-
SOHO RAPID ACCESSCLINIC.
AIMS:To provide a client focussed, low threshold flexible
prescribing service. To offer an easily accessible assessment and
treatment service to rough sleepers in Westminster.To provide
information and advice to drug and alcohol users aimed at harm
minimisation.
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BACKGROUND:Pilot project Oct 99-April 00, partnership between
Westminster DAT, BKCW, Westminster Social Services, Hungerford
Project and Rivendell Clinic.Engaging rough sleeping drug users in
the Soho Area, assessment, prescribing services, access to detox
and rehab.Over 70 assessments carried out in 6month period.Follow
up shows good levels of retention in treatment, but increase in use
of Crack. Application for funding to R.S.U, which is successful.Oct
00 Soho Rapid Access Clinic works from the Hungerford Project,
while waiting for premises. Hungerford Project continue to be
closely associated with SRAC, which is now funded jointly by BKCW
and The Rough Sleepers Unit.
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BACKGROUND:SRAC opens at Dean St Hostel Jan 2001, in partnership
with Bridge Housing and Arlington Care Association.SRAC continues
to be funded by R.S.U until July 2002, when it is absorbed into
CNWL Mental Health Trust, and funded by Westminster Substance
Misuse Commissioners.All referrals to SRAC are made through named
referrers, who work for external agencies, there is a close
relationship with the local Substance Misuse Units.SRAC is staffed
by a consultant psychiatrist, a team co-ordinator, staff grade Dr,
3 clinical nurse specialists and an administrator.
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PARTNERSHIP WORKSRAC currently works with a number of
partners.Equinox, Hungerford, Central CAT team, Westminster CAT
team, Passage Centre, Mobile Needle Exchange, Connections at St.
Martins, are the current main referrers.The clinic is based in Dean
St Hostel, which is run by Bridge Housing.All referrals are
accompanied by their external worker.Extensive liaison and support
from SRAC staff to referrers and agencies involved with service
users.
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SERVICES OFFEREDAssessment, medical, psychological and social.
Access to full psychiatric assessmentReferral for in patient
detoxReferral to Care Managers for fundingMethadone titration and
on going prescribingSubutex prescribingCommunity alcohol detoxOff
site assessment if neededTreatment for a twelve week
periodAssurance of transfer of prescribingRe titration on release
from prisonExtensive harm minimisation information relating to drug
using practices
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PHILOSOPHY & MODEL OF WORKThe assessment workers are trained
nurses, who have worked in drug services in both the voluntary and
statutory sector, and have experience within the field of
homelessness.Although the assessment tools are cumbersome, the
clinic practises flexibility with information gathering, aiming for
a sensitive and detailed history to assist with titration. Medical
appointments are flexible, most prescribing appointments offered
within two working days, with opportunity for on the spot titration
if appropriate. The atmosphere of the clinic is informal, and
sensitive to the social exclusion of its service users
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A BRIEF GLIMPSE INTO THE INJECTING PRACTICES AND CONCERNS OF A
GROUP OF ROUGHSLEEPERS
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BACKGROUNDThe Soho Rapid Access Clinic noticed increasing
reports of combined drug injecting, heroin & crack cocaine
prepared and injected together.
The client group all have a recent and often protracted history
of rough sleeping, little or negative experience of prescribing
services.
Traditional treatment services have had difficulty engaging this
population in treatment.
Service users were expressing concern about the lack of
information available on snowballing, experiencing more injecting
problems, and having difficulty stopping or controlling their
combination use.
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RESPONSE:Service user questionnaire completed by 14 service
users, seeking their views and experiences.No previous experience
of a programme for crack use.Interest in additional help with
problems they associated with snowballing and crack use.Triggers
for increasing or continuing use were: money, craving, boredom and
living in a West End hostel where drug use is pervasive
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RESPONSE:Focus group to invite user involvement and
consultation.
Feedback from this group has informed, and been part of the
development of a series of user informed supportive educational
groups.
The group is currently in a period of review, having run at
three West End hostels, in the substance misuse units.
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COMBINATION DRUG USE QUESTIONAIREBasic questionnaire completed
by 91 service users. This is in addition to service
requirements.
All service users asked at initial contact about sharing
injecting equipment., approximately 98% confirm sharing, many
within the past 24 hrs.
Also high levels of groin injecting, amongst this group, users
site ease of access being a primary reason for groin injecting.
