sheffield substance misuse services...etizolam, pyrazolam and flubromazepam. new psychoactive...

Sheffield Substance Misuse

Services

ANDY FALCONER

(Team Leader)

SHEFFIELD TREATMENT AND

RECOVERY TEAM

Who we are and what we do

A team of professionals that includes Nurses, Dr’s (Psychiatrists, GP’s, specialist doctors), social workers, drug and alcohol workers and admin staff.

Experts in the field of substance misuse providing an expert assessment, opinion and recommendation around substance misuse and treatment.

We aim to support people requiring help with substance misuse issues to be able to access services when they need it, at a time convenient to them and at a location that suits them.

Open 8am - 8pm Monday to Friday.

Supporting service users to achieve their goals and move towards recovery.

Opiate Service • City wide service. Based at Fitzwilliam Centre

• Self referral via open access and referral by a professional

• Providing assessment, treatment, needle exchange and recovery interventions

• Support for people:

– Using opiate based substances (Heroin, Morphine, Dihydrocodeine, co-codamol).

– With problematic alcohol use alongside opiate use.

– With co-morbid mental health problem

• By qualified nurses, social workers and doctors and drug workers with specialist training in the field of substance misuse.

• Drug workers trained in the field of substance misuse and counselling delivering recovery focussed interventions/treatment providing a menu of options for service users.

• Opiates, originally derived from the opium poppy, have

been used for thousands of years for both recreational

and medicinal purposes.

• The most active substance in opium is morphine—

named after Morpheus, the Greek god of dreams.

Morphine is a very powerful painkiller, but it is also very

addictive.

• In the sixteenth century, laudanum, opium prepared in

an alcoholic solution, was used as a painkiller.

• Morphine was first extracted from opium in a pure form

in the early nineteenth century. It was used widely as a

painkiller during the American Civil War, and many

soldiers became addicted.

• Codeine, a less powerful drug that is found in opium but

can be synthesized (man-made), was first isolated in

1830 in France by Jean-Pierre Robiquet, to replace raw

opium for medical purposes.

• Throughout the early nineteenth century, the recreational

use of opium grew and by 1830, the British dependence

on the drug reached an all-time high. The British sent

warships to the coast of China in 1839 in response to

China’s attempt to suppress the opium traffic (Britain

‘supplying’ China), beginning the “First Opium War.”

• In 1874, chemists trying to find a less addictive form of

morphine made heroin. But heroin had twice the potency

of morphine, and heroin addiction soon became a

serious problem.

• Methadone was first synthesized in 1937 by German

scientists Max Bockmühl and Gustav Ehrhart at the IG

Farben company. They were searching for a painkiller

that would be easier to use during surgery, with less

addiction potential than morphine or heroin.

• Unfortunately methadone is believed by many to be even

more addictive than heroin.

• As recently as the 1950’s heroin (diamorphine) was a

popular medicine prescribed by family doctors.

• The Times 1955 stated there were only 317 addicts of

‘manufactured’ drugs in the whole of Britain…

– Of which just 15% were dependent on heroin (47.5 heroin

addicts)…

– Mostly doctors or middle-class patients who could afford to

sustain a habit.

• Following pressure from the US, the UK implemented

the Drugs (Regulation of Misuse) Act in 1964.

• In 1971 the Misuse of Drugs Act (MDA) was passed,

continuing measures in previous legislation, and

classifying drugs into classes A (the most highly

regulated), B, and C.

• The number of deaths from heroin are at the

highest level since comparable records began.

• In the past five years death rates have doubled

in England, Wales and Scotland.

• On average in 2016, every five hours someone

died after using heroin and/or morphine.

• Almost one in three drug overdoses in Europe

happens in the UK, according to the European

Monitoring Centre for Drugs and Drug Addiction.

