Care Planning


With Care Planning you prepare your care plan alongside a worker from the Community Drugs Service. Your care plan belongs to you. You need to agree what is in it and you should be able to review it when you want. It should include your treatment goals and the steps you want to take in your recovery journey. Changes to your treatment regime should be decided by you with your treatment worker and recorded in your treatment plan.

Staying healthy

Staying healthy

When you take drugs, particularly by injection, you are more vulnerable to a wide range of viral and bacterial infections.


Health risks

A variety of health risks are associated with taking drugs, particularly if you inject. These include bacterial infections at injection sites and the spread of blood-borne diseases. Overall, around half of people injecting drugs have been infected with the hepatitis C virus (HCV), approximately one-third will have an injection-site bacterial infection and around one in a hundred have HIV.


Treatment options

Recent treatment advances have dramatically improved the quality of life for HCV and HIV patients. The unpleasant side effects and low success rates that have been associated with HCV treatment, for example, are now a thing of the past. New treatments are available that can cure HCV in just a few months with minimal side effects. There are still myths surrounding the treatments for drug-related infections and it is important to separate fact from fiction.


Getting help

If left untreated, drug-related infections can have very serious consequences and present further risks to your health. Your doctor can test you to find out whether you have any drug-related health issues and regular tests will allow you to access treatment quickly. Everyone fears a positive test result, but if you are one of the many people with an infection, it is important to arm yourself with the information necessary to make an informed decision about treatment, giving yourself the best possible chance of a healthy future. Regardless of whether or not you are getting therapy for heroin/opioid dependence, if you suffer from any drug-related health problems, you most certainly have a right to medical treatment.

Here you will find information that can help you understand how you can look after your health to prevent infection in the first place and how to seek help should you experience any drug-related issues. Specifically, information is provided on how to:

  • get vaccinated against hepatitis A and hepatitis B
  • prevent the likelihood of contracting and transmitting infections through safer injecting practice
  • recognise infections and learn when you may need help
  • understand the available treatment options for drug-related infections or health problems
  • find out how and where to seek treatment


Wound management

If you inject drugs you are at risk of developing an infection at the injection site, such as abscesses, ulcers, sores and open wounds. Injecting directly into muscles or just under the skin (‘skin popping’) causes significant damage to these delicate tissues and this makes it easier for them to get infected.

Dangerous injection sites

Injecting into arteries is particularly dangerous because of the risk of getting gangrene. The groin as an injection site is strongly associated with health risks because there is a large artery here (the femoral artery). Hitting the femoral artery can cause severe bleeding causing tissue death from blood loss. Moreover, there is a large number of germs in the groin, which increases the likelihood of an injection-site infection.

Reducing the risks

Safer injecting, for example using sterile needles, preparing drugs in a clean environment and not sharing equipment with others, can help prevent many injection-site infections. However, these precautions may not necessarily prevent wound botulism, anthrax or tetanus infections as these rare, but potentially fatal, infections can occur because the heroin itself is contaminated – remember, there is no quality control over street/illicit drugs and they are often not pure or sterile. If you think that you have an infection, you can talk to your doctor– the sooner treatment is started, the better the chances of a successful recovery from the infection.

Prevention and treatment

A vaccination to protect against tetanus is given as part of the NHS childhood vaccination programme, with booster injections recommended every 10 years. The vaccination is also available for adults through the NHS – visit your GP to make sure you are up to date. Bacterial infections of the skin are often easy to treat with a course of antibiotics. It is important to understand that, if left untreated, any skin infection can lead to more serious infections such as blood poisoning, soft tissue infection and heart valve infection, all of which can kill.


Safer sex

Drug use can reduce your inhibitions, which can put you at more risk in terms of your sexual activity. Having multiple sexual partners and/or not using appropriate contraception to protect against sexually transmitted infections can increase the risk of sexually transmitted diseases.