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Data
Total Participants91
Male76
Female15
Total91
Age Groups
16 - 2415
25 - 3049
35-4427
Total91
Ethnicity
White British70
White Scot6
White Irish8
White European3
Black Other3
Black African1
Total91
Do you ever combine heroin and crack in the same syringe?
Yes84
No7
Total91
How often do you combine them?
Always42
Most of the time31
Occasionally9
Rarely3
Never3
Not Applicable
Total88
If you use crack alone before you use heroin, do you smoke or
inject?
Mainly smoke22
Mainly inject47
Both6
Neither3
Not Applicable8
Total86
How long do you wait after using crack on average, before using
heroin?
Straight away
Under 5 minutes27
5 to 10 minutes9
10 to 30 minutes9
30 to 1 hour6
Over 1 hour11
Not Applicable25
Total87
Have you noticed any increase in injecting problems since
injecting crack?
Yes56
No26
Not Applicable
Total82
If yes, what have been the main problems you have had?
Abscesses16
Missed Hits11
DVT / Thrombosis8
Numbness1
Vein Access30
Lumps2
Rushing1
Cellulite1
Blood Congesting1
Inreased Usage / Tolerance Build Up4
Ulcers1
Paranoia1
Endo1
No Response
Total78
Will you be interested in attending a group to help you with
crack/combination drug use?
Don't Know6
Yes40
No16
Total62
The group will include sessions on the following, please tick
the ones you would find most useful?
Information on Crack13
Cutting down and stopping21
Health related issues17
Triggers12
Cravings11
Safer Injecting14
Day programs10
Detox, rehab and follow on support17
Total115
Gender
76
15
Gender
Responses
Client Gender Breakdown
Age
15
49
27
Age Range
Responses
Client Age Breakdown
Ethnicity
70
6
8
3
3
1
Responses
Ethnicity
Combination
84
7
Combine crack and heroin in the same syringe?
Responses
Crack & Heroin Combination
Often
42
31
9
3
3
Not Applicable
Frequency
Responses
How often are they combined?
Smoke - Inject
22
47
6
3
8
Responses
If using crack on its own, do you smoke or inject?
Wait
Straight away
27
9
9
6
11
25
Waiting Times
Responses
Waiting time before using heroin.
Problems
56
26
Not Applicable
Problems since injecting crack?
Problem Types
16
11
8
1
30
2
1
1
1
4
1
1
1
No Response
Problems
Frequency
Main problems from injecting crack.
Group
6
40
16
Frequency
Interested in a crack group?
Topics
13
21
17
12
11
14
10
17
Topics
Responses
Session Topics
-
Data
Total Participants91
Male76
Female15
Total91
Age Groups
16 - 2415
25 - 3049
35-4427
Total91
Ethnicity
White British70
White Scot6
White Irish8
White European3
Black Other3
Black African1
Total91
Do you ever combine heroin and crack in the same syringe?
Yes84
No7
Total91
How often do you combine them?
Always42
Most of the time31
Occasionally9
Rarely3
Never3
Not Applicable
Total88
If you use crack alone before you use heroin, do you smoke or
inject?
Mainly smoke22
Mainly inject47
Both6
Neither3
Not Applicable8
Total86
How long do you wait after using crack on average, before using
heroin?
Straight away
Under 5 minutes27
5 to 10 minutes9
10 to 30 minutes9
30 to 1 hour6
Over 1 hour11
Not Applicable25
Total87
Have you noticed any increase in injecting problems since
injecting crack?
Yes56
No26
Not Applicable
Total82
If yes, what have been the main problems you have had?
Abscesses16
Missed Hits11
DVT / Thrombosis8
Numbness1
Vein Access30
Lumps2
Rushing1
Cellulite1
Blood Congesting1
Inreased Usage / Tolerance Build Up4
Ulcers1
Paranoia1
Endo1
No Response
Total78
Will you be interested in attending a group to help you with
crack/combination drug use?
Don't Know6
Yes40
No16
Total62
The group will include sessions on the following, please tick
the ones you would find most useful?
Information on Crack13
Cutting down and stopping21
Health related issues17
Triggers12
Cravings11
Safer Injecting14
Day programs10
Detox, rehab and follow on support17
Total115
Gender
76
15
Gender
Responses
Client Gender Breakdown
Age
15
49
27
Age Range
Responses
Client Age Breakdown
Ethnicity
70
6
8
3
3
1
Responses
Ethnicity
Combination
84
7
Combine crack and heroin in the same syringe?
Responses
Crack & Heroin Combination
Often
42
31
9
3
3
Not Applicable
Frequency
Responses
How often are they combined?
