The Covid-19 period has provided insights into the needs of a marginalised homeless population enabling local teams to get a better picture of the requirements for harm reduction within such communities. As we enter a new phase of Covid-19, NHS APA poses the question:
“Should Overdose Prevention Centres be considered as a harm reduction approach across England?”
Dr Emily Finch Clinical Director of Addictions at the South London and Maudsley NHS Foundation, and Vice Chair of NHS APA, considers the benefits of Overdose Prevention Centres and considers where and how they could be implemented.
What are Overdose Prevention Centres? Overdose Prevention Centres are an evidence-based, harm reduction intervention which allow people who use illicit drugs to do so within a medically supervised environment. The use of Overdose Prevention Centres in other countries has been shown to reduce drug-related deaths, reduce health burdens and decrease public injection and syringe littering.
They are effective at engaging hard to reach, highly marginalised populations with drug treatment, healthcare and other services. People in treatment in other countries use less illegal heroin and other drugs, potentially reducing the scale of the illegal drugs market.
What is England’s current position on Overdose Prevention Centres?
Dr Finch explains that “so far government policy has not allowed Overdose Prevention Centres. However, what we are now seeing is an increase in drug related deaths, and we are aware that in some parts of the country there are significant injecting problems.
There is increasing evidence to show that there would be significant benefits of implementing Overdose Prevention Centres in some areas of England, with benefits including the potential for harm reduction, including better control of blood borne viruses and a reduction in overdose deaths”.
“There is increasing evidence to show that there would be significant benefits of implementing Overdose Prevention Centres in some areas of England”.
What are the key considerations for implementation?
Dr Finch stresses “It's important for us to consider what the needs are likely to be for service users. Considerations include: the rise of drug related deaths, problems with street homelessness, and the fact that we now have a mechanism to prevent overdose because we can give naloxone. In some parts of the world such sites are called Overdose Reduction Rooms and renaming of such centres as Overdose Prevention Sites would be useful here. There has been interest in setting an Overdose Prevention Centre in Glasgow, Scotland where they have identified a significant need”.
Currently such sites are illegal in the UK. The Government has not changed the law around tolerating the presence of illegal drugs as it currently stands. However, a number of reports, including one by the Advisory Council on the Misuse of Drugs, have recommended their use, the 2016 report “Reducing Opioid-Related Deaths in the UK” recommends the implementation of “medically supervised drug consumption clinics”.
How can we demonstrate the need for Overdose Prevention Centres?
First the local need has to be established. Something that may be suitable in one area of the country, may not be in another. Also, as Dr Finch explains, public support is essential: “You have to talk to the local population. I understand that in Glasgow they have gone a long way towards gaining local support. Strong local support is absolutely paramount, and would also involve local police services, for example”.
Dr Finch continues, “You would also want strong input from the local drug user community, including recovery communities and other support services This is because ideally you want the sites to be for harm reduction but you also want service users to be able to access other support there too, such as mental health support and physical health care.
You have to acknowledge that we are aiming to provide services for a group who are very underserved - so you have to ensure that wherever an Overdose Prevention Centre may be commissioned that there is appropriate health advice, mental health advice and high quality harm reduction. It is also essential that staff have adequate training and to run such a service”
“Strong local support is absolutely paramount, and would also involve local police services, for example”.
Is a localised pilot scheme the first step for England?
Dr Finch believes that a localised pilot scheme may be the answer: “The NHS APA supports Overdose Prevention Sites where there is a local need, so in an area where there are high levels of injecting and drug related deaths. It is imperative that they are considered to be part of an overall treatment system so that service users can have access to the whole range of substance misuse treatment options when they are ready for them.
We appreciate that implementing an Overdose Prevention Centre would be challenging and would need to be carefully planned and evaluated. NHS APA would support pilots where there is a local need, where there are the skills in place, and where they are commissioned as part of an overall treatment system”.
References Jarryd Bartle report- ROOM FOR IMPROVEMENT: How drug consumption rooms save lives. ACMD (Advisory Council on the Misuse of Drugs)- Reducing Opioid-Related Deaths in the UK.