DISPENSING
HOPE
A pioneering approach to reducing harm from drug abuse is changing lives. Jackie Rankin met the nurse prescribing much more than medication and the people who benefit.
Nurse prescriber John Gerrard.
S
hane is a resident at Liverpool’s YMCA hostel. He’s 35 and has been addicted to heroin since he was 18.
Desperate to be reunited with his young son in Ireland, he’s tried and failed to beat the drug. Now hope has arrived with a new programme that takes his treatment to him. Previously residents would attend regular clinics, then travel up to half an hour each day to collect their medication from a pharmacy. Now Shane and 40 other residents are reviewed by their drug service at the hostel and receive their methadone on site. The service was launched in 2017 when nurse prescriber John Gerrard (above) realised that clients were struggling to keep appointments and not taking their medication, with often dire consequences. John explains: “Research recommends easy access to opiate substitute treatment (OST). But if someone whose addiction consumes their every waking hour must attend regular clinics, then travel somewhere else every day to collect their medication, they can be overwhelmed, give up and revert to illicit drugs and more risky behaviour.
Being caught up in addiction and funding it is a 24 hour activity. YMCA Housing Operational Lead Jason Thomas agrees. “Being caught up in addiction and having to fund it is a 24 hour activity. You have every intention of going to your appointment, but your addiction gets in the way of your efforts to give up.” Funding illicit drug use can cost upwards of £100 a day so people resort to borrowing, dealing, begging or criminal activity. They suffer physical health issues from Hepatitis C and HIV to infections and deep vein thrombosis and at worst accidental overdose and death. The service faced resistance from those who felt having controlled drugs outside of pharmacies was high risk. But John and his team held strong the belief that removing barriers to treatment would reduce harm and save lives.
Within weeks of the launch numbers swelled from eight to 25. “People who had never been consistent were keeping appointments,” said John. There were obstacles – we were breaking with established practices. We had to bring GPs, managers, pharmacists onside to develop new procedures. But ultimately it was about the client and the local community.”
People who had never been consistent were keeping appointments. The programme was working well, yet the team felt simply prescribing on site wasn’t enough. “People would still have to travel up to half an hour to a pharmacy every day to pick up their medication,” said John. “If you miss three consecutive days of methadone your tolerance levels drop and there’s a risk of overdosing, so pharmacists won’t dispense. Consequently people dropped out of treatment.” Continued on page 14.
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