Smoke - Inject
22
47
6
3
8
Responses
If using crack on its own, do you smoke or inject?
Wait
Straight away
27
9
9
6
11
25
Waiting Times
Responses
Waiting time before using heroin.
Problems
56
26
Not Applicable
Problems since injecting crack?
Problem Types
16
11
8
1
30
2
1
1
1
4
1
1
1
No Response
Problems
Frequency
Main problems from injecting crack.
Group
6
40
16
Frequency
Interested in a crack group?
Topics
13
21
17
12
11
14
10
17
Topics
Responses
Session Topics
-
Data
Total Participants91
Male76
Female15
Total91
Age Groups
16 - 2415
25 - 3049
35-4427
Total91
Ethnicity
White British70
White Scot6
White Irish8
White European3
Black Other3
Black African1
Total91
Do you ever combine heroin and crack in the same syringe?
Yes84
No7
Total91
How often do you combine them?
Always42
Most of the time31
Occasionally9
Rarely3
Never3
Not Applicable
Total88
If you use crack alone before you use heroin, do you smoke or
inject?
Mainly smoke22
Mainly inject47
Both6
Neither3
Not Applicable8
Total86
How long do you wait after using crack on average, before using
heroin?
Straight away
Under 5 minutes27
5 to 10 minutes9
10 to 30 minutes9
30 to 1 hour6
Over 1 hour11
Not Applicable25
Total87
Have you noticed any increase in injecting problems since
injecting crack?
Yes56
No26
Not Applicable
Total82
If yes, what have been the main problems you have had?
Abscesses16
Missed Hits11
DVT / Thrombosis8
Numbness1
Vein Access30
Lumps2
Rushing1
Cellulite1
Blood Congesting1
Inreased Usage / Tolerance Build Up4
Ulcers1
Paranoia1
Endo1
No Response
Total78
Will you be interested in attending a group to help you with
crack/combination drug use?
Don't Know6
Yes40
No16
Total62
The group will include sessions on the following, please tick
the ones you would find most useful?
Information on Crack13
Cutting down and stopping21
Health related issues17
Triggers12
Cravings11
Safer Injecting14
Day programs10
Detox, rehab and follow on support17
Total115
Gender
76
15
Gender
Responses
Client Gender Breakdown
Age
15
49
27
Age Range
Responses
Client Age Breakdown
Ethnicity
70
6
8
3
3
1
Responses
Ethnicity
Combination
84
7
Combine crack and heroin in the same syringe?
Responses
Crack & Heroin Combination
Often
42
31
9
3
3
Not Applicable
Frequency
Responses
How often are they combined?
Smoke - Inject
22
47
6
3
8
Responses
If using crack on its own, do you smoke or inject?
Wait
Straight away
27
9
9
6
11
25
Waiting Times
Responses
Waiting time before using heroin.
Problems
56
26
Not Applicable
Problems since injecting crack?
Problem Types
16
11
8
1
30
2
1
1
1
4
1
1
1
No Response
Problems
Frequency
Main problems from injecting crack.
Group
6
40
16
Frequency
Interested in a crack group?
Topics
13
21
17
12
11
14
10
17
Topics
Responses
Session Topics
-
Data
Total Participants91
Male76
Female15
Total91
Age Groups
16 - 2415
25 - 3049
35-4427
Total91
Ethnicity
White British70
White Scot6
White Irish8
White European3
Black Other3
Black African1
Total91
Do you ever combine heroin and crack in the same syringe?
Yes84
No7
Total91
How often do you combine them?
Always42
Most of the time31
Occasionally9
Rarely3
Never3
Not Applicable
Total88
If you use crack alone before you use heroin, do you smoke or
inject?
Mainly smoke22
Mainly inject47
Both6
Neither3
Not Applicable8
Total86
How long do you wait after using crack on average, before using
heroin?
Straight away
Under 5 minutes27
5 to 10 minutes9
10 to 30 minutes9
30 to 1 hour6
Over 1 hour11
Not Applicable25
Total87
Have you noticed any increase in injecting problems since
injecting crack?
Yes56
No26
Not Applicable
Total82
If yes, what have been the main problems you have had?
Abscesses16
Missed Hits11
DVT / Thrombosis8
Numbness1
Vein Access30
Lumps2
Rushing1
Cellulite1
Blood Congesting1
Inreased Usage / Tolerance Build Up4
Ulcers1
Paranoia1
Endo1
No Response
Total78
Will you be interested in attending a group to help you with
crack/combination drug use?