Use of condoms during sex with new partners as well as dental dams for oral sex can protect against the spread of sexually transmitted diseases. Free condoms can be obtained through the NHS and the NHS Choices website has a ‘free condom finder’ service: http://www.nhs.uk/Service-Search/Free-condoms/LocationSearch/732


Blood-borne viruses

A blood-borne virus is a virus that is transmitted not only by blood itself, but also by body fluids that contain blood. The most common blood-borne viruses are HCV, hepatitis B virus (HBV) and HIV. Many viruses can remain infectious in blood outside of the body for up to several weeks, in particular inside syringes.

The following activities can transmit these viruses from you to others:

  • using used or unsterile tattoo or piercing needles
  • sharing needles and injecting equipment, such as syringes, spoons, filters and water
  • sharing any drug paraphernalia that is at risk of coming into contact with blood, for example cocaine straws and crack pipes

Sexual transmission of HCV is rare, unless the sexual activities are associated with skin cuts or tears, as the virus is most concentrated in the blood. However, both HBV and HIV can also be transmitted through other body fluids and are sexually transmitted during unsafe sexual practices. Around half of all injection drug users have HCV, around 1% have HIV and about 17% have been infected with HBV as some point (though only a small number of those infected go on to develop a chronic disease). Your GP, sexual health clinic, genitourinary medicine (GUM) clinic or drug treatment service will be able to provide testing for infection with blood-borne viruses.


HCV

Hepatitis C (HCV) is a virus that can infect and cause damage to the liver. It can be either ‘acute’ or ‘chronic’. An acute infection is a short-term illness that occurs within the first six months of someone being exposed to the HCV virus; for most people, this leads to chronic infection, which can cause long-term liver damage. Treatments have been continually improving and the latest treatments can cure HCV in as little as 12 weeks with minimal side effects.

Transmission

If you are infected with the virus, it will become concentrated in your blood and can be transmitted through blood-to-blood contact, for example through sharing needles. There is currently no vaccination for HCV, so if you inject drugs, practising safer injecting is the best way to avoid catching and spreading the disease. If you have HCV, there is no need to panic about passing the virus on to loved ones or children as long as you take precautions to avoid blood-to-blood contact. If you are pregnant there is a small risk (3–6%) of passing the virus on to your child during childbirth.

Getting tested

Approximately half of all people who inject drugs will have HCV. However, just a small proportion of those infected with HCV are treated each year, despite it being curable. Left untreated, HCV may cause cirrhosis of the liver and liver cancer, so it is important to get tested for the virus; if you think you might be at risk of infection, you can speak to your doctor about being tested. Your GP, sexual health clinic, genitourinary medicine (GUM) clinic and drug treatment service should all offer blood testing for HCV. There are two types of test for HCV, an antibody test, which tells you whether you have ever been exposed to the virus, and an RNA or PCR test, which tells you whether you currently have the virus. It’s important that you know the difference because having a positive antibody test does not necessarily mean you are currently infected.

Getting treated

There is around a 60–90% chance of curing the viral infection with medical treatment. Therapy is improving all the time, with newer medications having fewer side effects and reduced therapy times.

New treatments

Interferon-free treatments, which have minimal side effects, are currently being developed. At the end of 2013, the first of these, called sofosbuvir, was licensed for ‘chronic’ HCV infection. This is the first drug to be found effective for the treatment of certain HCV infection types without the need for combination with interferon – which means fewer side effects. These new therapies can achieve patient cure rates of over 90% in as little as 12 weeks, with minimal side effects.

Traditional treatments

Before these interferon-free treatments became available, the most effective medical treatment for HCV consisted of taking two drugs: pegylated interferon and ribavirin. In 2012, newer treatments were approved for HCV.These so-called protease inhibitors are taken in combination with the existing treatments; they are effective against the most common subtype of HCV (genotype 1). This combined therapy is more effective compared with earlier treatment approaches and can greatly reduce the length of treatment for some people.

Even if you are using drugs at the moment, you still have a right to treatment. Regardless of whether you are ready to approach recovery from heroin/opioid dependence, you can be treated for HCV. Alternatively, if you do decide to engage with heroin/opioid treatment, this is the perfect time to also seek treatment for any drug-related health issues and make the most out of your recovery.


