Sector News

  1. Challenges faced by Peer Helpers

    Background

    • The role of peer helpers came out of a need to address the limitations of the traditional “provider-client model.”
    • Mediators or Peer Helpers act as both secondary distribution agents and advocates. They have become a valuable component of the most successful strategies aimed at injection drug using communities as they bring the reality of the lives of marginalized populations into strategic discussions.
    • This study aimed to explore the difficult situations peer helpers may find themselves in when they attempt to implement harm reduction practices and balance potential serious health problems and even death against anticipated backlash from users, medical staff, and the community.

    Approach

    A series of focus group sessions were conducted with peer helpers over a two-year time frame in Cape Breton, Canada.

    Findings/Key Themes

    Officially sanctioned peer helper practices

    • Overall, few moral dilemmas arose with the official distribution part of the peer helper role unless there was a shortage of supply.
    • Peer helpers viewed education of new users as a very important part of their harm reduction role. They felt that the hidden nature of injecting left them responsible for “how to” training.
    • Contrary to public discourse, peer helpers attempt to dissuade individuals from taking that first hit. However, they were exposed to threats from others such as neighbours and child protection workers because of how their role is perceived by the general public.
    • Peer helpers can be credited with the high rates of safe needle disposal. They play a key role in developing and reinforcing return practices.

    Unofficial peer helper practices

    • Given that peer helpers are viewed as authorities on safe injection within their community, one of the first ways they can be drawn into an unofficial role is through requests for assistance.
    • The imminent threat of death from overdose is on the top of the minds of peer helpers, not the threat of blood-borne pathogens.
    • Peer helpers are the ones who typically step in to deal with overdose and will usually make the call to emergency services despite repercussions from health professionals and police as well as the users themselves. As a result, peer helpers find themselves caught in the middle of competing courses of action – do they call the police or not?
    • Due to users’ hesitation to seek medical treatment, peer helpers find themselves treating wounds and abscesses. Some helpers find themselves saving and sharing antibiotics (even though they know it’s problematic) to help those who refuse to seek medical attention.
    • Many peer helpers also take on the role of counselor
    • Peer helpers lived experience enables them to empathize with those struggling with addiction – “they almost never give up on people.” They let people who were homeless come to their homes for food, a shower and a night’s sleep.

    Conclusion

    Peer helpers find themselves in difficult situations with user populations often because people who inject drugs feel undeserving of services and discriminated against when they do seek services. This adversely impacts users, and particularly the peer helpers seeking to assist them. In an effort to keep users alive, peer helpers engage in practices that extend far beyond their roles of disseminating sterile syringes and safe injection materials.

    Dechman, M.K. (2015). Peer helpers’ struggles to care for “others” who inject drugs. International Journal of Drug Policy. Vol. 26. Pp. 492-500.

  2. Posted in:

    Exploring Methods and Treatment for Hepatitis C virus in People Who Inject Drugs

    Background

    Population size is a key factor in modeling of cost-effectiveness analysis and resource allocation, yet there is no gold standard method of estimating the size of “hidden” populations such as people who inject drugs (PWID) and there is no ideal method for all drugs and settings. Chronic hepatitis C virus (HCV) infection is high (approximately 50%) in current PWID. Due to the development of effective treatment for hepatitis C virus (HCV) there is growing interest to understand how increased treatment uptake will impact the burden of HCV.

    Findings:

    • Direct methods use data from general population surveys asking people about their drug use.
    • Advantages: accurately estimates prevalence when the population is representative and people honestly disclose drug use.
    • Disadvantages: 1) relies on household surveys so excludes people who are homeless or in unstable housing; 2) if contacted, PWID may be reluctant to disclose injection drug use.
    • Indirect methods involves adjustment of prevalence data from known, non- random samples such as drug treatment agencies, harm reduction services, and criminal justice agencies.
    • Advantages: uses data from multiple sources.
    • Disadvantages: linked data sources can introduce biases that are difficult to disentangle (such as cross-references between criminal and health data sources).
    • In England, approximately 85% of HCV occurs in current or former PWID. This was estimated through indirect methods and has resulted uncertainty in the number of PWID carrying HCV antibodies. Separating out different populations of PWID is complex, but it is critical for prevention and prioritization of treatment.
    • In order to assess transmission of HCV, it is important to define current/recent PWID from former PWID. However, this is difficult due to the relapsing nature of drug dependence it is difficult to determine a cutoff for permanent vs. short term quitting of injection drug use.
    • Assessing HCV prevalence overtime needs to sample PWID from multiple sites such as community, needle exchange and specialist drug treatment.

    Role of OST, NST and Prisons in Prevention of HCV

    • HCV incidence is decreased in PWID in opiate substitution treatment. HCV testing and notification is increased. OST clinics provide an opportunity to give HCV care and treatment.
    • Needle syringe programs also reduce HCV incidence, especially in combination with OST.
    • In order to assess impact of interventions on HCV transmission and prevalence, it is key to have information on the coverage and duration of time PWID are in OST and NSP.
    • Approximately, 41% of current PWID populations in Australia spend time in OST and 12% in prison. The high HCV incidence of HCV in prisons and high rates transitioning between prisons and communities is also important in designing HCV treatment as prevention and estimating population size and effects.

    Conclusion

    In order to develop appropriate public health policy and services to people who inject drugs (PWID), the ability to estimate current and former PWID populations is vital for both HCV treatment and prevention in new and existing measures such as opioid substitution treatment and needle and syringe programs. Improving epidemiological data on people who inject drugs is key for increasing the effectiveness of future interventions

    Larney., L., Grebely, J., Hickman, M., De Angelis, D., Dore, G.J., and Degenhardt, L. (2015). Defining populations and injecting parameters among people who inject drugs: Implications for the assessment of hepatitis C treatment programs. The International Journal of Drug Policy. Vol 26:10. Pp. 950-957.