Don't Know6
Yes40
No16
Total62
The group will include sessions on the following, please tick
the ones you would find most useful?
Information on Crack13
Cutting down and stopping21
Health related issues17
Triggers12
Cravings11
Safer Injecting14
Day programs10
Detox, rehab and follow on support17
Total115
Gender
76
15
Gender
Responses
Client Gender Breakdown
Age
15
49
27
Age Range
Responses
Client Age Breakdown
Ethnicity
70
6
8
3
3
1
Responses
Ethnicity
Combination
84
7
Combine crack and heroin in the same syringe?
Responses
Crack & Heroin Combination
Often
42
31
9
3
3
Not Applicable
Frequency
Responses
How often are they combined?
Smoke - Inject
22
47
6
3
8
Responses
If using crack on its own, do you smoke or inject?
Wait
Straight away
27
9
9
6
11
25
Waiting Times
Responses
Waiting time before using heroin.
Problems
56
26
Not Applicable
Problems since injecting crack?
Problem Types
16
11
8
1
30
2
1
1
1
4
1
1
1
No Response
Problems
Frequency
Main problems from injecting crack.
Group
6
40
16
Frequency
Interested in a crack group?
Topics
13
21
17
12
11
14
10
17
Topics
Responses
Session Topics
-
Data
Total Participants91
Male76
Female15
Total91
Age Groups
16 - 2415
25 - 3049
35-4427
Total91
Ethnicity
White British70
White Scot6
White Irish8
White European3
Black Other3
Black African1
Total91
Do you ever combine heroin and crack in the same syringe?
Yes84
No7
Total91
How often do you combine them?
Always42
Most of the time31
Occasionally9
Rarely3
Never3
Not Applicable
Total88
If you use crack alone before you use heroin, do you smoke or
inject?
Mainly smoke22
Mainly inject47
Both6
Neither3
Not Applicable8
Total86
How long do you wait after using crack on average, before using
heroin?
Straight away
Under 5 minutes27
5 to 10 minutes9
10 to 30 minutes9
30 to 1 hour6
Over 1 hour11
Not Applicable25
Total87
Have you noticed any increase in injecting problems since
injecting crack?
Yes56
No26
Not Applicable
Total82
If yes, what have been the main problems you have had?
Abscesses16
Missed Hits11
DVT / Thrombosis8
Numbness1
Vein Access30
Lumps2
Rushing1
Cellulite1
Blood Congesting1
Inreased Usage / Tolerance Build Up4
Ulcers1
Paranoia1
Endo1
No Response
Total78
Will you be interested in attending a group to help you with
crack/combination drug use?
Don't Know6
Yes40
No16
Total62
The group will include sessions on the following, please tick
the ones you would find most useful?
Information on Crack13
Cutting down and stopping21
Health related issues17
Triggers12
Cravings11
Safer Injecting14
Day programs10
Detox, rehab and follow on support17
Total115
Gender
76
15
Gender
Responses
Client Gender Breakdown
Age
15
49
27
Age Range
Responses
Client Age Breakdown
Ethnicity
70
6
8
3
3
1
Responses
Ethnicity
Combination
84
7
Combine crack and heroin in the same syringe?
Responses
Crack & Heroin Combination
Often
42
31
9
3
3
Not Applicable
Frequency
Responses
How often are they combined?
Smoke - Inject
22
47
6
3
8
Responses
If using crack on its own, do you smoke or inject?
Wait
Straight away
27
9
9
6
11
25
Waiting Times
Responses
Waiting time before using heroin.
Problems
56
26
Not Applicable
Problems since injecting crack?
Problem Types
16
11
8
1
30
2
1
1
1
4
1
1
1
No Response
Problems
Frequency
Main problems from injecting crack.
Group
6
40
16
Frequency
Interested in a crack group?
Topics
13
21
17
12
11
14
10
17
Topics
Responses
Session Topics
-
Data
Total Participants91
Male76
Female15
Total91
Age Groups
16 - 2415
25 - 3049
35-4427
Total91
Ethnicity
White British70
White Scot6
White Irish8
White European3
Black Other3
Black African1
Total91
Do you ever combine heroin and crack in the same syringe?
Yes84
No7
Total91
How often do you combine them?
Always42
Most of the time31
Occasionally9
Rarely3
Never3
Not Applicable
Total88
If you use crack alone before you use heroin, do you smoke or
inject?
Mainly smoke22
Mainly inject47
Both6
Neither3
Not Applicable8
Total86
How long do you wait after using crack on average, before using
heroin?
