adding life to years and years to life delivering effective needle and syringe programmes working...
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Adding life to years and years to life
Delivering Effective Needle and Syringe Programmes
Working With and Providing Services for Performance
and Image Enhancing Drug Users (PIEDs)
Mark Harrison. Ralph Heron. County Durham Drug and Alcohol Action Team
Adding life to years and years to life
DISCUS
DRUGS IN SPORT CLINIC and USERS SUPPORT
DRUGS IN SPORT CLINIC and USERS SUPPORT
“The use of images in this presentation does not imply an individuals’ use of performance and image enhancing drugs, rather that they are used to depict the attainment of a desired physique and appearance of the individuals.”
Adding life to years and years to life
Adding life to years and years to life
Adding life to years and years to life
Adding life to years and years to life
Why DISCUS• Need identified locally in 1993• 50% of needle exchanges were for PIED users• April-Sept 07 43% all new registrations• Prevention of blood borne viruses• PIED users reluctant to approach existing “drugs” services• Experience within gyms• Gateway service focussing on harm reduction• Some users collecting for up to 250 users
Adding life to years and years to life
The DISCUS Team
DISCUS Service User
Clinic Co-ordinator
R.M.O.
15 years old this yearNurse
Sports DietitianSports Massage
Onward Referral
Adding life to years and years to life
Services Available 1• 2 Hours per week • Over 1000 individuals registered • Informal and confidential• Full range of needle exchange services• Safer injecting advice• Responsible Medical Officer• Nursing assessment
Adding life to years and years to life
Services Available 2• Specialist Dietician• Hepatitis A and B vaccination• Regular blood investigations• ECG• Body fat analysis• BBV testing• Referral on to other services if / when necessary
Adding life to years and years to life
Services Available 3Regular blood investigations• FBC• LFT’s• Cholesterol• HDL/LDL• Testosterone levels• Thyroid Stimulating Hormone (TSH)• Hepatitis Titre
Adding life to years and years to life
DISCUS Activity 2008-2009• Number of attendances 750• Number of Individuals 198• New Registrations 53• Needle Exchanges 225• Bloods Taken 154
Durham Harm Minimisation Services (April-September 07)• 43% of all new registrations to all Harm Minimisation services
were for PIEDs users.
Adding life to years and years to life
DISCUS Gender Ratio
Male97%
Female3%
Male
Female
DISCUS Gender Split
Female 3%
Male 97%
Adding life to years and years to life
Adding life to years and years to life
Harm Minimisation• Start with lowest dose/stack possible
• Optimise diet and training regimes
• Use low androgenic initially
• Regular investigations
• Shortest cycle possible with max. time clean
• Use your own, sterile injecting equipment
• Correct injecting technique
• Know your source of gear
Adding life to years and years to life
Creatine Monohydrate• Acts as muscle’s capacitor
• Effective in 70% of users
• 5-7lb of lean muscle
• Each dose = 2lb steak
• Take in warm drink with 100g of carbohydrate
• Loading phase = 10g for 5/7 then 5g for 5/7
• Maintenance phase = 2g daily
Adding life to years and years to life
Style of PIED Use• Style of usage – stacking
style of cycle duration of cycle
time off cycle
• Oral or I.M. ? 17 Alpha-Alkylation
Adding life to years and years to life
Indications of Public Health in the English Regions
Indicator England North East
North West
Yorkshire & Humber
East midlands
West Midlands
East England
London South East
South West
Rate per 1000 population who have used anabolic steroids
(2007-2008)
5.36 11.97 5.21 7.37 7.34 3.78 1.83 3.05 6.94 3.78
Better than average Consistent with average
Worse than average
Rates of Performance and Image Enhancing Drugs
Association of Public Health Observatories (2009) (from British Crime Survey)
Adding life to years and years to life
Our Role (1)• Drug misusers have the same entitlement as other patients to the
services provided by the NHS.
• The General Medical Council has stated: “The investigations or treatment you provide or arrange must be based on the
assessment you and the patient make of their needs and priorities, and on your clinical judgement about the likely effectiveness of the treatment options.”
You must not refuse or delay treatment because you believe that a patient’s actions have contributed to their condition.
Drug Misuse and Dependence: UK Guidelines on Clinical Management (2007)
Adding life to years and years to life
Our Role (2)
The General Medical Council has stated:• You must treat your patients with respect whatever their life choices
and beliefs.
• You must not unfairly discriminate against them by allowing your personal views (including your views about a patient’s lifestyle) to adversely affect your professional relationship with them or the treatment you provide or arrange.”
Where do PIED users fit into this guidance????
Adding life to years and years to life
Recognition• British Medical Association identified DISCUS as an
“example of good practice”. (Pressure to Perform BMA 2001)• October 2008 DISCUS presented to Advisory Council
on the Misuse of Drugs (ACMD) and contributing to national review of PIEDs.
• Previous presentations at national injecting and PIED conferences.
Adding life to years and years to life
Adding life to years and years to life
Contact Details
Mark Harrison
Joint Commissioning Manager
Office: 0191 3837800
Mobile: 07747475402
Ralph Heron
Development Manager
Office: 0191 3837800
Mobile: 07884436320