Shared learning database

The Cambridge Centre
Published date:
March 2014

The Cambridge Centre has a twenty five year history of providing high quality drug, alcohol and criminal justice services to the community within North Yorkshire. The Cambridge Centre have seen an increase in image and performance enhancing drugs (IPED) service user activity within the centre-based needle and syringe exchange programme (NSP) in Scarborough. We currently estimate that IPED activity represents 13% - 19% locally. Jim McVeigh from the Centre for Public Health at Liverpool John Moore's University said: "Injectors of anabolic steroids and associated drugs are now the biggest client group at many needle and syringe programmes in the UK" (Gov.UK PHE-2013).

The work undertaken by The Cambridge Centre demonstrates how NICE PH52 Recommendation 10: Provide equipment and advice to people who inject image- and performance-enhancing drugs, can be implemented in a local setting.

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

The Cambridge Centre hoped to facilitate a scheme of peer led NSP in a gym environment that was familiar and comfortable to IPED injectors.
We aimed to;
- Provide IPED injectors with clean injecting paraphernalia
- Engage IPED injectors in a gym environment through provision of peer exchange NSP
- Reduce the spread of blood borne virus's (BBV) within the community
- Provide harm reduction interventions to IPED injectors
- Facilitate a weekly Cambridge Centre gym clinic for interventions such as BBV screening and safer injecting techniques.

Reasons for implementing your project

Through research on IPED forums and blog sites and through anecdotal feedback from IPED service users and local gym owners we were able to establish that IPED injectors were ordering online paraphernalia and/or engaging in secondary distribution whereby service users were acquiring large amounts of paraphernalia to then distribute on to other injectors. The rationale disclosed by IPED service users for not accessing NSP directly includes; stigma, negative perceptions of drug services, apathy, ignorance, and concerns around confidentiality.

The Cambridge Centre have previously targeted this client group through developing relationships with Gym owners, the provision of sharps disposal, the provision of training, and through specific promotional and marketing strategies. Despite this approach gym owners mainly denied any IPED issues within their businesses with only one gym allowing sharps disposal support to be provided by the NSP.

Whilst the NSP was able to target the IPED injectors that were known The Cambridge Centre were aware that there was a significant and growing number of IPED injectors outside of treatment.

The consequences of this situation meant a potential increase in; injecting related injuries, blood borne virus transmission rates, poor injecting practice, harmful initiation of new injectors, and vitally a dangerous lack of knowledge and appropriate harm reduction messages about performance enhancing drugs.

Secondary issues that should be highlighted are that a lack of knowledge around IPEDs amongst drug and alcohol workers can translate into lack of confidence working with IPED injectors therefore opportunities to engage with this client group and build trusting relationships can be limited.

How did you implement the project

Thanks to the commitment of our dedicated team and an open minded local gym owner we managed to develop opportunities with one of the local Gyms. From the initial collection of used sharps to promoting our mobile NSP this inevitably led to conversations with the owner about Steroid use within the Gym.

The main obstacle to any dialogue around potential provision of NSP within a Gym environment was that there was no local or national precedent. Through local discussion and with key national partners including The Bridge Project and Exchange Supplies it was agreed that we needed to approach this in two distinct ways;

- Set up a peer exchange scheme within the gym
- Facilitate a Cambridge Centre worker-led 'gym clinic' to provide the more sophisticated interventions such as BBV (Blood Borne Virus) testing and educated harm reduction IPED information.
Instigating a peer exchange scheme highlighted several issues around competence, training, recording and paperwork. The Cambridge Centre has facilitated peer exchange in the past to IDUs (injecting drug users) however it was clear that extra training for staff and peer's needed to be arranged specifically for PIED. Nick Wilson (Exchange Supplies) identified Joe Kean a dedicated IPED trainer from the Bridge Project Bradford, Joe proved to be an invaluable partner in developing this project.

Approximately twenty five staff from both The Cambridge Centre and the local gym attended comprehensive training on IPEDs, delivered by Joe. This enabled us to identify gaps in knowledge and practice and up skill all who attended, whilst also establishing a relationship with the gym staff and supporting them throughout. The relationship with the gym was further enhanced by The Cambridge Centre team manager and dedicated IPED workers visiting the gym to liaise with gym staff building confidence and trust whilst establishing professional respect.

Key findings

Bespoke paperwork for recording NSP activity and initial assessment for those presenting for NSP for the first time at the Gym had to be developed. Essentially this had to be both concise and meaningful whilst being user friendly and free of jargon, the most difficult task was to separate vital information required on assessment from the less appropriate information requested from peers: For example it was felt that issues around safeguarding/criminal justice should not be assessed by peers on this scheme.

Initially one of the most challenging parts of instigating a peer exchange scheme within a gym environment was to identify who exactly the peers would be, this seemed to lean naturally to the gym owner and a member of his staff who had expressed a desire to be involved from the start, all that was needed further was to establish competence in facilitation through training and ongoing supervision.

The 'Gym clinic' and what interventions should be offered (and when) was the next issue to be addressed. The Gym owner made a generous offer to allow The Cambridge Centre's mobile needle exchange worker to use facilities at the Gym whenever it was felt needed, this would foster a working relationship with not only the staff but clients at the Gym itself. The clinic would take place weekly in situ with the mobile needle exchange worker being the main contact between the staff and the Cambridge Centre, the project is supported further by ongoing weekly supervision from the worker and in turn their line management.

It was decided that the 'gym clinic worker'could offer interventions specifically around;
- BBV dry blood spot screening for HIV/AIDS HCV/HBV.
- Safer injecting work, site rotation, appropriate site injection and paraphernalia used.
- Harm reduction advice.
- Referral into wound care services at The Cambridge Centre.
- Referral into Sexual health services at The Cambridge Centre and distribution of condoms.

The story so far is that the gym peer exchange scheme has been running for several weeks and we have seen an uptake in NSP from a hard to engage client group. The peer led NSP has distributed 60 syringes and needle ends along with other harm reduction paraphernalia and has completed two new initial assessments for NSP, one of which was a female (to my knowledge we have never seen a female IPED injector in Centre-based exchange).

Key learning points

In conclusion, The Cambridge Centre has sought to engage IPED users in their own environment through an innovative way of facilitating NSP. Nationally we have seen an increase in IPED injectors and reluctance on their part to engage in the more traditional forms of drug services in particular centre based needle exchange.

In response to this The Cambridge Centre continues to look at innovative ways to deliver harm reduction interventions to the individual and the community as a whole. We are keen to share our experiences around the instigation of this scheme and would recommend any service seeking to engage IPED injectors through peer led gym NSP take away these key points from our experience;
- The relationship between services and the gym owner are fundamental to initiating a peer led scheme
- Seek the owners input and advice from the start , involve them in the decision making process
- Assess levels of competence and need for training in gym staff early on, offer and facilitate training
- Once the scheme is up and running support the gym owner/peers throughout
- Identify which interventions need to be delivered by professionals and which interventions can be delivered by peers
- Assess your own staff's knowledge of IPEDs and identify training needs
- Identify what other services locally and nationally are delivering and contact them for advice/support/information, work collaboratively.

Contact details

Chris Long
Engagement Team Manager
The Cambridge Centre

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