A national newsletter on substance misuse management in primary care NETWORK
training. There have been 33 reported appropriate uses of naloxone with no reported adverse outcomes.
Training sessions were initially confined to the Glasgow Drugs Crisis centre but are now rolling out across NHS Greater Glasgow and Clyde to addiction services, homeless services and other voluntary agencies in contact with drug users. The aim is to reach more at risk individuals and to make the training sessions and naloxone supplies available locally.
Critics of the programme claim that providing naloxone may lead to more risky drug taking. Evidence from research does not support this and may even indicate a positive effect, with increased entry into treatment and contact with harm reduction agencies for drug users9
Naloxone is a drug of low toxicity10 and its main adverse effect is to precipitate acute withdrawal. There have been adverse reactions
9 Join Together (2005, 4th November) Harm reduction cuts OD deaths in San Francisco: 10 www.toxbase.org
Adfam outline the five key challenges to delivering support to families of problem drug and alcohol users. Ed.
Policy = Practice? The Adfam Manifesto
Adfam engaged key partners across the country and held 9 regional consultations from October to December 2009. Representatives from across the partnerships attended and audiences included family support providers, drug and alcohol professionals, commissioners, children’s services
representatives, criminal justice workers and
healthcare professionals. The strong common themes from these consultations form the basis for five key challenges affecting the delivery of family support.
Challenge 1 – Supporting families in their own right
Where family support is provided and accessed, families report significant benefits and improvements in their well being and that of the drug or alcohol user. Unfortunately there still remain many local areas where there is no support for families in their own right.
Challenge 2 – Involving families in treatment
There remains limited guidance and support for practitioners on how best to engage families safely and appropriately. Not all families are supportive or are appropriate to be involved in someone’s treatment and practitioners need to be skilled in how to deal with this. We need to encourage a common sense application of confidentiality that respects the service user and the family.
Substance use doesn’t happen in a vacuum and for a long time treatment services have worked solely with the substance user. It was expressed that there needs to be a culture shift to focus beyond the substance user and to look to the wider context. It was felt that for this culture shift to work there had to be full strategic support at all levels.
reported in world literature, but most of these are minor and were thought to be related to the effects of hypoxia and acute opiate withdrawal 11 12
It is too early to conclude that naloxone has impacted on drug related deaths in Glasgow and with an estimated excess of 12,000 problematic drug users in the city it is very much a work in progress. All of those involved in the programme are confident however that the supply of naloxone with overdose awareness and resuscitation training can only have a positive effect on drug related deaths in the city.
Samantha Perry FRCP FCEM, Consultant, Emergency Medicine Glasgow and Carole Hunter, BSc (Hons),BA, MSc, MRPharmS Lead Pharmacist Greater Glasgow & Clyde Addiction Service
11 Yealy DM, Paris PM, Kaplan RM, Heller MB, Marini SE (1990). The safety of prehospital naloxone administration by paramedics. Ann Emerg Med.1990;19 (8):902
12 I, Naess AC, Jacobsen D Bros O (2004) Adverse events after naloxone treatment of episodes of suspected acute opiod overdose. Buajordet Eur J Emerg Med.2004;11 (1):19-23
Challenge 3 – Monitoring effectiveness
It is important to be able to monitor the effectiveness of family support and ensure consistency of delivery across all areas and to consider that in some ways family support currently has the opportunity to be innovative and responsive without being constrained by overall arduous administration systems. It was felt that what is needed is a balanced approach to implementation of any system.
Challenge 4 – Public services thinking family
Public services play a key role in engaging and supporting families and it is essential that those services are aware of the needs of families. Family members often comment that their GP is the common point of access for support and sometimes they feel their needs have not been recognised. All public services have a responsibility to look beyond the patient’s presenting problems and be aware of the impact of a loved one’s drug or alcohol use, especially when treating children. There is currently a lack of consistency in practice, with some examples of families’ needs being dismissed.
Challenge 5 – Commissioning effectively
Historically family support has been poorly funded and is either provided through community or individual goodwill or sporadically offered surpluses at the end of funding cycles. This inevitably leads to, in some areas, no provision or where it is provided, an insecurity which means it is a continual struggle to meet the need and develop further.
We would ask that commissioning processes reflect the broad functions and agendas that the provision of family support can meet. Housing, drugs and alcohol, health, crime – these agendas need to be considered when assessing the needs of communities and pulled together to form a coherent strategy.
We must ensure that family support remains a long term objective and becomes embedded within longer term provision and not an added extra to current service delivery. It is clear that the new government intends to continue to work with the needs of families. One of their key principles in the coalition agreement highlights the needs of families with multiple problems and the development of the Children and Families Taskforce. However the task remains for those who come into contact with these families to recognise their needs and concerns and work to improve their quality of life.
Joss Smith, Head of Policy and Regional Development, Adfam
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