Powys Substance Use Harm Reduction Plan launch

Linda Hutchings, Brecon peer support worker

“Developing a partnership response to Harm Reduction across Powys 

to meet the needs of people with drug and alcohol concerns.”

The first thing I picked up at this Harm Reduction Plan launch recently was a flyer about nitazenes (synthetic opioids known for their potent nature) and the changing face of heroin. I hadn’t even pinned on my attendee badge. The bizarre names of drugs like naloxone (a potentially life-saving medication) and nitazene (an extremely harmful drug) were scattered throughout the day and I realised I had a lot to learn.

Fortunately this highly informative day at the Metropole Hotel in Llandrindod brought together a multitude of statutory and voluntary sector agencies with a wealth of knowledge and experience around substance misuse. But perhaps even more importantly it called upon those with the lived experience of the harm that can be caused by substance misuse - be that alcohol or drugs - and the often catastrophic effects resulting in damaged mental and physical health, relationships, living arrangements (homelessness and debt being extreme but not unusual outcomes) and an increased likelihood of coming into contact with the criminal justice system.

Jan Roberts (Suicide Prevention, Harm Reduction & Postvention Quality Improvement Lead), Joy Garfitt (Interim Executive Director of Operations, Mental Health Services) & Carol Daly (Harm Prevention & Reduction Lead - Substance Misuse)
Powys Teaching Health Board

Joy Garfitt, Interim Executive Director of Operations - Mental Health Services in Powys, and chair of the Area Planning Board, welcomed everyone. She explained that the APB brought together agencies across the county with the shared ambition of reducing harm from substance use. (There is a longer definition in the Welsh Government document Working together to reduce harm). The APB plans, commissions and delivers services and also brings networks together. As Joy explained, Powys is actually as long as the distance between the Severn Bridge and the Marble Arch, so this is quite challenging!

What is harm reduction and how can it benefit Powys - Rick Lines, Public Health Wales, Head of Programmes, Substance Use

Rick described how he was first introduced to harm reduction 30 years ago in his hometown of Toronto in Canada. He worked supporting prisoners who, he explained, were inevitably using drugs. His experience supporting people who had been traumatised by early life events, and went on to use drugs, led him to ask in court: “Have you heard this woman’s story? Why is the state looking at it through the context of drugs?” Rick highlighted that putting this particular woman in prison repeated the trauma she had experienced from authority figures when she was a child.

Rick saw the same scenario play out when he later worked in Eastern Europe. He said 90% of drug use is not problematic (how many people do we know who use alcohol on a regular basis socially…?) and asked what we can do to reduce deaths, to show that we care whether people live or die, and to help reduce the risk of using drugs in a risky fashion. We should be respecting the dignity of people who use drugs by providing services, and reducing feelings of vulnerability and stigma.

Recent concerns are around changes in the drug market whereby synthetic and highly dangerous drugs (like nitazenes) are increasingly coming onto the market. Rick championed the ongoing work in the 3rd sector and community pharmacies to provide harm reduction services - “it is the people on the ground who are making the difference”.

Welsh Government policy is committed to harm reduction, and is unique in the United Kingdom, and rare in the world. This policy influences how the police, prisons and partners regard substance use and filters down to the statutory and community organisations.

Current position in Powys and the focus of Harm Reduction - Carol Daly, Harm Prevention and Reduction Lead (Substance Misuse)

Carol’s aim is to set up a multi-agency Powys Harm Reduction sub-group (one of seven across Wales) to drive action across the county. This would draw on the knowledge of local organisations to deliver the key priorities, including:

Supporting the work of the Health Board in working to the World Health Organisation's global aim of eliminating Blood Borne Viruses by 2030. Powys is rolling out treatment and testing for people at risk of Blood Borne Viruses such as HIV, Hepatitis B and C.

• Training up peer supporters and carers.
• Developing pharmacy services to increase the uptake of Needle and Syringe Provision and Blood Borne Virus Testing.
• Raising awareness of the real risks of synthetic drugs coming onto the market.
• Increasing availability of Naloxone across partner agencies.
• Addressing the stigma (it was again pointed out that most people use some sort of substance, for example, alcohol).
• Prevention - the APB has commissioned services to educate children and young people about drugs, and Carol is working with Child & Adolescent Mental Health Services (CAMHS) to increase knowledge of new synthetic opiates.