Straight away
Under 5 minutes27
5 to 10 minutes9
10 to 30 minutes9
30 to 1 hour6
Over 1 hour11
Not Applicable25
Total87
Have you noticed any increase in injecting problems since
injecting crack?
Yes56
No26
Not Applicable
Total82
If yes, what have been the main problems you have had?
Abscesses16
Missed Hits11
DVT / Thrombosis8
Numbness1
Vein Access30
Lumps2
Rushing1
Cellulite1
Blood Congesting1
Inreased Usage / Tolerance Build Up4
Ulcers1
Paranoia1
Endo1
No Response
Total78
Will you be interested in attending a group to help you with
crack/combination drug use?
Don't Know6
Yes40
No16
Total62
The group will include sessions on the following, please tick
the ones you would find most useful?
Information on Crack13
Cutting down and stopping21
Health related issues17
Triggers12
Cravings11
Safer Injecting14
Day programs10
Detox, rehab and follow on support17
Total115
Gender
76
15
Gender
Responses
Client Gender Breakdown
Age
15
49
27
Age Range
Responses
Client Age Breakdown
Ethnicity
70
6
8
3
3
1
Responses
Ethnicity
Combination
84
7
Combine crack and heroin in the same syringe?
Responses
Crack & Heroin Combination
Often
42
31
9
3
3
Not Applicable
Frequency
Responses
How often are they combined?
Smoke - Inject
22
47
6
3
8
Responses
If using crack on its own, do you smoke or inject?
Wait
Straight away
27
9
9
6
11
25
Waiting Times
Responses
Waiting time before using heroin.
Problems
56
26
Not Applicable
Problems since injecting crack?
Problem Types
16
11
8
1
30
2
1
1
1
4
1
1
1
No Response
Problems
Frequency
Main problems from injecting crack.
Group
6
40
16
Frequency
Interested in a crack group?
Topics
13
21
17
12
11
14
10
17
Topics
Responses
Session Topics
-
Data
Total Participants91
Male76
Female15
Total91
Age Groups
16 - 2415
25 - 3049
35-4427
Total91
Ethnicity
White British70
White Scot6
White Irish8
White European3
Black Other3
Black African1
Total91
Do you ever combine heroin and crack in the same syringe?
Yes84
No7
Total91
How often do you combine them?
Always42
Most of the time31
Occasionally9
Rarely3
Never3
Not Applicable
Total88
If you use crack alone before you use heroin, do you smoke or
inject?
Mainly smoke22
Mainly inject47
Both6
Neither3
Not Applicable8
Total86
How long do you wait after using crack on average, before using
heroin?
Straight away
Under 5 minutes27
5 to 10 minutes9
10 to 30 minutes9
30 to 1 hour6
Over 1 hour11
Not Applicable25
Total87
Have you noticed any increase in injecting problems since
injecting crack?
Yes56
No26
Not Applicable
Total82
If yes, what have been the main problems you have had?
Abscesses16
Missed Hits11
DVT / Thrombosis8
Numbness1
Vein Access30
Lumps2
Rushing1
Cellulite1
Blood Congesting1
Inreased Usage / Tolerance Build Up4
Ulcers1
Paranoia1
Endo1
No Response
Total78
Will you be interested in attending a group to help you with
crack/combination drug use?
Don't Know6
Yes40
No16
Total62
The group will include sessions on the following, please tick
the ones you would find most useful?
Information on Crack13
Cutting down and stopping21
Health related issues17
Triggers12
Cravings11
Safer Injecting14
Day programs10
Detox, rehab and follow on support17
Total115
Gender
76
15
Gender
Responses
Client Gender Breakdown
Age
15
49
27
Age Range
Responses
Client Age Breakdown
Ethnicity
70
6
8
3
3
1
Responses
Ethnicity
Combination
84
7
Combine crack and heroin in the same syringe?
Responses
Crack & Heroin Combination
Often
42
31
9
3
3
Not Applicable
Frequency
Responses
How often are they combined?
Smoke - Inject
22
47
6
3
8
Responses
If using crack on its own, do you smoke or inject?
Wait
Straight away
27
9
9
6
11
25
Waiting Times
Responses
Waiting time before using heroin.
Problems
56
26
Not Applicable
Problems since injecting crack?
Problem Types
16
11
8
1
30
2
1
1
1
4
1
1
1
No Response
Problems
Frequency
Main problems from injecting crack.
Group
6
40
16
Frequency
Interested in a crack group?