Referrals

+ The Fitzwilliam Centre 143-145 Fitzwilliam Street

Sheffield

S1 4JP

( 0114 3050500

• Self referrals – telephone/walk in

• Email: sct-ctr.fitzwilliamcentrereferrals@nhs.net

Non-opiate Service

• City wide service for the people of Sheffield who use non-opiate based substances including cannabis, Khat, stimulants, NPS etc

• Commissioned to deliver: – Needle exchange

– Open access and assertive outreach

– High volume, low intensity psychosocial interventions

– Recovery interventions

– Universal prevention/education

– Learning schemes

– SPICE Clinic

– JUICE Clinic (Steroid Users)

• By drug workers with specialist training in the area of substance misuse to support people in accessing structured treatment interventions.

• Cannabis was the most commonly used

drug in the 2017/18 with 7.2 per cent of

adults aged 16 to 59 having used it in the

last year (around 2.4 million people).

• Research shows that 10% of regular cannabis users

become dependent on it. Your risk of getting addicted is

higher if you start using it in your teens or use it every

day.

• As with other addictive drugs, such as cocaine and

heroin, you can develop a tolerance to cannabis. This

means you need more to get the same effect.

• If you stop using it, you may get withdrawal symptoms,

such as cravings, difficulty sleeping, mood swings,

irritability and restlessness.

• If you smoke cannabis with tobacco, you're likely to get

addicted to nicotine and risk getting tobacco-related

diseases such as cancer and coronary heart disease.

• If you cut down or give up, you will experience

withdrawal from nicotine as well as cannabis.

New psychoactive substances (NPS) are drugs which were designed to

replicate the effects of illegal substances like cannabis, cocaine and

ecstasy. NPS began to appear in the UK drug scene around 2008/09.

Previously legal hence the name ‘legal highs’ They fall into four main

categories:

• Synthetic cannabinoids – these drugs mimic cannabis and are traded

under such names as Clockwork Orange, Black Mamba, Spice and Exodus

Damnation. They bear no relation to the cannabis plant except that the

chemicals which are blended into the base plant matter act on the brain in a

similar way to cannabis.

• Stimulant-type drugs – these drugs mimic substances such as

amphetamine, cocaine and ecstasy and include BZP, mephedrone, MPDV,

NRG-1, Benzo Fury, MDAI, ethylphenidate.

New psychoactive substances (NPS) are drugs which were designed to

replicate the effects of illegal substances like cannabis, cocaine and

ecstasy. NPS began to appear in the UK drug scene around 2008/09.

Previously legal hence the name ‘legal highs’ They fall into four main

categories:

• Hallucinogenic drugs – these drugs mimic substances like LSD and

include 25i-NBOMe, Bromo-Dragonfly and the more ketamine-like

methoxetamine.

New psychoactive substances (NPS) are drugs which were designed to

replicate the effects of illegal substances like cannabis, cocaine and

ecstasy. NPS began to appear in the UK drug scene around 2008/09.

Previously legal hence the name ‘legal highs’ They fall into four main

categories:

• ‘Downer’/tranquiliser-type drugs – these drugs mimic tranquiliser or anti-

anxiety drugs, in particular from the benzodiazepine family and include

Etizolam, Pyrazolam and Flubromazepam.

New psychoactive substances (NPS) are drugs which were designed to

replicate the effects of illegal substances like cannabis, cocaine and

ecstasy. NPS began to appear in the UK drug scene around 2008/09.

Previously legal hence the name ‘legal highs’ They fall into four main

categories:

THE LAW

• 2016 Psychoactive Substances Act, which

means it’s illegal to give away or sell.

• There’s no penalty for possession, unless

you are in prison.

• Supply and production can get you up to 7

years in prison, an unlimited fine or both.

Online training

http://neptune-clinical-guidance.co.uk/e-learning/

• Khat or qat (is a flowering plant native to the

Horn of Africa and the Arabian Peninsula. Khat

contains the alkaloid cathinone, a stimulant,

which is said to cause excitement, loss of

appetite, and euphoria…

Referrals

+ Sidney Street Service

44 Sidney Street

Sheffield

S1 4RH

( 0114 2721481

• Self referrals – telephone/walk in

• Email: sct-ctr.start.nonopiates@nhs.net

Alcohol Services

• City wide service for the people of Sheffield who use alcohol or are

affected by someone else’s alcohol use.