This important agenda would save lives - and has saved thousands of lives already with the information and tools to help people who take drugs do so in a safer manner.

During discussion Barry Eveleigh from Kaleidoscope (the local substance misuse service provider) highlighted the financial element - if you can keep someone out of A&E you can save £2000. A liver transplant is £150,000. It costs £1000 a week to keep someone in prison. In comparison to these figures the costs of providing safe drug alternatives are minor.

There were also questions about decriminalising drugs as has happened in other countries such as Portugal, where the person using drugs is regarded as a patient rather than a criminal. Michael Curties from the Welsh Government explained that the criminal justice system is not devolved to Wales so this is not an option open to the Welsh Government.

What’s already being done and what are our priorities? - Neville Brookes, Area Planning Board Manager

Neville asked: “how can co-production work with this agenda?” We need to learn from people with lived experience, and spend time with individuals in the treatment system. “Who better to talk to when waiting for a service than another peer?”

Peers design relapse prevention programmes - they know what works. If people become part of a peer mentor programme they often give back to services and there is an onward pathway to work within the field if they choose.

He also said:

• Harm reduction should be on all our agendas - not just thought of as a clinical intervention.
• Out of hours community support is needed (this was identified by focus groups).
• We need to simplify the service so that individuals have a single pathway.

The overall outcome would be to enhance and improve systems and processes for everyone involved.

How we use peers, with lived experience, to enhance service provision - Elwyn Thomas, Co-production Lead, Kaleidoscope

Elwyn has been in post for 18 months now. He started as a peer on a script in a prison cell. He worked on a Welsh Government peer to peer support project providing the heroin substitute naloxone - over an 8 week period 237 kits were delivered! Amazingly eighty people did not even know that it existed.

There are now seven teams across Wales delivering this important service. Everyone was trained in just a year, and other initiatives have also been put into place including creating pathways to treatment and needle exchange schemes. Elwyn spoke of how people’s esteem and self-worth was raised after having access to the training, with peer uniforms (branded “ask me about Naloxone”) and lanyards breaking barriers.

In 2 years the delivery of harm reduction has changed massively in Wales, from prescribed scripts from nurses to working alongside peers.

Linda Hutchings, a Brecon peer, has lived experience for many years using drugs but is now drug free. She agreed that people can be the best they can be with training and involvement. She is now accepted in her community, not as a drug addict, but as someone with lived experience. “I built up belief in myself as I didn’t have any.” Linda started work with peer mentoring service Cyfle Cymru on 8 February.

Round table discussions & feedback

In round table discussions we looked closely at Powys challenges and priorities. The top three challenges on our table were: rurality, silos and stigma. We were very keen to promote the idea of a support bus which could travel the whole length of the county, the distance from the Severn Bridge to Marble Arch - and back again!

Our priorities were - prevention, communication and collaboration. We agreed that it was important to reach out into the community (it’s that bus again!) rather than expect people to come to us.

Overall it felt that there was a great enthusiasm in the room for genuine collaboration and partnership working to make real change so that people using drugs and alcohol, for whatever reason, could live well in the county.

Closing remarks - Michael Curties, Substance Misuse Policy Team, Welsh Government

Michael raised many relevant and important topics in his summing up in relation to the APB, data sharing, working more closely with GPs and prevention, etc. To finish off I’ll highlight just a couple of his comments that particularly resonated with me:

The Harm Reduction challenge is the same as it is for all other services - we solve it by working together. “How do we get to the point where there is no wrong door? Where people walk in and get a service wherever they are?”

“Coproduction is about learning - what do we say that gets in your way? We need to hear if there are those barriers. Ask - can we do it differently?”

I look forward to finding out more about developing drug and alcohol services in Powys as Carol continues her vital work on the Harm Reduction plan.

You find out more about Alcohol and Substance Misuse resources

on this Powys Teaching Health Board website page.