Topics
13
21
17
12
11
14
10
17
Topics
Responses
Session Topics
-
Data
Total Participants91
Male76
Female15
Total91
Age Groups
16 - 2415
25 - 3049
35-4427
Total91
Ethnicity
White British70
White Scot6
White Irish8
White European3
Black Other3
Black African1
Total91
Do you ever combine heroin and crack in the same syringe?
Yes84
No7
Total91
How often do you combine them?
Always42
Most of the time31
Occasionally9
Rarely3
Never3
Not Applicable
Total88
If you use crack alone before you use heroin, do you smoke or
inject?
Mainly smoke22
Mainly inject47
Both6
Neither3
Not Applicable8
Total86
How long do you wait after using crack on average, before using
heroin?
Straight away
Under 5 minutes27
5 to 10 minutes9
10 to 30 minutes9
30 to 1 hour6
Over 1 hour11
Not Applicable25
Total87
Have you noticed any increase in injecting problems since
injecting crack?
Yes56
No26
Not Applicable
Total82
If yes, what have been the main problems you have had?
Abscesses16
Missed Hits11
DVT / Thrombosis8
Vein Access30
Inreased Usage / Tolerance Build Up4
Others9
Total78
Will you be interested in attending a group to help you with
crack/combination drug use?
Don't Know6
Yes40
No16
Total62
The group will include sessions on the following, please tick
the ones you would find most useful?
Information on Crack13
Cutting down and stopping21
Health related issues17
Triggers12
Cravings11
Safer Injecting14
Day programs10
Detox, rehab and follow on support17
Total115
Gender
76
15
Gender
Responses
Client Gender Breakdown
Age
15
49
27
Age Range
Responses
Client Age Breakdown
Ethnicity
70
6
8
3
3
1
Responses
Ethnicity
Combination
84
7
Combine crack and heroin in the same syringe?
Responses
Crack & Heroin Combination
Often
42
31
9
3
3
Not Applicable
Frequency
Responses
How often are they combined?
Smoke - Inject
22
47
6
3
8
Responses
If using crack on its own, do you smoke or inject?
Wait
Straight away
27
9
9
6
11
25
Waiting Times
Responses
Waiting time before using heroin.
Problems
56
26
Not Applicable
Problems since injecting crack?
Problem Types
16
11
8
30
4
9
Problems
Frequency
Main problems from injecting crack.
Group
6
40
16
Frequency
Interested in a crack group?
Topics
13
21
17
12
11
14
10
17
Topics
Responses
Session Topics
-
Data
Total Participants91
Male76
Female15
Total91
Age Groups
16 - 2415
25 - 3049
35-4427
Total91
Ethnicity
White British70
White Scot6
White Irish8
White European3
Black Other3
Black African1
Total91
Do you ever combine heroin and crack in the same syringe?
Yes84
No7
Total91
How often do you combine them?
Always42
Most of the time31
Occasionally9
Rarely3
Never3
Not Applicable
Total88
If you use crack alone before you use heroin, do you smoke or
inject?
Mainly smoke22
Mainly inject47
Both6
Neither3
Not Applicable8
Total86
How long do you wait after using crack on average, before using
heroin?
Straight away
Under 5 minutes27
5 to 10 minutes9
10 to 30 minutes9
30 to 1 hour6
Over 1 hour11
Not Applicable25
Total87
Have you noticed any increase in injecting problems since
injecting crack?
Yes56
No26
Not Applicable
Total82
If yes, what have been the main problems you have had?
Abscesses16
Missed Hits11
DVT / Thrombosis8
Numbness1
Vein Access30
Lumps2
Rushing1
Cellulite1
Blood Congesting1
Inreased Usage / Tolerance Build Up4
Ulcers1
Paranoia1
Endo1
No Response
Total78
Will you be interested in attending a group to help you with
crack/combination drug use?
Don't Know6
Yes40
No16
Total62
The group will include sessions on the following, please tick
the ones you would find most useful?
Information on Crack13
Cutting down and stopping21
Health related issues17
Triggers12
Cravings11
Safer Injecting14
Day programs10
Detox, rehab and follow on support17
Total115
Gender
76
15
Gender
Responses
Client Gender Breakdown
Age
15
49
27
Age Range
Responses
Client Age Breakdown
Ethnicity
70
6
8
3
3
1
Responses
Ethnicity
Combination
84
7
Combine crack and heroin in the same syringe?
Responses
Crack & Heroin Combination
Often
42
31
9
3
3
Not Applicable
Frequency
Responses
How often are they combined?
