Jenny Scott

Experiencing “The Other Side”: A Study of Empathy and Empowerment in General Practitioners Who Have Been Patients

Work-related pressures and susceptibility to health problems mean that many general practitioners (GPs) will, at some stage, experience the role of patient. However qualitative evidence about their experiences of illness and patienthood is sparse. Our study offers an interpretative perspective on GPs’ experiences of illness and the influence that this has had on their practice. Seventeen GPs who had experienced significant illness took part in semistructured interviews. Data were analyzed using interpretative phenomenological analysis (IPA). The findings highlight the relationship between empathy and empowerment and explore the role of self-disclosure of GP status by GPs in consultations. We make suggestions as to how empathy in doctor—patient relationships can be developed through consideration of power and status as well as through interaction with patients from similar backgrounds. Future research should focus on more specific ways to integrate these ideas into medical training.

Community pharmacy services to drug misusers in the south west of England: results of the 2003–2004 postal survey

Objectives To quantify current levels of methadone dispensing and supervised consumption for the treatment of drug misuse in community pharmacies in the south west of England. To compare 2003–2004 data to estimates made in 1995.

Laboratory study of the effectiveness of filters used by heroin injectors

Aims: (a) To compare in the laboratory the effectiveness of various filters at removing particles from heroin injections; (b) To measure the amount of heroin retained by the filters; and (c) To describe the relevance of these preliminary findings to future research. Design: A laboratory‐based investigation. Injections were prepared with street heroin obtained from the police, copying the methods of injectors. Pieces of cigarette filter, hand‐rolling cigarette filter, cotton wool from buds and commercially produced syringe filters were tested. The Coulter Multisizer (IIe) was used to count and size particles; Capillary Zone Electrophoresis was used to measure the amount of heroin retained in the filters. Findings: All methods of filtration reduced the amount of particles, with the commercially produced syringe filter producing the largest reduction. The syringe filter retained the most heroin after use; however, less drug material was evident on the spoon, suggesting further work is needed with a range of quantities. The cigarette, hand‐rolling and cotton bud filters all retained some drug with no significant difference detected between the different filters. Conclusions: This preliminary study suggests all the filters tested may convey health benefits. Further work is needed with varying quantities of drug, acid and water and to establish safety in use. Then future studies can establish the health consequences for injecting drug users from the use of such filters.

Injection preparation processes used by heroin and crack cocaine injectors

Background In the UK, most heroin and crack cocaine is not soluble in water alone. They require conversion to a soluble form before they can be injected. To accomplish this, users add weak acids, for example citric acid, lemon juice or vinegar. There is little information in the literature examining the preparation steps in detail. A better understanding would inform safer injecting research and practice. Aim To investigate the preparation of insoluble illicit drugs for injection with identification of the common procedures, materials and equipment used. Methods A novel interview design was used. This incorporated a semi‐structured questionnaire in combination with a practical demonstration of preparation of fake drug material. The preparation steps, materials and equipment used were recorded. Results Sixty‐five injectors were interviewed at three needle exchanges. The preparation of heroin, crack cocaine and ‘speedball’ injections was characterized. The steps to prepare injections were similar in the majority of cases. Each participant used acid in the preparation. Heroin and ‘speedball’ injections were heated; crack injections were not. Each injection was filtered. The equipment chosen and the proportions of drug, acid and water used varied. Conclusions This work indicates that the basic steps used by the sample of injectors were similar, but the details within each step varied. It highlights areas of injection preparation that can be targeted in harm reduction information and research. Further work could determine the prevalence of these techniques.

