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HOT TOPIC 2020 HTM file
‘Dignity first’: improving the lives of homeless people who drink and take drugs
One of our hot topics offering background and analysis on important issues which sometimes generate heated debate. Putting people with experiences of homelessness and substance use problems at the centre of social policy, this hot topic asks what solutions would look like if they prioritised saving lives and improving lives.
Strong evidence from two US cities that moving from a blanket prohibition on possession of equipment for injecting illegal drugs to providing this equipment via legal needle and syringe programmes prevented thousands of HIV infections, resulting in large savings in the treatment of these infections.
The UK has a long history of prescribing heroin for the treatment of heroin dependence. What has research from six countries concluded about this intensive intervention intended for patients who would otherwise be considered ‘unresponsive’ to treatment?
For prison populations with multiple risk factors for acquiring hepatitis C, can a peer-supported screening programme improve the uptake of testing and treatment?
How can testing and treatment for hepatitis C be optimised in custodial settings? Prisons in the North East of England trialled new care pathways including a universal offer of testing using less invasive procedures and treatment facilitated by digital technology.
REVIEW 2019 HTM file
Supervised consumption sites: a nuanced assessment of the causal evidence
How high should the evidence bar be set when deciding whether to endorse drug consumption rooms?
Has enough high-quality evidence accumulated over the past five years to improve confidence in the effectiveness of residential treatment?
DOCUMENT 1987 HTM file
High time for harm reduction
Impelled by the injecting-related AIDS crisis, Merseyside was where harm reduction in the UK first took root. From there in 1987 came this groundbreaking call for a turn away from what was seen as a failed attempt to prevent use to mitigating the harm. Expressed modestly as a “prudent” suggestion, with Russell Newcombe’s essay, “harm reduction” had come of age.
At issue was whether by successfully referring heroin users to treatment, probation services in England would protect them from fatal overdose and prevent drug-related crime. Yes to one, but not the other, were the answers; in fact, crime went up.
What would happen to rates of infection with hepatitis C if we closed down all the needle exchanges? In three UK municipalities, the answers were predicted to be more infections, lost low-cost opportunities to improve and save lives, and in two of the areas, greater health-related costs overall. Conclusion was that these services are among the best investments UK health services can make. town
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