Smoke - Inject
22
47
6
3
8
Responses
If using crack on its own, do you smoke or inject?
Wait
Straight away
27
9
9
6
11
25
Waiting Times
Responses
Waiting time before using heroin.
Problems
56
26
Not Applicable
Problems since injecting crack?
Problem Types
16
11
8
1
30
2
1
1
1
4
1
1
1
No Response
Problems
Frequency
Main problems from injecting crack.
Group
6
40
16
Frequency
Interested in a crack group?
Topics
13
21
17
12
11
14
10
17
Topics
Responses
Session Topics
-
Data
Total Participants91
Male76
Female15
Total91
Age Groups
16 - 2415
25 - 3049
35-4427
Total91
Ethnicity
White British70
White Scot6
White Irish8
White European3
Black Other3
Black African1
Total91
Do you ever combine heroin and crack in the same syringe?
Yes84
No7
Total91
How often do you combine them?
Always42
Most of the time31
Occasionally9
Rarely3
Never3
Not Applicable
Total88
If you use crack alone before you use heroin, do you smoke or
inject?
Mainly smoke22
Mainly inject47
Both6
Neither3
Not Applicable8
Total86
How long do you wait after using crack on average, before using
heroin?
Straight away
Under 5 minutes27
5 to 10 minutes9
10 to 30 minutes9
30 to 1 hour6
Over 1 hour11
Not Applicable25
Total87
Have you noticed any increase in injecting problems since
injecting crack?
Yes56
No26
Not Applicable
Total82
If yes, what have been the main problems you have had?
Abscesses16
Missed Hits11
DVT / Thrombosis8
Numbness1
Vein Access30
Lumps2
Rushing1
Cellulite1
Blood Congesting1
Inreased Usage / Tolerance Build Up4
Ulcers1
Paranoia1
Endo1
No Response
Total78
Will you be interested in attending a group to help you with
crack/combination drug use?
Don't Know6
Yes40
No16
Total62
The group will include sessions on the following, please tick
the ones you would find most useful?
Information on Crack13
Cutting down and stopping21
Health related issues17
Triggers12
Cravings11
Safer Injecting14
Day programs10
Detox, rehab and follow on support17
Total115
Gender
76
15
Gender
Responses
Client Gender Breakdown
Age
15
49
27
Age Range
Responses
Client Age Breakdown
Ethnicity
70
6
8
3
3
1
Responses
Ethnicity
Combination
84
7
Combine crack and heroin in the same syringe?
Responses
Crack & Heroin Combination
Often
42
31
9
3
3
Not Applicable
Frequency
Responses
How often are they combined?
Smoke - Inject
22
47
6
3
8
Responses
If using crack on its own, do you smoke or inject?
Wait
Straight away
27
9
9
6
11
25
Waiting Times
Responses
Waiting time before using heroin.
Problems
56
26
Not Applicable
Problems since injecting crack?
Problem Types
16
11
8
1
30
2
1
1
1
4
1
1
1
No Response
Problems
Frequency
Main problems from injecting crack.
Group
6
40
16
Frequency
Interested in a crack group?
Topics
13
21
17
12
11
14
10
17
Topics
Responses
Session Topics
-
SUMMARY What can agencies learn from excluded service users who
are homeless?
What prevents services from keeping up with the changing drug
use patterns/market ?
How can we respond to drug using practices which challenge
traditional treatment provision?
How can we respond to the increase in injecting problems, and
service users concerns?
