// Harm Reduction Information Labels

As part of the Frontier commitment to harm reduction, information leaflets informing injecting drug users of relevant issues surrounding injecting (usually developed in conjunction with needle exchange scheme coordinators) are placed in most packs.
In order to consolidate this practice even further we have now developed a range of labels which, we feel, underline the most important of these harm reduction messages.

// It All Adds Up

Section 1.3.7 of Part 2 of the Models of Care document states: Clinical governance (NHS Executive 1999a) has introduced at local levels systematic processes and systems to monitor care and to assure the quality of care. Risk assessment and management is intended to identify health and other risks and predicting factors to reduce accidents, ill health and disease, mortality and morbidity. Substance misuse services are faced with a number of concerns, such as accidents and drug-related deaths including overdose, blood-borne infections, suicide and homicide.

This label attempts to reinforce this point by informing injecting drug users that mixing drugs can seriously increase the risk of overdose.

Label Ref No. 4170 - 0059

// Overdose, Dial 999

Section 1.3.7 of Part 2 of the Models of Care document states: Clinical governance (NHS Executive 1999a) has introduced at local levels systematic processes and systems to monitor care and to assure the quality of care. Risk assessment and management is intended to identify health and other risks and predicting factors to reduce accidents, ill health and disease, mortality and morbidity. Substance misuse services are faced with a number of concerns, such as accidents and drug-related deaths including overdose, blood-borne infections, suicide and homicide.
Section 2.2.3 of Part 2 of the Models of Care document states: …… Commissioners must also meet the government's agenda to reduce drug-related death and prevent overdose (ACMD 2000; Department of Health 2001d) and ensure that local misusers have access to a wide range of harm reduction initiatives, whilst 2.2.2.1 states that the objectives of syringe exchange schemes as identified by the Task Force to Review Services for Drug Misusers (1996) are to offer overdose prevention and response advice and information.

This label supports these recommendations and also indicates both the recovery position and the
emergency services ‘999’ telephone number.

Label Ref No. 4170 - 0062

// Don't Share, Prepare

Section 2.2.1 of Part 2 of the Models of Care document talks about the provision of needle exchange and states: Needle exchange facilities are Tier 2 services, although some (most commonly, community pharmacies) are located in Tier 1. Needle and syringe exchange schemes were developed within the wider context of harm minimisation or risk reduction, which refers to the reduction of the various forms of drug-related harm, including social, medical, legal, and financial problems, until the drug misuser is ready and able to come off illegal drugs (Department of Health et al. 1999). They are important for preventing blood-borne diseases, most particularly HIV and hepatitis, as well as being important public health measures (Department of Health 2001b).
The majority of needle exchange schemes are those where sterile needles and syringes are given out and their safe disposal is offered. Some services provide additional injecting equipment, including swabs, filters, sterile water ampoules, citric acid and so forth.
The major objective of needle exchanges was the minimisation of the risk of infection by making injecting equipment accessible to all injectors, and thus reducing sharing (Task Force to Review Services for Drug Misusers 1996). Needle exchanges were developed within a wider approach that advocated a hierarchy of goals: stopping sharing injecting equipment, moving from injectable to oral drug use, to decreasing drug use, and ultimately to abstinence (ACMD 1988).
Preventing the sharing of injecting equipment remains high on the policy agenda. One of the targets of the government's ten-year strategy, Tackling drugs to build a better Britain, is "to reduce the proportion of drug misusers who share injecting equipment in the previous month" (UKADCU 1998a). Needle exchange has had a crucial and well-documented role in keeping rates of HIV low in England. The recent Department of Health guidance on hepatitis C mentions its importance, along with other harm reduction measures, in reducing the spread of hepatitis C virus (HCV). The guidance states: "It is important that those working with drug users are aware of, and actively promote, the use of local schemes and provision" (Department
of Health 2001b).

The need to ensure that such services are commissioned at local levels cannot be stressed enough. The message associated with this label encourages the above approach and discourages sharing.

Label Ref No. 4170 - 0061

// Had a Break, Go Easy Not Over

Section 2.7.6.4 of Part 2 of the Models of Care document suggests aftercare following departure from the programme and onward referral should be a planned element of the programme. Aftercare can maximise the benefits of residential rehabilitation programmes and reduce the risk of relapse and drug-related harm Patients may be at particular risk of drug-related death due to overdose if they leave residential rehabilitation and return to previous levels of drug and alcohol misuse. All residential rehabilitation services should educate and work with service users to reduce the risk of harm due to drug-related death - particularly those who are discharged or leave programmes prior to completion.

This label reiterates the dangers of overdose after a break from drug use.

Label Ref No. 4170 - 0060

// Not Just Needles

Section 2.2.1 of Part 2 of the Models of Care states needle exchange facilities are Tier 2 services, although some (most commonly, community pharmacies) are located in Tier 1. Needle and syringe exchange schemes were developed within the wider context of harm minimisation or risk reduction, which refers to the reduction of the various forms of drug-related harm, including social, medical, legal, and financial problems, until the drug misuser is ready and able to come off illegal drugs (Department of Health et al. 1999). They are important for preventing blood-borne diseases, most particularly HIV and hepatitis, as well as being important public health measures (Department of Health 2001b).
In 1998, there were 2,000 needle and syringe exchange outlets in the UK distributing over 25 million syringes annually (Hunter et al. 2000). The majority of needle exchange schemes are those where sterile needles and syringes are given out and their safe disposal is offered. Some services provide additional injecting equipment, including swabs, filters, sterile water ampoules, citric acid and so forth.

This label indicates that the items of paraphernalia noted above can be disposed of in the sharps container.

Label Ref No. 4170 - 0063