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BackgroundIn July 2022 the Health and Care Act 2022 introduced a requirement that regulated service providers ensure their staff receive training on learning disability and autism, appropriate to the individual’s role. This was the result of campaigning by the parents of Oliver McGowan following his untimely death (https://www.olivermcgowan.org/). Tier 1 training comprises e-learning (e-lfh,2022) followed by a 1 hour online interactive session with facilitators with learning disability and autism diagnoses.AimTo facilitate the delivery of the interactive (face-to-face) element of the Tier 1 mandatory training to circa 38,000 health and social care staff across South Yorkshire in three years.MethodUtilise the novel ECHO methodology to facilitate one-hour Oliver McGowan interactive sessions either via Zoom or MS Teams. Specifically trained ‘trios’ of facilitators (one with a learning disability; one with autism, and, a specially training facilitator) will be joined by an ECHO administrator to deliver nationally agreed content to groups of 30 staff per session. Answers to pre-submitted questions will be prepared and delivered during ECHO sessions. Healthcare staff are to book their interactive session within a fixed time frame (to be laid out in the ‘code of practice’ when published later in 2023) once the e-learning is completed. To manage bookings and report training activity at scale a Customer Relations Management (CRM) system is in implementation. Information sharing between the employing organisations and the CRM will be essential to ensure eligibility to attend the ECHO session.ResultsNo results are available as yet as delivery is anticipated to start in the middle of May 2023.ConclusionThrough the use of pre and post session questionnaires we hope to show increased knowledge and understanding around learning disabilities and autism and how accurate information sharing will ensure timely booking and attendance at an interactive ECHO session for those who are required to attend.

Methadone is an effective treatment for opioid dependence. When people who are receiving methadone maintenance treatment for opioid dependence are incarcerated in prison or jail, most US correctional facilities discontinue their methadone treatment, either gradually, or more often, abruptly. This discontinuation can cause uncomfortable symptoms of withdrawal and renders prisoners susceptible to relapse and overdose on release. We aimed to study the effect of forced withdrawal from methadone upon incarceration on individuals' risk behaviours and engagement with post-release treatment programmes. In this randomised, open-label trial, we randomly assigned (1:1) inmates of the Rhode Island Department of Corrections (RI, USA) who were enrolled in a methadone maintenance-treatment programme in the community at the time of arrest and wanted to remain on methadone treatment during incarceration and on release, to either continuation of their methadone treatment or to usual care—forced tapered withdrawal from methadone. Participants could be included in the study only if their incarceration would be more than 1 week but less than 6 months. We did the random assignments with a computer-generated random permutation, and urn randomisation procedures to stratify participants by sex and race. Participants in the continued-methadone group were maintained on their methadone dose at the time of their incarceration (with dose adjustments as clinically indicated). Patients in the forced-withdrawal group followed the institution's standard withdrawal protocol of receiving methadone for 1 week at the dose at the time of their incarceration, then a tapered withdrawal regimen (for those on a starting dose >100 mg, the dose was reduced by 5 mg per day to 100 mg, then reduced by 3 mg per day to 0 mg; for those on a starting dose >100 mg, the dose was reduced by 3 mg per day to 0 mg). The main outcomes were engagement with a methadone maintenance-treatment clinic after release from incarceration and time to engagement with methadone maintenance treatment, by intention-to-treat and as-treated analyses, which we established in a follow-up interview with the participants at 1 month after their release from incarceration. Our study paid for 10 weeks of methadone treatment after release if participants needed financial help. This trial is registered with ClinicalTrials.gov, number NCT01874964. Between June 14, 2011, and April 3, 2013, we randomly assigned 283 prisoners to our study, 142 to continued methadone treatment, and 141 to forced withdrawal from methadone. Of these, 60 were excluded because they did not fit the eligibility criteria, leaving 114 in the continued-methadone group and 109 in the forced-withdrawal group (usual care). Participants assigned to continued methadone were more than twice as likely than forced-withdrawal participants to return to a community methadone clinic within 1 month of release (106 [96%] of 110 in the continued-methadone group compared with 68 [78%] of 87 in the forced-withdrawal group; adjusted hazard ratio [HR] 2·04, 95% CI 1·48–2·80). We noted no differences in serious adverse events between groups. For the continued-methadone and forced-withdrawal groups, the number of deaths were one and zero, non-fatal overdoses were one and two, admissions to hospital were one and four; and emergency-room visits were 11 and 16, respectively. Although our study had several limitations—eg, it only included participants incarcerated for fewer than 6 months, we showed that forced withdrawal from methadone on incarceration reduced the likelihood of prisoners re-engaging in methadone maintenance after their release. Continuation of methadone maintenance during incarceration could contribute to greater treatment engagement after release, which could in turn reduce the risk of death from overdose and risk behaviours. National Institute on Drug Abuse and the Lifespan/Tufts/Brown Center for AIDS Research from the National Institutes of Health.

