie Smith, Dean Acreman, Janet Keauffling, Chris Emmerson
Programme and National Lead for Substance Misuse
Health Protection, Public Health Wales
Change in Trends
• Geographically distinct
• Two groups:
–established / experienced heroin injectors
–Recreational stimulant users moving to injecting
Average length of injecting:Opioids
Harm Reduction Database Wales, 2015
Average length of injecting:Stimulants
Harm Reduction Database Wales, 2015
Average lengthof injecting:NPS (primary)
Harm Reduction Database Wales, 2015
NPS (any use) 2014-15
Harm Reduction Database Wales, 2015
Specialist drug treatment
WNDSM, 2014
NSP activity: self-reported length of injecting careers
50
60
70
80
90
100
110
120
130
140
150
160
170
180
190
200
210
2011-12 2012-13 2013-14 2014-15
In
dex (
20
11
-12
=1
00
)
All substances: 0-2 years
All substances: More than 2 years
Harm Reduction Database Wales, 2015
50
60
70
80
90
100
110
120
130
140
150
160
170
180
190
200
210
2011-12 2012-13 2013-14 2014-15
In
dex (
20
11
-12
=1
00
)
All substances: 0-2 years
All substances: More than 2 years
Primary stimulant/NPS use: More
than 2 years
NSP activity: self-reported length of injecting careers
Harm Reduction Database Wales, 2015
50
60
70
80
90
100
110
120
130
140
150
160
170
180
190
200
210
2011-12 2012-13 2013-14 2014-15
In
dex (
20
11
-12
=1
00
)
All substances: 0-2 years
All substances: More than 2 years
Primary stimulant/NPS use: 0-2 years
Primary stimulant/NPS use: More than 2 years
NSP activity: self-reported injecting careers
Harm Reduction Database Wales, 2015
Individuals accessing NSP services with primary NPS use
0
100
200
300
400
500
600
700
2011-12 2012-13 2013-14 2014-15
Nu
mb
er o
f servic
e u
sers
Any NPS use (pharmacy only)
NPS primary (pharmacy only )
Any NPS use (stat/vol)
NPS primary (stat/vol )
Impacts:
• Physical:
- Granular (‘gritty’) lumps remain
- Abscesses
DVTs Groin Amputations
- Severe weight loss
• Psychological: Memory loss/Psychosis / suicidal
ideation
• Sexual health and vulnerability• Criminal Justice
Blood borne virus: HCV
• Prevalence of Hepatitis C infection rates in South Wales
–Cardiff & Vale 2006: 38%1
2011: 28%2
2014: 36.6%2
–Swansea 2006: 42%1
2014: 71.7%2
plus linked clusters
1. Craine et al 2009. Incidence of hepatitis C in drug injectors: the role of homelessness, opiate substitution treatment, equipment sharing, and community size. Epidemiology and Infection; 137 (9), 1255-1265
2. Hope et al. Unlinked Anonymous Monitoring, Health Protection Agency/Public Health England
Blood borne virus: HIV
• HIV –new infections in people who inject drugs – risk:mephedrone injecting
• Injecting vs sexual transmission?... “first cluster of IDU cases in 14 years …”
• Contract tracing ongoing...including prisons (male and female)
Injecting site infections, DVT and amputation
• Abscesses
• Major reconstructive surgery to femoral veins ‘looked like they had dissolved’
• ITU
• Amputations
Why inject?• Nose bleeds and intense pain in nose when snorting –
many reported although they would have preferred to snort,it was too painful and they had to bomb (ingest orally) or inject intravenously instead.
• Vomiting, indigestion and epigastric pain from oral ingestion
• ‘Helped get off the gear’
• ‘Cheap and plentiful’
Why groin?• Less visible – no marks
• Cultural / peer informed
• Frequency of injecting +15 per day
Groin injecting by length of injecting career – South Wales NSP –all drugs (exc. Steroid and image enhancing drugs)
Responses• Information and awareness raising
Responses• Information and awareness raising
• Training: e-learning and face/face
• Increased detection: DBS / clinics
• Redevelopment of enhanced surveillance
• Injecting equipment provision/tender/5 year plan re. coverage
• Prevalence estimate of problematic and injecting drug use
• Welsh Assembly Health and Social Care Committee: service redesign
Recommendation 10.That the Welsh Ministers work with health boards and other relevant public services to identify the steps that need to be taken to adapt substance misuse support services to meet the needs to NPS users and support early intervention. This work should include:– considering a revision to the commissioning and performance management framework for support services; and – increasing the provision of drop in services and co-location with other services.
“…legislation alone will not solve the problems caused by NPS use in Wales”
Contact details
www.wedinos.orgwww.siedsinfo.co.ukwww.wales.nhs.uk/sitesplus/888/page/72997