The needs of injecting drug users in the city of Southampton
By Lucy Dorey
Prior to getting involved with research projects, I was working as a psychiatric nurse and counsellor in drug and alcohol services. In 2019 I completed a PhD in Health Sciences focused on the experiences of people using Alcohol Specialist Nurse Services in general hospitals. After submitting my thesis I had the opportunity to work alongside Southampton City Council and the University of Southampton on two projects related to the needs of injecting drug users in the city. I was really happy to be offered this opportunity as it allowed me to use my research skills in a way that could inform local service development.
A small percentage of people who use heroin and other injectable drugs do not respond well to existing treatments, such as methadone substitution, that are routinely available in the UK. These people often have a combination of housing problems, mental health issues, and criminal justice system involvement. They are at a high risk of harms such as: overdose, blood born viruses, wound infections. While many injecting drug users do so in private and employ strategies to reduce harm, a small number of drug users can be seen using publicly and some discard drug using equipment such as needles in public, causing a public health risk to the wider community. There is therefore a good rationale to consider alternative interventions to prevent harm to the individuals and to the community.
There is good evidence to support supervised Heroin Assisted Treatment (HAT) for injecting drug users who don’t engage well with methadone treatment. In a rapid review I summarised the evidence to support HAT, and identified the barriers to implementation. The primary barrier is the high cost of providing this service, and the cost of pharmaceutical heroin itself. However, when you take into account the wider societal costs such as crime, supervised HAT has been shown to be cost effective.
Drug Consumption Rooms (DCRs) are places where drug users can use street drugs more safely than on their own or on the streets. DCRs exist in a number of European countries, but have never officially been implemented in the UK, as their legal status is unclear. I summarised the evidence for DCRs finding that there is a strong health based argument for implementation, and looked at the local need. I was able to visit several DCRs in Berlin and Amsterdam as part of the project, helping to gain insight into the broader role these services can play in improving lives.
I presented a Poster to the Public Health England Conference in 2019. These reviews will now inform decision making in the city council. It might take several years for these interventions to be implemented locally if at all. The work I have done sets out a case that can be presented to the local decision makers when the time is right. I appreciated the insight this project gave me into the decision making processes of service commissioners, and the wider context that needs to be considered for the implementation of research findings. I really enjoyed this work, and I hope that in the future DCRs and HAT will be implemented and evaluated locally.
Lucy Dorey is a PhD Student within the Faculty of Health Sciences at the University of Southampton. She is a BACP Accredited Counsellor, ACT (Acceptance and Commitment Therapy) Therapist, and Mindfulness Trainer. She has recently been working in private practice and previously worked in the addictions field for 15 years as a psychiatric nurse and counsellor.