Barely six months ago, two-year-old Brandon Davis became the victim of methadone poisoning in a death that shocked the community and made headlines across the nation. The toddler from Walkers Heath, Birmingham died after taking the heroin substitute, which is often dispensed as a sweet green syrup.
The tragedy was the latest in a rising toll of deaths from methadone poisoning. With growing numbers of addicts getting treatment for their addiction, it is hardly surprising that the number of methadone-related deaths has doubled, from 159 in 2004 to well over 300 in 2007.
However, a scheme at an addiction centre in Solihull is working to prevent such tragedies by teaching patients about drug safety and tightening up prescription procedures and health checks. The Bridge substance misuse service was set up two years ago following the deaths of 11 heroin or cocaine addicts between 2004 and 2006 and the death of a child who was thought to have accidentally swallowed methadone.
Masterminded by the centre's addiction psychiatrist, Dr Sanju George, the project — part of the Birmingham & Solihull Mental Health trust — has made a considerable impact on its 400-plus patients, who are all heroin or cocaine addicts. Although one-third are still injecting, thanks to the new emphasis on patient safety, no patient has died in the last 12 months. Furthermore, many have been identified with potentially serious illnesses and received life-saving treatment.
Determined to have no preventable deaths from overdose, George and his team of 19 staff reviewed all systems and policies to see where risks of overdoses could be reduced. The result was a comprehensive redesign of existing systems, improved links with other agencies, and the introduction of new methods of joint working involving users, carers and staff.
Addicts about to embark on treatment programmes now have a single point of contact, Welcome, a drug charity soon to be integrated with the Bridge. Vulnerable patients at higher risk of overdosing, such as injecting drug users, newly released prisoners and people with mental health problems, are fast-tracked into treatment, receiving help within 48 hours of referral.
However, it is perhaps the introduction of education measures that has played a key role in keeping patients and their families safe. Regular one-to-one sessions between doctors and patients highlight the risk of overdose and the safety of medication. Harm-reduction advice is given at informal evening group sessions where users and carers can raise any concerns.
"Safety is our number-one priority," says George. "We talk about the importance of storing medication — in a bottle with a child-resistant cap, in a locked cupboard out of the reach of children. Women patients with children have a dedicated drug worker who goes to the family home and works with social workers. At the same time we are checking prescriptions constantly."
Another change that has had a tangible impact is the introduction of health MOTs. Regular checks are made on the physical health of patients, who may suffer from dental abscesses or blood-borne viruses such as hepatitis and HIV as a result of their addiction. They are also monitored on an ECG machine for heart abnormalities — a sideeffect of taking high doses of methadone. In 30% of cases, abnormalities have been found. "Often the physical health of addicts is not taken seriously by patients or GPs," says George. "These health MOTs have picked up problems."
Drug users have welcomed the new service. "For several people, the reassurance that they are able to do something to make themselves feel good has been highly motivating," George reports. As accidental overdoses can still happen, training in overdose management is given to users, carers and staff. Indeed, 25 high-risk patients, and their carers, have been issued with a naloxone injection — a fast-acting heroin antidote usually given in hospital. They have also been taught to carry out cardiopulmonary resuscitation.
For Colin Bartlett, a user representative for the Bridge and Welcome, the recent changes show patients that staff are willing to "go the extra mile" to avoid preventable deaths. "I cannot imagine the horror of a child dying from an overdose," he says. "My wife and daughter left me as a result of my addiction, and that was bad enough. Here at the Bridge and Welcome, everyone is working to keep people safe."
Service delivery, complex needs award
Sponsor
Care Services Improvement Partnership (CSIP)
WINNER
The Bridge, Birmingham & Solihull Mental Health NHS trust for teaching addicted patients about drug safety, and tightening up prescription procedures and health checks
Runners-up
St Christopher's Hospice for helping the terminally ill to tell their life stories through art
Samaritans for enabling young people in distress to contact them via text messaging