BackgroundA Clinical Oncology department at a University hospital is the first new oncology department in Upper Egypt since 1970. The hospital provides oncology services for up to 3000 new and existing patients per year. Through connections with the Global Cancer Care Egypt-UK charity, a six-bedded palliative care unit has been established within the hospital.AimTo establish and deliver a palliative care/end of life training programme for the medical/nursing staff of the new palliative care unit led by the St Luke’s Hospice team. The training will target 15 clinical staff including junior and intermediate grade oncology doctors and also include senior nurses who can pass on the training to junior nurses. MethodECHO methodology has shown how palliative care knowledge can improve patient care through virtual delivery to those in hard to reach locations (White, McIlfatrick, Dunwoody, et al. BMJ Support Palliat Care. 2019;9:202–208; Manson, Gardiner, Taylor, et al. BMJ Support Palliat Care. Published online: 24 February 2021). A learning needs questionnaire was developed and completed by the Egyptian team to establish the learning priorities for the unit staff. Utilising ECHO, a rolling programme of six ECHO sessions has been designed to be delivered via zoom to the team in Egypt. The six sessions are: (1) Recognising dying. (2) Communication on dying/challenging conversations/breaking bad news. (3) Supporting physical care at end of life. (4) Nausea/vomiting/bowel obstruction (including pharmacological considerations). (5) Palliative care emergencies. (6) Pain management (including pharmacological considerations).Pre and post programme self-efficacy confidence and competence evaluation questionnaires will be completed to measure learning and establish future needs.ResultsNo results available as yet as anticipated start of delivery is early June 2023.ConclusionWe hope to show increased knowledge of palliative and end of life care in the oncology team following attendance at the six ECHO sessions. Should the evaluation show a positive outcome the expectation is that the programme may be repeated annually.

Objectives Unpredictable fluctuations in the illicit drug market increase overdose risk. Drug checking, or the use of technology to provide insight into the contents of illicit drug products, is an overdose prevention strategy with an emerging evidence base. The use of portable spectrometry devices to provide point-of-service analysis of the contents of illicit drugs been adopted by harm reduction organizations internationally but is only emerging in the United States. This study aimed to identify barriers and facilitators of implementing drug checking services with spectrometry devices in an urban harm reduction organization and syringe service program serving economically marginalized people who use drugs in Boston, Massachusetts (USA). Methods In-vivo observations and semi-structured interviews with harm reduction staff and participants were conducted between March 2019 and December 2020. We used the consolidated framework for implementation research to identify implementation barriers and facilitators. Results This implementation effort was facilitated by the organization’s shared culture of harm reduction—which fostered shared implementation goals and beliefs about the intervention among staff persons—its horizontal organizational structure, strong identification with the organization among staff, and strong relationships with external funders. Barriers to implementation included the technological complexity of the advanced spectroscopy devices utilized for drug checking. Program staff indicated that commercially available spectroscopy devices are powerful but not always well-suited for drug checking efforts, describing their technological capacities as “the Bronze Age of Drug Checking.” Other significant barriers include the legal ambiguity of drug checking services, disruptive and oppositional police activity, and the responses and programmatic changes demanded by the COVID-19 pandemic. Conclusions For harm reduction organizations to be successful in efforts to implement and scale drug checking services, these critical barriers—especially regressive policing policies and prohibitive costs—need to be addressed. Future research on the impact of policy changes to reduce the criminalization of substance use or to provide explicit legal frameworks for the provision of this and other harm reduction services may be merited.

To the Editor: We applaud the article by Okie (Nov. 18 issue) 1 on the increasing number of overdose deaths, since we have seen far too many patients die prematurely of opioid overdoses. One topic was missing from this article: the usefulness of providing access to naloxone to be administered by laypersons to prevent death from an opioid overdose. Several studies involving illicit-drug users have confirmed that training laypeople to recognize and respond appropriately to an overdose situation is feasible, safe, and effective. 2 – 4 Thousands of lives have been saved with either intramuscular injection or intranasal spray of naloxone. 5 If it . . .