• SEAP (Single Entry Access Point)

– First access point into alcohol services, providing triage

assessment, advice, interventions and access to tier 3

assessment and treatment.

– Delivered by trained, experienced alcohol workers with access to

a multidisciplinary team.

The assessment team or

Tier 3? • Comprehensive assessment of need and

recommendation for treatment interventions including:

Structured PSI/key working

Detox (community/inpatient)

Recovery Interventions

Recovery support

• By qualified Nurses, Social Workers and Doctors with

specialist training in the area of substance misuse.

• alcohol

• [al-kuh-hawl, -hol] /ˈæl kəˌhɔl, -ˌhɒl/

• noun 1. Also called ethyl alcohol, grain alcohol, ethanol, fermentation alcohol. a colourless, limpid, volatile, flammable, water-miscible liquid, C 2 H 5 OH, having an ether-like odour and pungent, burning taste, the intoxicating principle of fermented liquors, produced by yeast fermentation of certain carbohydrates, as grains, molasses, starch, or sugar, or obtained synthetically by hydration of ethylene or as a by-product of certain hydrocarbon syntheses: used chiefly as a solvent in the extraction of specific substances, in beverages, medicines, organic synthesis, lotions, tonics, colognes, rubbing compounds, as an automobile radiator antifreeze, and as a rocket fuel. Compare denatured alcohol, methyl alcohol.

• 2. whiskey, gin, vodka, or any other intoxicating liquor containing this liquid.

• 3. Chemistry. any of a class of chemical compounds having the general formula ROH, where R represents an alkyl group and –OH a hydroxyl group, as in methyl alcohol, CH 3 OH, or ethyl alcohol, C 2 H 5 OH.

a colourless, limpid, volatile, flammable, water-miscible liquid, C2H5OH, having an ether-like odour and pungent, burning taste, the intoxicating principle of fermented liquors, produced by yeast fermentation of certain carbohydrates, as grains, molasses, starch, or sugar, or obtained synthetically by hydration of ethylene or as a by-product of certain hydrocarbon syntheses: used chiefly as a solvent in the extraction of specific substances, in beverages, medicines, organic synthesis, lotions, tonics, colognes, rubbing compounds, as an automobile radiator antifreeze, and as a rocket fuel.

Alcohol: A depressant psychoactive drug that slows down brain activity on areas involved in inhibition and judgment.

A psychoactive drug - any substance that, when taken, has an impact on thinking, mood or behaviour.

Sarpa salpa

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• Evidence on the risks of alcohol consumption is complex.

• Most systems in the body can be damaged by alcohol consumption.

• The rate at which harm increases in relation to the amount of alcohol consumed varies.

• Liver disease has an exponential relationship with alcohol consumption.

• The risk of cancers shows a dose dependent relationship.

• Risk linked to other factors including: • Amount

• Frequency

• Genetics

• Age

• Adults living in households in the

highest income quintile are twice as

likely to drink heavily than adults in the

lowest income quintile – 22% compared

to 10%

• Older people tend to drink more

frequently than younger people. The

proportion of adults who drank every

day increases with each group.

• 1% of 16-25 year olds had drunk every day

during the previous week,

• 13% of individuals 65+.

Evidence suggests that identifying

early those who drink to excess and

intervening with low-cost

educational and motivational

programs could significantly reduce

the prevalence of alcohol-related

disabilities and associated disease.

• Pathways are not clear

• Misconception that it takes a long time to

get into alcohol treatment

• Lack of time

• Reluctance to be ‘referred’

• Problems with identification

• Asking the wrong questions

Referrals

+ Matilda Street Service 44 Sidney Street

Sheffield

S1 4RH

( 0114 3050550

• Self referrals – telephone/walk in

• Email: sct-ctr.start.alcohol@nhs.net