Cocaine Services IN AN IDEAL WORLD – HOW SHOULD THEY WORK?

Presentation Overview Key Considerations for Service Provision Outline aims of service provision relating to 4 groups of stimulant users as highlighted by SACDM working group Focus mainly on role of dedicated stimulant services Barriers to service development

Service Design Every aspect of the service should be measured against its ability to: Reduce BARRIERS Increase OPPORTUNITIES Keep SERVICE USER at the centre

Reducing Barriers Consider Target Group/s What needs to be done? Who is best placed to do this? What training & support do they need? Ensure that this is available

Early Experimenters Aim: Ensure that individuals, especially young people, make informed decisions about drug use & take necessary steps to reduce potential risks

Early Experimenters – cont’d Target population: General population Individuals and groups known to be experimenting Services who work with young people Parents High risk occupations / students

Early Experimenters – cont’d Information - Accessible and Credible Information about Cocaine should be available through existing contact with young people and included in drugs education. Targeted information should be a feature to those at high risk eg universities & colleges, high risk occupations. Training, support and service information must be accessible to teachers, youth workers, parents etc. Media campaigns etc should target this group

Regular Stimulant Users Aim: To reduce harm associated with regular stimulant use To prevent problematic or dependent drug use To provide access to other specialist services for those experiencing problems

Regular Stimulant Users Target Population: Regular stimulant users Peers Parents Staff at clubs & events i.e. managers, promoters, security staff, first aid providers Employers Services / professionals who work with and /or provide education to young people

Regular Stimulant Users Service Provision Credible and easily accessible harm reduction information designed by specialist providers Targeted delivery of interventions where regular users are e.g. clubs, pubs, on the street Easy access to services for problematic users

Harm reduction information should be targeted and include: Direct harm associated with drug, methods patterns etc Risk to self and others e.g. sex work, employment Prevention of problematic use and progression to opiates to deal with come down Access to specialist advice or help Wide range of information sources Anonymous access such as helpline. Peer education Specific locations identified at local level eg A&E, NX, GUM.

Targeted delivery Input by specialist services to planning of festivals / events involving young people Input to clubs & pubs Presence at events Promotion and provision of Chill Out area – provision of water, fruit, condoms, staff with specialist knowledge and skills Partnership working with Events Organisers, pub managers, First Aid providers, Ambulance Service etc Consider and regularly review where regular users are, and deliver targeted service tailored to group, place and time.

Easy access to services for problematic users (bridge) Easy access to services for problematic users One specialist service targeting both regular and problematic use – to avoid barrier of referral, establish trust and credibility Use opportunity for motivational interventions Reduce period between 1 st use and seeking help (10 years)

Problematic Stimulant Users Aim: To reduce harm associated with problematic stimulant use and provide opportunities to address problems and support positive change

Problematic Stimulant Users Target Population: Primary stimulant users who are experiencing problems related to their use Parents / partners of problematic stimulant users Generic agencies in contact with target group Mental Health services Employers and Trades Unions

Minimise barriers & create opportunities to access specialist service Provide range of referral routes Keep requirement for personal information to a minimum Access through Telephone Helpline, outreach venues, referrals from other services Provision of drop-in service including complementary therapies Flexible opening times Ensure that reception staff are trained and sensitive to service user needs Specialist services need the ‘right’ image to attract target group

Minimise barriers & create opportunities to access specialist service Provide training to generic services to improve response to Cocaine users Target mental health services, A & E, generic drug services Ensure that drugs helpline workers have high level of knowledge and understanding of stimulant use and specialist services

Problematic Stimulant Users – Specialist Services Should be holistic and tailored to individual need – use of assessment as an intervention Emphasis on motivational skills Identification of problems and areas of desired change Provision of a range of co-ordinated interventions to provide structured programme

Problematic Stimulant Users Interventions Based on assessment, interventions should provide a structured programme, tailored to individual need. Assessment should highlight problems relating to physical health, mental health, relationships, and social circumstances

Problematic Stimulant Users Interventions Core interventions should include: counselling; skills training (eg problem solving, relaxation); lifestyle change (including diet); cognitive behavioural approaches including relapse prevention and lapse management; complementary therapies; harm reduction

Problematic Stimulant Users Interventions Easy access to: Mental health assessment and treatment services as & when required Symptomatic prescribing GP services Psychologist

Specialist Service – essential features Specific project image Track record with user group Credibility with service users Trusted In touch with local trends at street level Flexible and responsive to changing trends

Specialist Service – essential features Staff team (Core) Multi-disciplinary team High level of knowledge & understanding of stimulant use, user groups and related issues Experienced Must include mental health expertise Commitment to user group Training skills

Specialist Service – essential features Staff team (Core/sessional or fast track) Mental health assessment and treatment Symptomatic prescribing Psychologist GP services

Overcoming Barriers - examples Complementary therapies - especially acupuncture should be available Use of texting is beneficial for a range of reasons

Opiate / Stimulant co-users Aim: To adapt services designed for opiate users, so that they more effectively address needs in relation to stimulant use

Opiate / Stimulant co-users Target Population: Heroin users who are also using Crack / Cocaine / Amphetamines Individuals who are prescribed Methadone or other opiate substitutes and using stimulant drugs (usually Crack) Prescribing services, needle exchange/harm reduction services, generic drug services

Opiate / Stimulant co-users Assessment of co-users is more complex than opiate use alone Assessments need to take account of relationship between patterns and circumstances of drugs used, how one effects the other and the impact of prescribing Service users need to be encouraged to disclose stimulant use without fear of service being withdrawn

Opiate / Stimulant co-users Co-users require a flexible service Workers in these services require specific training and support from specialist services Opportunistic support can be provided through enhanced needle exchange services, outreach services, projects for sex workers etc

Overcoming Barriers to effective Service Development – priority areas At Strategic level, plans and models of service delivery must be reviewed to take account of best practice for stimulant users. Strategy must address all stages Primary stimulant users must be prioritised Service development and design MUST be informed by individuals / groups who have direct knowledge and experience with the user group The delay between identifying a need and delivery MUST be reduced

Overcoming Barriers to effective Service Development – priority areas Commissioning arrangements should be outcome based (realistic), and support responsive and creative services rather than be prescriptive. Professional and post qualifying training requires specific input Media portrayal of Crack users / myths needs to be balanced with accurate, factual information Services / projects need to be adequately resourced and supported Funding needs to be secure to ensure that learning is not lost, and high quality staff are recruited and retained.

Senga MacDonald Drugs Action 7 Hadden Street Aberdeen AB11 6NU Tel: