Addiction Health Integration Team- ADDHIT

Matt Hickman, Barbara Coleman, Tim Williams

Jo Kesten, Katie Porter, David Troy

Acknowledgements• NIHR Collaborations for Leadership in Applied

Health Research and Care (CLAHRCs) West• NIHR Health Protection Research Unit in

Evaluation of Interventions• Sabi Redwood, Maggie Telfer, Rachel Ayres,

Jane Neale, Jody Clarke, Isabel Oliver, Peter Vickerman

• Clare Fleming, Jelena Savović, Helen Thorely, Tim Jones, Elsa Marques

• Marcus Munafo, Olivia Maynard, Angela Attwood

support the development and commissioning of evidence-based services to improve the health of people dependent on drug and alcohol and reduce drug and alcohol related harm

AimADDHIT

Research Opportunities• Evaluating the impact of opiate substitution treatment on

drug related deaths in the population (NIHR HS&DR)• How to improve HCV case finding in primary care and

specialist drug clinics (NIHR PHP)• Investigate the cost-effectiveness of Needle Exchange

interventions (NIHR PHP)• Pilot Trial of alcohol screening and brief intervention

(ASBI) in custody suites (NIHR SPHR)• Evaluation of ASBI training and delivery for young

people services in NHS, Schools, CJS (NIHR SPHR)• Scope Health Impact Assessment of Licensing Policy

(NIHR SPHR)

ADDHIT

Progress• Low vs high dead space syringes: an investigation of user

preferences and attitudes (CLAHRC West & NIHR HPRU) • Systematic review – could addressing malnutrition in

alcohol dependent people prevent cognitive deficit and alcohol related brain damage (CLAHRC West)

• Evaluation on efficacy of straight beer glasses to reduce alcohol consumption in the general population (NIHR PHP).

ADDHIT

Low versus high dead space syringes

• High Dead Space Syringes (HDSS) contain ten times more “dead space” between the plunger and needle and transfer more blood if re-used than Low Dead Space Syringes (LDSS)

• HCV and HIV survive for longer in HDSS vs LDSS

• Increasing the proportion of LDSS in circulation could significantly reduce the prevalence of blood-borne viruses

• WHO and NICE recommend needle and syringe programmes offer LDSS

• Recommended that needle and syringe programmes supply injecting equipment suited to the needs of local drug users

Research questions:

1. How acceptable are LDSS to injecting drug users? 2. Is a public health intervention needed to encourage the provision and use of

LDSS?

An investigation of user preferences and attitudes

Study objectives1. To systematically review literature on LDSS (including interventions encouraging their use)2. To explore the views of 25-35 injecting drug users and 10-15 professionals and volunteers who work with them on the use of LDSS3. To develop evidence-based recommendations for the introduction of LDSS and determine need for public health intervention

Qualitative methods• Two study sites in the South West of England• Maximum variation sampling (range of demographic characteristics, drug type and injecting preferences)• Semi-structured one-to-one interviews exploring:

– Experiences of different types of syringes– How the available options are chosen between– Facilitators, barriers and processes of changing injecting equipment – Attitudes towards LDSS using a sorting task (ordering features of LDSS by importance)

Progress• Review in draft• Interviews underway

Alcohol dependency and malnutrition in the homeless population

• Malnutrition causes brain damage (confusion, poor memory, balance and co-ordination problems), may impair wound healing and the ability to change behaviour.

• Drinkers are not underweight as they get empty calories from alcohol.

• Few papers on intervention trials. No clear way forward. • Public Health alcohol lead and Homeless Health GP

worked together to develop the bid, sharing papers, and discussing how to present the case.

Alcohol dependency and malnutrition: systematic review

• Q: What are the effective and cost-effective interventions for preventing and/or correcting micronutrient deficiencies and other forms of malnutrition and related comorbidities in a population of homeless and vulnerably housed persons with alcohol dependency?

• Meta-analysis: Malnutrition profile in a population of homeless and vulnerably housed persons with alcohol dependency.

• Then develop a research bid for an intervention

Lab Experiment - Drinking Data

** p = 0.007

Feasibility Study

• Run in 3 public houses in Bristol over 2 weekends

• Either all straight or curved half-pint and pints• Monetary takings as proxy for consumption• Implementation of intervention – takings

reduced by:• -24% (95% CI -77% reduction to 29% increase)• Future trial: 30 pubs over 6 months (multi-site

- NIHR PHP “Choice Architecture” theme

• Systematic Review on Models of Community Alcohol Detox (and community detox vs. hospital/residential)

• Investigate community MRSA outbreaks among PWID – enhance surveillance and develop and pilot interventions

• Investigate gabapentin and pregabalin misuse, risk and strategies to prevent drug related harm

• Conduct Health Impact Assessment of new psycho-active substances

• Alcohol Policy in Bristol

ADDHIT

Future plans

ADDHIT Members• Bristol City Council• University of Bristol• University of the West of England• ROADs and other service providers• NHS England• Clinical Commissioning Group• GPSIs• University Hospitals Bristol• North Bristol Trust• Public Health England• Police• Probation