Safe consumption spaces (SCS) are evidence-based interventions that reduce drug-related morbidity and mortality operating in many countries. However, SCS are yet to be widely implemented in the USA despite the escalating overdose epidemic. The aim of this multi-city study was to identify the factors associated with willingness to use a SCS among people who use drugs (PWUD) in Baltimore, Providence, and Boston, stratified by injection drug use status. Our secondary aim was to characterize the anticipated barriers to accessing SCS if they were to be implemented in these cities. PWUD were invited to complete a cross-sectional survey in 2017. The analysis was restricted to 326 opioid users (i.e., heroin, fentanyl, and non-medical opioid pill use). The majority (77%) of participants expressed willingness to use a SCS (Baltimore, 78%; Providence, 68%; Boston. 84%). Most respondents were male (59%), older than 35 years (76%), non-white (64%), relied on public/semi-public settings to inject (60%), had a history of overdose (64%), and recently suspected fentanyl contamination of their drugs (73%). A quarter (26%) preferred drugs containing fentanyl. Among injectors, female gender, racial minority status, suspicion of drugs containing fentanyl, and drug use in public/semi-public settings were associated with higher willingness to use a SCS; prior arrest was associated with lower willingness. Among non-injectors, racial minority status, preference for fentanyl, and drug use in public/semi-public settings were associated with higher willingness, whereas recent overdose held a negative association. The most commonly anticipated barriers to accessing a SCS in the future were concerns around arrest (38%), privacy (34%), confidentiality/trust/safety (25%), and cost/time/transportation (16%). These data provide evidence of high SCS acceptability among high-risk PWUD in the USA, including those who prefer street fentanyl. As SCS are implemented in the USA, targeted engagement efforts may be required to reach individuals exposed to the criminal justice system.

Literature searches were performed, many existing tools were considered. The facilitator from the mental health trust shared her work with the acute trust and concluded working together on one tool would be an efficient approach and aid cross agency working. Following on from project work across Doncaster, personnel from primary and social care joined the collaboration to produce CCAST (Care and Clinical skills ASsessment Tool) suitable for use by all health and social care settings across the Doncaster footprint with the first meeting of all agencies in November 2017.ResultsPreliminary data from the roll out across the Mental Health Trust suggested an increased compliance with competence assessment and positive feedback regarding the ease of use of the tool. Following this pilot, changes were made in collaboration with all agencies.DiscussionThe pilot results revealed themes such as increased flexibility due to a broader scoring system; reduced subjectivity on the part of the assessor and the tool clearly shows achieved competence and areas for further growthRecommendationTo implement CCAST across the Doncaster locality gathering data from the start. User feedback will be obtained via 1:1 interviews using purposive sampling of the assessments performed across all care settings.Findings will be reported at conference.Formal publication of this project work showing how one tool can be developed to be suitable for use in the assessment of competence in any skill in any health and social care setting enabling movement of staff between organisations with the assurance of level of competence and, demonstrating the benefits of joined working – ‘Maximising Impact’.ReferencesDreyfus& Dreyfus Model discussed by Benner P. From novice to expert: Excellence and power in clinical nursing practice 1984. Addison Wesley.Pendleton D, Schofield T, Tate P, Havelock P. The consultation: An approach to learning and teaching1982. Oxford: Oxford University Press: 68–72.

Amid the increase in fatal overdoses in Rhode Island (RI) over the past decade, understanding substance use and harm reduction practices is critical for informing prevention strategies. This work aimed to evaluate trends in substance use behaviors, overdose experiences, and harm reduction practices among people who use non-prescribed substances in RI. In a convenience sample of 673 participants from the 2021-2024 Harm Reduction Surveillance System (HRSS), the most reported substances used in the past 30 days were: alcohol (73%), crack cocaine (72%), cannabis (69%), cocaine (42%), and fentanyl/heroin (39%). We observed a decrease in harm reduction practices in 2024, including always using fentanyl test strips and always using substances in the presence of others after an increase from 2021 to 2023. Notably, 86% of respondents reported having a disability. These findings emphasize the ongoing need for comprehensive harm reduction programs to engage high-risk individuals, tailored to those with disabilities.

Amid the increase in fatal overdoses in Rhode Island (RI) over the past decade, understanding substance use and harm reduction practices is critical for informing prevention strategies. This work aimed to evaluate trends in substance use behaviors, overdose experiences, and harm reduction practices among people who use non-prescribed substances in RI. In a convenience sample of 673 participants from the 2021-2024 Harm Reduction Surveillance System (HRSS), the most reported substances used in the past 30 days were: alcohol (73%), crack cocaine (72%), cannabis (69%), cocaine (42%), and fentanyl/heroin (39%). We observed a decrease in harm reduction practices in 2024, including always using fentanyl test strips and always using substances in the presence of others after an increase from 2021 to 2023. Notably, 86% of respondents reported having a disability. These findings emphasize the ongoing need for comprehensive harm reduction programs to engage high-risk individuals, tailored to those with disabilities.