harm reduction and health curricula

hello from london again! I am currently in the process of getting a bid together (at very short notice) to fund a project which evaluates the impact of providing standard (which is just 3 hours of drug/alc awareness, and a bit about detox) plus extended lectures on harm reduction to student nurses (RN's) in terms of attitudes towards drug use/users (versus students who just get the standard teaching). I have reviewed a few attitude to drug use/users questionnaires but none have got me excited .... does anyone know of any good measures in this area?
thanks
peter

Overdose prevention

Hello fellow bloggers! and more greetings from London. I'm posting this question/comment about naloxone and overdose prevention in the hope that we can get naloxone more widely available in the UK. I recently was in New Mexico to look at the way they offer naloxone to current users. Users are trained up in OD management and then given (prescribed) two syringes with naloxone ready to use. It was amazing to see how this worked, and to hear the report of one user who returned for a refill- he had saved at least one life with what he had been given. Just stunning ...

Here in the UK there are 'medico-legal' reasons not to allow narcan to be distributed more freely and some of the work is about giving relatives the prescription instead. After I left New Mexico I also heard that several n/ex's in NYC are approaching naloxone this same way. Do any of you know about that? What were the problems in getting this set up etc? Are there any published reports of this approach? Thinking the right approach is to get a one day meeting set up to discuss and make a plan of action.

Peter Phillips

"Opt Out" HIV Screening

In September the CDC revised its HIV testing recommendations. They now recommend that all persons age 13 through 64 be screened for HIV. They also recommend annual screening for "high risk" people. An "Opt Out" model is proposed. I understand this to mean that when routine blood work is to be obtained an HIV test will also be done. The patient will be informed of this and consent for the HIV test will be included in the general consent to blood work. The patient may opt out of the HIV test. This is meant to apply in any medical facility including drug treatment facilities.
Here are my questions:
Are any of you doing this?
If so how are results disclosed and who handles the disclosure?
What measures are taken to avoid a positive result being inferred merely by triggering the disclosure system?
Counselors at my clinic have also raised concerns that patients enrolling in a methadone clinic are "too early" in their recovery to handle learning they have HIV.
Any thoughts?

A Harm Reductionist approach to buprenorphine

This won't be new to any of you who have EVER heard me speak on buprenorphine however my harm reduction based approach to buprenorphine therapy for opiate addiction in primary care is now officially published someplace you can cite! Click on the highlighted bit to see a PDF of the publication. Be patient it is slow to open. Some of my other slide sets are also available to view and canabalize at will.
Happy Harm Reducing and Hannukah!

NYS - DOH Substance Use and HIV Guidelines

I am resending my last post as I did not give it a title:

link to NYS - DOH Substance Use and HIV Guidelines
http://www.hivguidelines.org/Content.aspx?PageID=262
the chapter : Working with the Active User - just released 10/06

and thanks to Melinda/Ro for getting this going
nancy murphy

Needle Exchange in a Methadone Clinic

Greetings!

I have been so excited since the conference, and I returned to my methadone clinic here at San Francisco General Hospital determined to begin distributing clean needles to our patients who want them. Amazingly, I have strong support from the clinic leadership, and we are developing a protocol. Apparently, no other methadone clinic in California is currently distributing clean needles. Thus far there don't seem to be any insurmountable obstacles. At this point we are looking at providing needles for our own patients only, as there are too many complicated issues with serving other patients. However we hope that these clean needles will find distribution to other users in the broader community.

I'm interested in thoughts from any of you out there and advice about potential challenges. Also advice about needle disposal kits and other adjunctives would be great.

We are also moving forward with a naloxone distribution program which I hope to see in place for the new calendar year.

Thanks to all for the huge boost of energy coming out of our gathering!

--Brad Shapiro

bloggng in from the uk

Hi from the UK Ro and everyone else!

I hope the exams go well Ro, its a good idea to invite your fellow students and teachers to contribute to our blog - a good way of opening up the discussion. I've been telling my colleagues at the university of Greenwich here in London all about the recent conference - our meeting and the blog of course - they are really interested but generally have not had an opportunity to explore HR much yet - many of them work in mental health, child health etc etc.

However if I can get some of them to participate here then it would be a good way to find out more from other international and perhaps UK-based colleagues. I'm going to 'prod' (safely!) my dear colleague, Peter Phillips, also in London, who attended our recent meeting to start blogging here as well - although like Ro, he's busy preparing for his PhD defense in a few weeks time - GOOD LUCK Pea! :)

Hope to hear a lot more from all you guys soooooooon!

Olive McKeown (London) oliviamck@hotmail.com