infections.
As such it has developed over
the years into a primary care led service which recognises
the need to offer specialist drug treatment targeting specific
drug using groups.
Treatment at the Drug Unit is obviously expected to produce
a number of results, the ultimate objective is that patients
will cease to use drugs but this can take some time, intermediate
goals are therefore pursued: |
| |
| Patient 'goals' |
| |
- Patients
should attempt to reduce, and preferably, cease
use of
street drugs.
- If injecting,
they should change to safer methods and move towards
injecting prescribables only, and then towards a
cessation of
injecting altogether.
- All patients
should be stabilised on oral methadone prescriptions
if possible.
- Patients
should then attempt to reduce their consumption
of prescribed drugs.
- A reduction
in drug related criminality is also a desired goal.
- There
should be a general improvement in physical and
mental
health and in general health seeking behaviour.
|
 |
|
| To
facilitate these goals methadone is used as the primary prescribed
drug treatment substitute. It is prescribed in its four main
forms: |
| |
- Methadone
linctus 1mg/1ml, also available as sugar free, dye free.
- Methadone
ampoules, 50mg, 35mg, etc.
- Methadone
reefers, prescribed in a nicotine free base, 60mg and
30mg, other doses by special arrangement. Smokeable prescription
drugs are in the process of being phased out in 2002!
- Methadone
tablets, rarely given except for medical reasons and short
term reductions.
|
Diamorphine
is prescribed in exceptional circumstances.
To achieve these aims with a large
client group of approximately 900, the service is organised
as below: |
| |
| Three
Review Teams, two staff in each team,
monitor the progress of 510 clients. They are reviewed every
3 months by their Keyworker and every six months by the Clinical
Director or one of his 4 clinical assistants. Should problems
arise this contact rate can be increased. A further 400 clients
are cared for by the specialist services within the clinic,
as these services are 'in house' necessary transfers are more
easily achieved. |
| |
| The unit will
work intensively with poly drug users whose drug use, in particular
benzodiazepine use gives real cause
for concern. They are given a full benzodiazepine assessment
and a long-term reduction plan is arranged. Only when this
has been achieved to a satisfactory degree will the opiate/methadone
problem be addressed. This unit is actively working towards
a policy of non-prescribing of nitrazepam, to convert to diazepam
those who are using nitrazepam and to reduce clients who have
a genuine and long standing benzo habit, in line with Clinical
Guidelines. |
| |
| A
Mental Health Worker cares for a caseload
of 50 clients who have mental health problems as well as a
drug problem, clients traditionally falling through the safety
net of two separate services, Drugs and Psychiatry. These
clients are now cared for using a 'dual diagnosis' model,
and are monitored at the drug unit. This worker also provides
support and ward times at the in-patient psychiatric unit,
offering advice and support to both patients and staff. The
worker and indeed the unit. |
| |
| Comprehensive
support is offered by the Women's Worker,
whose caseload consists of pregnant women, those women involved
with the Social Services and others whose childcare gives
cause for concern. This worker is also used as a focal point
for advice and referrals to the women's clinic. Not all pregnant
women are monitored by this worker but confirmation of treatment
plans for more stable women is always sought, by the GP Team
for example. See the separate page for more detailed information
on the women’s services. |
| |
|
Particularly chaotic
clients, with severe drug related health problems, or severe
poly-drug use issues, are keyworked by Nurse Practitioners
based in The
Old Lodge, Wirral's harm reduction centre. A full description
of this work can be found on their own web page within this
site. |
| |
| The
Sexual
Health Scheme Workers also have their own page |
| |
| A
Probation
Worker has been attached to the Drug
Service since it opened in 1991. This worker 'fast tracks'
probation clients whose offending behaviour would benefit
from specialist drug treatment. Again not all probation clients
are monitored by this worker, only
those whose drug use is still heavily bound up with crime
and court appearances. |
 |
|
Clients who have recently left prison, still with drug
problems, can also be seen relatively quickly. They
are seen at least monthly, as this is normally a requirement
of the courts probation order. Recent structural changes
at Merseyside Probation Service may mean the end of
this link, we remain hopeful however that the relationship
will continue in some form. |
|
| |
| Wirral
Drug Service believes
that it delivers an efficient and effective drug treatment
service, its working model and practice allows it to operate
with a large client group. We are a primary care led service,
community based and where necessary we operate shared care
systems with appropriate agencies. This service is not a counselling
agency; other organisations can and do provide that service.
We are a health care service attracting a client group not
normally attracted to health services. By focussing on the
individual health of our clients we feel that the other aims
of the treatment provided, reduction in crime, better health
and a better quality of life, etc., will more readily follow.
We attempt to provide a client led service, enabling individuals
to make their own informed decisions, this approach normalises
'drug treatment therapy'. This approach to drug treatment
not only benefits individual clients of the service but also
the wider community in terms of public health and acquisitive
drug related crime. |
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