The availability of injecting paraphernalia in the UK following the 2003 law change to permit supply

Aim: To describe the availability of injecting paraphernalia in the UK following the introduction of legislation that permits supply for harm reduction purposes. Methods: A postal questionnaire undertaken 18 months after the law change, sent to all identified UK drugs services. Those providing needle exchange were asked to respond. Co-ordinators of their schemes completed the questionnaires. Findings: A total of 469 services were identified and contacted, 403 (86%) responded. Of these, 231 provided needle exchange (NX) from 1521 outlets. On average, they were responsible for 1.6 agency-based, 4.2 pharmacy, 0.7 outreach and 0.2 ‘other’ NX outlets. Of those providing NX, 212 (92%) supplied one or more items of paraphernalia, most commonly swabs (n = 220, 87%), followed by citric acid sachets (n = 155, 67%), filters (n = 106, 46%), spoons (n = 102, 44%), vitamin C sachets (n = 69, 30%) and sterile water (n = 52, 23%). Other items supplied were citric acid loose powder (n = 34, 15%), tourniquets (n = 34, 15%) and vitamin C loose powder (n = 6, 3%). Only 4% (n = 10) said their services supplied all six items necessary in the injection process (sterile water, spoons, an acid, filters, tourniquets and swabs). Most commonly only two items were supplied, usually swabs and one acid and 63% (n = 144) supplied 3 or less items. Most commonly finances were said to limit supply. Sharing paraphernalia is associated with an increased risk of IDUs being hepatitis C (HCV) antibody positive. These data suggest that the range of paraphernalia supplied by needle exchanges could be extended from the majority of outlets, in the absence of information that can attribute risk to the sharing of specific items. Conclusions: Although the majority of services supplied some form of paraphernalia, most did not supply the full range. Further research is needed to establish the impact of this supply on blood-borne virus and bacterial infections and whether increased supply is warranted.

South West England needle exchange pharmacist's knowledge of the updated UK 'paraphernalia laws'

Background: The supply of some injecting paraphernalia was legalized in the UK in 2003 in order to reduce harm, prevent blood born virus transmission and encourage access to services. Pharmacies comprise over three quarters of needle exchange outlets in the UK. The extent to which needle exchange pharmacists are aware of the law change or have embraced the new supply opportunities is unknown. Methods: A survey of pharmacy based needle exchanges (PBNX) in the South West of England (n = 143), undertaken using telephone interviews 6 months after the main law change. Results: Participation rate was 85% (n = 121), 66% (n = 80) of PBNX provided needles and syringes only, 34% (n = 41) supplied one or more items of paraphernalia. The most commonly supplied paraphernalia item was citric acid. Forty‐two per cent of pharmacists said they were aware of the law change. However, only 2% of these could fully describe it, 41% could partially describe it, 59% were either out of date, wrong or did not know. Most pharmacists saw themselves as ‘middle men’, acting on behalf of local healthcare planners or drugs services. Most said they had no influence over equipment choice. Conclusions: Although PBNX is extensive within the UK, in the South West of England, the law change to permit the supply of paraphernalia has not been fully implemented. Pharmacists appear to be little involved in decisions around supply with areas for improvement in knowledge of the new law identified. Involving pharmacists more in local decisions may increase their feelings of accountability for the service they provide to injectors.

Class, alliances and harm reduction: a personal view

academic findings into real life. Without this ability, many of the benefits of research may be lost or missed. In order for harm-reduction researchers to translate their findings into application to the wider community, they too may benefit from forming alliances, in terms of partnerships with community groups, service providers and drug users. This may in a sense provide a ‘reality check’ to prevent academic work from being too abstract. In conclusion, the formation of alliances is a positive way forward for many in the drugs field, as long as human rights values J. Scott / International Journal of Drug Policy 12 (2001) 37–40 40 are common to all groups involved and upheld. Issues of class play a key role but we must be careful not to make assumptions of class based on job title, lifestyle and income alone. For the harm reduction cause to be won, we need to consider the issue of class in the debate. We also should consider drugs worker recruitment, the importance of their political values and maximisation of their campaign power. Friedman et al. are to be commended for beginning such an important debate.

