REACHING FEMALE MISUSERS

My aim in proposing a project for the 'From Practice to People' Awards was
to focus on women drug misusers, because the number and proportion of
females using the Berkshire pharmacy needle exchange scheme was increasing,
especially in the under 25 age group.

This became especially noticeable towards the end of the last financial year
(between January and March 1998).

For pharmacy needle exchange client visits, the male to female ratio overall
was 3.1:1, but the male to female ratio in the under 25 age group was, and
has remained at, 1.7 to 1.

During 1998 there were 27 Berkshire pharmacies offering needle exchange.
Each month, on average, female drug misusers make 180 visits to these
pharmacies. Over half the clients are under 25 years old. Visits by males
average over 570 per month, with about 160 per month under 25-year-olds.

During discussions with the two Berkshire community drugs teams (CDTs), we
felt we could make use of the fact that the pharmacists were in frequent and
regular contact with this often difficult to reach group. But organising
such a scheme was outside the scope of my contract as pharmacy needle
exchange co-ordinator.

The 'From Practice to People' Award has made it possible for pharmacists to
demonstrate their ability to identify a problem as it develops (the
increasing numbers of female drug misusers), and to offer suggestions as to
how to tackle it.

Achievements so far:

* Approval to action the proposal was obtained from the Health Authority,
the Berkshire Substance Misuse Advisory Group (which includes
representatives from the two CDTs) and the Community Pharmacy Working Group
(CPWG) a working group of the LPC

* Initiation and maintenance of collaboration with maternity services

* Support from the Berkshire Health Promotion Service (an information and
resource centre funded by the health trusts) with assistance in leaflet design

* Research of current leaflets and information for women and for women who
use drugs

* Compilation of local and national contact telephone numbers

* Agreement from a national 'signposting' telephone helpline service to
include its number on the leaflet

* Detailed discussion with a group of 12 female drug misusers

* First draft design of leaflet produced

* System set up for recording interventions by pharmacists

* Collation of resources and information appropriate to pharmacists.

Multidisciplinary

By approaching the community pharmacy working group, I was able to get
'official' support for the proposal. In addition, the assistant director of
primary care agreed to act as my health authority link which helped to
ensure I was not inadvertently contradicting health authority policies. She
also allowed me to use health authority headed notepaper for correspondence.

As a result of my writing to the two senior midwifery managers, one
maternity unit reviewed its records for the preceding months and discovered
there had been an increase in the number of pregnant women admitting to drug
misuse.

This has prompted the CDT and maternity unit to set up a series of training
sessions for the midwives, with the aim of establishing a liaison antenatal
drug and alcohol service.

The other maternity services unit received the information with interest. It
regularly liaises with the CDT because one of the drugs team key-workers is
an ex-midwife. As a way of thanking them for their help, I supplied them
with copies of a useful new booklet, 'Drugs, Pregnancy and Childcare'
(published by ISDD at #5.95).

Discussions with sexual health advisers and the health advisers at the local
genito-urinary medicine clinics all resulted in confirmation that using the
pharmacists and the pharmacy needle exchange scheme was a sensible method of
reaching this group of people. The health advisers confirmed they were
willing to handle queries from female drug misusers.

As a result, there is heightened awareness of the increasing incidence of
female injecting drug misusers and consideration is given to the impact this
may have on services.

Information needed

The manager of a local probation hostel invited me to speak to interested
residents. Twelve women who had all been injecting drug users chatted openly
about what sort of information they wanted.

This included information on:

* drugs in pregnancy

* contraception and termination

* effects on menstruation

* encouragement to seek help about their drug problem how to handle social
services

* risk of overdose and what to do if you were with someone who has overdosed

* needle fixation

* food and nutrition problems

* risks from injecting street drugs 'cut' with unknown substances

* HIV, hepatitis B and hepatitis C risks, testing and vaccination

* access to legal advice.

The conversation also highlighted other points of interest. Freephone
numbers are preferred to face to face contact. Linked to this,
confidentiality needs to be emphasised and explained. The importance of not
injecting in front of non-injectors but remembering that they should never
inject alone in case they overdose should be emphasised

Leaflet design

At the suggestion of the CPWG, I contacted the health promotion services
department which has been extremely helpful. The original idea was to adapt
a leaflet produced by the Manchester Needle Exchange Forum called 'Drugs
and pregnancy'.

As health promotion staff got involved and became more enthusiastic about
the idea, they suggested that the scope of the leaflet should be broadened.
Using their experience we were able to work out the main points to be
considered in the design of the leaflet, such as:

* preferred reading age for leaflets (age 12) and appropriate colour

* is the term 'female' appropriate?

* what are the aims of the leaflet? (to get across the message that they do
have options and can make choices about their future)

* to encourage the use of the accessible services of the pharmacist

* telephone numbers the main problem being that there were too many. We
decided to limit the list to a few core numbers.

As a result of this input, the leaflet design process has become much more
complicated than was originally intended and we are now at the draft stage.

Once completed, the leaflet will be distributed via needle exchange
pharmacies. Hopefully it will be acceptable for distribution through other
services such as CDTs, maternity and GUM clinics.

Pharmacy help

Most pharmacies hold a range of leaflets and information, but I have been
able to collect information which pharmacists may have difficulty in finding.

It will be possible to advertise to local pharmacists the resources
available through the health promotion department and how to access them. I
now hope to produce an information manual, of manageable size,
cross-referencing information they already have.

One important aspect of providing information for the pharmacists is
encouraging them that they already have the skills and resources necessary
to deal with female drug misuser queries. As needle exchange coordinator, I
will be able to visit the pharmacies and work through the manual with each
pharmacist.

Arrangements are in place for recording interventions by pharmacists and
feedback from clients.

Conclusion

It is anticipated that these services will become an integral part of the
work of the pharmacists involved in the pharmacy needle exchange scheme and
will further enhance their role.

The resources and information collated as a result of the 'Practice to
People' Award will help to support the pharmacists in providing a
pharmacy-led service to individuals whom other health professionals regard
as a 'difficult to reach' group.

By ensuring that data on numbers contacted via the scheme continues to be
fed back to CDTs, the health authority and maternity services, collaboration
between services will be maintained to the benefit of clients, patients and
staff.