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ID: HR19-384

Presenting author: Saket Priyadarshi

Presenting author biography:

Saket is the medical director of Glasgow's alcohol and drug services. He chairs the city’s multi-agency Alcohol and Drug Harms Prevention working group and is the clinical lead for the implementation of a Safer Drug Consumption Facility and Heroin Assisted Treatment service in the city.

Learning from an HIV outbreak in Glasgow- the UK's first Safer Injecting Facility is required to reduce harms and address complex needs

Saket Priyadarshi, Emilia Crighton, Mark Rogers, Emily Tweed

Background

During an outbreak of HIV in people who inject drugs in Glasgow, Scotland in 2015, injecting in public places was seen as an important risk factor. We investigated the characteristics and health needs of people involved in this practice, current service provision for them and stakeholder attitudes to new harm reduction interventions such as Safer Injecting Facilities (SIFs) and Heroin Assisted Treatment (HAT).

Methods

We undertook a health needs assessment: analysing local and national data sources; a series of rapid literature reviews; and an engagement exercise with people currently injecting in public places, people in recovery, and staff from relevant health and social services.

Results

There are between 400 and 500 individuals who regularly inject in public places in Glasgow city centre. Most experience a combination of profound social vulnerabilities (complex needs / severe and multiple disadvantages). We describe the characteristics of the at risk population and their circumstances. Priority health needs identified were addictions care; prevention and treatment of blood-borne viruses; other injecting-related infections and injuries; and overdose and drug-related death. Among people with lived experience and staff from relevant services, there was widespread – though not unanimous – support for the introduction of a SIF and HAT service. These were supported to reduce injecting related harms, and, in an integrated system, to help address complex needs.

Conclusions

The environment and context in which drug use occurs is a key determinant of harm, and is clearly linked to multiple social factors. Public injecting therefore requires a multifaceted response- safer spaces to use drugs and appropriate services to address health and complex needs. Understanding the attitudes of key stakeholders gave important insights into local facilitators and barriers. Glasgow now plans to establish the UK’s first drug consumption room (DCR) and the world’s first co-located DCR and HAT service.