These aims are not difficult to achieve, as they are directed at
service users, who have been asking in many ways for accessible
services for years. The issues of negative stereotyping of drug use
is a problem for users and providers, no more so than the tabliod
image of the homeless drug user. This is an issue which requires
more than accessible services to rectify it. SRAC is often
described as an oasis by its population. Here we see how the clinic
started, and see the high take up of services, the prescribing
partner was from the private sector. This is an unusual combination
of providers, and required a high level of commitment from the
partners. Prescribing of Physeptone and dexedrine was provided, as
an attempt to match the drugs market. Crack was identified as a
problem from the beginning, and remains so currently. Later in the
presentation I will return to the issue of Crack useThis slide
shows the development of the clinic, its partners and funding
source.The gateway to SRAC is only open to named referrers, the
relationship of the clinic with its referrers is of equal
importance as its relationship with service users. We have a weekly
meeting which is open to referrers, close working relationships are
beneficial to all, but this requires time, and the opportunity to
understand and respect the working practices of others.Here are the
services we provide, I will just speak briefly to eachHere again I
cannot impress enough that this group are perhaps the most
marginalized of drug users. Ever present are issues of past
treatment failures and negative life experiences, sensitivity and
humour are the skills required, as well as a good knowledge of drug
using practices.Although my presentation was about rapid access, it
is irresponsible to to imply the issues end when the door opens at
the right speed. If you open the door you will raise the
expectations of service users, and they will engage with new
issues, expecting a quality response. This is where we return to
Crack, which I believe is also a very current issue in Scotland. I
want to present you with information gathered from 91 service
users. Without their co-operation and ideas the Snowballing Group
would not have happened.Just talk to each point, again stressing
the negative view of this group as being outside treatment. The
treatmetn services have not responded in an accessible way.I have
been aware of snowballing as a way of drug use for many years, but
have been focussing on this for the past four years, since seeing
this practice grow in the West End, and become the main way of drug
using in this populationThe Rapid Access Clinic was set up in
response to the increasing street drug use in the West End, as a
point of raid assessment for rough sleepers who have difficulty
accessing mainstream services. The focus group was made up of SRAC
clients, and the feedback has formed the basis for the
"Snowballers" group.Here the approach of user consultation and
involvement, is vital when responding to drug use, when information
is scant. This a respectful and transparent way of working which
avoids workers feeling de skilled.The Combination drug use
questionnaire is a very basic tool, I knew it was important to
gather information, prior to seeking funding for the group.91
service user ( more now) have completed the questionnaire, and the
following slides will give you a picture of the results, which are
not rocket science. This is the result of workers and service users
combining their skills and information.You will also see that
sharing injecting equipment is prevalent in the population seeking
assessment from SRAC As you may expect, the majority of service
users are male, it may be that women are using in a different way,
and even with this small number Iam able to tell you that more of
the women smoke as well as inject crack/snowballs.This speaks for
itself, the majority are under 30, the under 25's still report high
levels of combination use. The Rapid Access clinic needs to reach
the under 25's more effectivelyNo surprise here, the majority of
service users are White British, I don't know off the top of my
head whether this is representative of the Rough Sleeping
Population in the West End.I guess this is my most important slide,
84 out of 91 service users report combination drug use. This was
what I had imagined it to be, and I continued to ask myself why
Drug Treatment Centres still focussed mainly on opiate use, when it
seemed to be a thing of the past. I checked with both local DTC's
fro their response to crack/combination use, and neither had any
specific on site response, with people being asked to travel to
another agency, after the supervised consumption of thier
Methadone, which can take a while, for help with crack use. Why not
work with both drugs together?As you can see, 73 out of 91 combine
heroin and crack fairly routinely. This is clearly an established
way of drug using. So any "on top" use will usually involve a
snowball. I began to think that people would leave SRAC with a
dependency on three drugs, Heroin, Crack and Methadone. What were
we doing, adding another drug, without addressing the issue of
Crack. Here we see a fairly high level of solo crack injection, and
anecdotally, women are reporting more solo crack injection than men
in this small sample. A large majority report increasing injecting
problems, and the next slide will give some detailsService users
were asked to describe the problems they were experiencing, as you
can see a major concern was that injecting sites were failing
quickly. Many service users are in very poor health at the point of
referral, with hospital admission being quite high for DVT,
Pneumonia, abscess, septicaemia and ulceration of iv sites. Service
users and myself are aware of amputation as a result of prolonged
crack injection. This is a small drug using community, and news
travels fast.We ask for an expression of interest in the group, and
clearly there is a desire to do something. Many service users have
come to the group, and it is now ppart of the programme in three of
the SMU's (substance misuse units within hostels)As you can see the
majority are interested in cutting down and stopping
crack/combination use. Some service users report an increase in
crack use when getting onto Methadone initially, and there is a
real desire for information on Crack, again we will be able to give
more detail of the Snowballing Group this afternoon. Well that was
a whirlwind, now some questions for you. If agencies want to plan a
rapid response to drug users, the whole picture of exclusion has to
be considered, and realise that no one agency can provide all the
solutions, partnership work is not just with providers, but with
service users. In order to learn, negative views and opinions need
to be challenged. Lack of knowledge and fear are a problem for
services who rely on medication as there main intervention. There
is a lack of information on snowballing. We have been seeing this
form of drug use becoming widespread, I am aware that services in
South London are seeing a high proportion of snowballers, we are
aware that these drugs are sold together, used together, and the
snowball is no longer the treat it was in the 70's & 80's.
Service users need to be incorporated into service provision,
responded to in constructive adult way.