Use of clinical guidelines in cardiology practice in Sudan

RATIONALE, AIMS, AND OBJECTIVE The aim of this study was to explore the views of prescribers in cardiology in Sudan about the use of guidelines in clinical practice and the extent to which guidelines whether national or international can be adopted in clinical practice in Sudan. METHODS Interviews were conducted with the consultants in 2 of the main cardiac hospitals in Sudan. This was followed by a survey amongst the doctors in the hospitals to examine the views of a larger population of prescribers about the matter investigated. RESULTS Twelve consultants were interviewed, and 47 prescribers (60%) replied to the questionnaire that followed. Most doctors relied on foreign guidelines to prescribe for their patients. The doctors acknowledged the limitation of using foreign guidelines in Sudan. A number of doctors were not in favour of following any guidelines, as they perceived that the practice in Sudan does not allow implementation of guidelines. CONCLUSION The prescribers in Sudan had to rely on guidelines made in foreign countries if they want to get the benefit of evidence-based medicine to their patients, but they had to find a way to adapt these guidelines to their patients and to the health care system they are working within. However, it is not known if this adaptation of foreign guidelines is providing the benefits intended or is risking evidence-based medicine.

‘Care and Prevent’: rationale for investigating skin and soft tissue infections and AA amyloidosis among people who inject drugs in London

BackgroundSkin and soft tissue infections (SSTIs) are a leading cause of morbidity and mortality among people who inject drugs (PWID). International data indicate up to one third of PWID have experienced an SSTI within the past month. Complications include sepsis, endocarditis and amyloid A (AA) amyloidosis. AA amyloidosis is a serious sequela of chronic SSTI among PWID. Though there is a paucity of literature reporting on AA amyloidosis among PWID, what has been published suggests there is likely a causal relationship between AA amyloidosis and injecting-related SSTI. If left untreated, AA amyloidosis can lead to renal failure; premature mortality among diagnosed PWID is high. Early intervention may reverse disease. Despite the high societal and individual burden of SSTI among PWID, empirical evidence on the barriers and facilitators to injecting-related SSTI prevention and care or the feasibility and acceptability of AA amyloidosis screening and treatment referral are limited. This study aims to fill these gaps and assess the prevalence of AA amyloidosis among PWID.MethodsCare and Prevent is a UK National Institute for Health Research-funded mixed-methods study. In five phases (P1–P5), we aim to assess the evidence for AA amyloidosis among PWID (P1); assess the feasibility of AA amyloidosis screening, diagnostic and treatment referral among PWID in London (P2); investigate the barriers and facilitators to AA amyloidosis care (P3); explore SSTI protection and risk (P4); and co-create harm reduction resources with the affected community (P5). This paper describes the conceptual framework, methodological design and proposed analysis for the mixed-methods multi-phase study.ResultsWe are implementing the Care and Prevent protocol in London. The systematic review component of the study has been completed and published. Care and Prevent will generate an estimate of AA amyloidosis prevalence among community recruited PWID in London, with implications for the development of screening recommendations and intervention implementation. We aim to recruit 400 PWID from drug treatment services in London, UK.ConclusionsCare and Prevent is the first study to assess screening feasibility and the prevalence of positive proteinuria, as a marker for AA amyloidosis, among PWID accessing drug treatment services. AA amyloidosis is a serious, yet under-recognised condition for which early intervention is available but not employed.

Doping in Gymnasiums in Amman: The other side of Prescription and Nonprescription Drug Abuse

This study investigated the abuse of over-the-counter (OTC) products (e.g. proteins, dietary supplements) and prescription drugs (e.g. hormones) in gymnasiums in Amman by random distribution of a structured questionnaire to 375 gym clients (November 2012–February 2013). Data were analyzed using SPSS for Windows (version 17.0). A total of 31 (8.8%) clients admitted to using 21 products (mentioned 71 times) of anabolic steroids and other hormones (e.g., growth hormone and thyroxine) to increase muscular power at the gym or build muscle mass. Abuse of different prescription and OTC drugs among gymnasium clients is present in Jordan, but current methods for controlling the problem are ineffective. Better methods should be developed. The studys limitations are noted.