Hepatitis A/B

Hepatitis A virus (HAV) and HBV also cause inflammation of the liver. HAV is rarely life threatening; however, HBV, like HCV, can cause cirrhosis of the liver and liver cancer. HBV is transmitted through blood-to-blood contact and around 17% of injecting drug users in the UK have been infected with HBV as some point.

Transmission

Sharing needles and drug-preparation equipment is the major risk factor for being infected with HBV. It can also be passed on during childbirth from a HBV-infected mother to her baby. In the UK, all pregnant women are tested for HBV. Outbreaks of HAV infection have also been reported among people who inject drugs. Such outbreaks are believed to occur through injecting. HAV is also found in the stool of people with the virus and can be transmitted through faecal–oral routes that involve passing the virus from the stool of one person to the mouth of another person, for example by unclean hands that have been used to prepare drugs for smoking.

Prevention

Vaccinations for both viruses are available and these are your best defence against contracting the viruses. Separate HAV and HBV vaccinations, or a combined HAV/ HBV vaccination, are available from GP surgeries and sexual health or GUM clinics – these vaccinations are provided free of charge. Booster doses will be required for full protection. If you have not been vaccinated and are injecting drugs you may wish to get tested for both HAV and HBV. If you think that you have come into contact with the hepatitis A or B virus, go to the doctors immediately as you can receive an injection of immunoglobulin to reduce the likelihood of developing any illness.

Recovery

Most people who do have HBV can recover without any treatment, but those with poor immune systems or with chronic infections may require treatment with antiviral medication to reduce the risks of significant liver damage. These medications are very effective at suppressing the virus, preventing liver damage and allowing the body time to repair any existing damage. There are currently no treatments for HAV and the best option is to rest until the infection passes. Whatever form of hepatitis you have, drinking alcohol will increase the progression rate of liver cirrhosis.


HIV

Around 1% of injecting drug users in the UK has HIV. Like hepatitis, HIV is a blood-borne virus; therefore, safer injecting can reduce transmission, as can practising safe sex, as the virus is also sexually transmitted.

About HIV and AIDS

The HIV virus weakens the immune system and limits a person’s ability to fight infections. AIDS is the final stage of HIV when your immune system becomes very badly damaged and you become vulnerable to multiple infections. If you are diagnosed with HIV, there are treatments available that prevent the HIV virus from multiplying and destroying your immune system. Preventing HIV from progressing to AIDS will enable you to continue to fight off life-threatening infections for as long as possible. This means that people in treatment for HIV can often lead a long and healthy life.

Stop it before it starts

If you think that you have been exposed to the HIV virus within the last 3 days (72 hours) an anti-HIV medication, called post-exposure prophylaxis (PEP), may stop you becoming infected in the first place. PEP must be started within 72 hours of coming into contact with the virus.

Treatment

HIV is treated with antiretrovirals (ARVs), which slow down the spread of the virus in the body. HIV can quickly adapt and become resistant to one single ARV, so patients tend to take three or more types of ARV medication, known as combination therapy or antiretroviral therapy (ART). Treatment prevents HIV from progressing to AIDS. This means that if you have the virus you can live a long and healthy life; seeking treatment early will give you the best chance possible.

It is important for you to understand that regardless of whether you are ready to tackle your heroin/opioid dependence, you can still be treated for HIV to stay healthy. However, continuing to take drugs without support, as well as excessive drinking, may weaken your immune system and affect your ability to commit to HIV treatment, reducing its effectiveness.

Testing

The earlier that HIV is detected, the more likely it is that treatment will be successful, so if you think that you may be at risk you may wish to get tested – testing is widely available and free on the NHS. Self-testing kits are also available. If you do test positive, the virus can be monitored over time. Treatment normally starts once tests show that the immune system has started to weaken.

Multiple infections

If you have a co-occurring illness, such as hepatitis, the immune system may start to weaken earlier than in someone who has HIV alone. Approximately one-third of HIV-positive people are also infected with HCV and so might want to think about being screened for HCV upon receiving a positive HIV diagnosis. If you have HCV, a doctor will decide whether it is appropriate to treat this infection first or together with HIV. While interactions between HCV and HIV medications are common, they can easily be managed by your doctor with dose adjustments.