Community responses to acute drug harm

Communities can proactively set up a response group that coordinates any actions relating to acute drug incidents. This group can work with stakeholders and the media to reduce any further harm and get people the support they need.

Keep this group small so they can be agile and make sure members are authorised to publicly comment on behalf of their organisations.

The response group should reach out to all relevant stakeholders to identify what is and isn’t known about the drug incidents. For example, what the substance is, what it looks like, what populations are affected, and relevant harm reduction advice.

If possible, the group should arrange to get the substance tested by The Institute of Environmental Science and Research (ESR) through the Police or emergency department.

The effects, harm and withdrawal from different drugs can be extremely varied, particularly new psychoactive substances. So tailored public health key messages should be distributed to target populations as soon as possible to prevent further harm.

This information might include what the substance is, where it was found, harm reduction information, what to do in an emergency and where to get help.

Get the information out as soon as possible. The messaging might not be perfect, but it can be refined as you go. Make sure you ‘sense check’ these messages with relevant agencies so they are relevant and understood by the target population.

Here is an example from the synthetic cannabinoids crisis.

 Possible communication avenues include:

• Joint media release
• Sending out a public alert via social media
• Reaching out to identified key agencies and at-risks groups with tailored harm reduction advice and tools. 

Download the full public health messaging and interventions guide.

Identify what health and social services need to know and do to respond effectively. This might include:

• Providing psychosocial and transitional care in emergency departments, particularly if people are at-risk of using hazardous drugs again
• Pooling resources to establish outreach teams that can deal with complex needs. Think about what skillsets and relationships are required to engage with the people most affected
• Setting up rapid referral pathways so ambulance, police and emergency departments can quickly learn what works and respond well to acute incidents. This will help make sure everyone has quick access to the right support and minimise the burden on emergency services.

Harm reduction plays a critical role in responding to acute drug incidents. Communities must be proactive and pragmatic about building these practices into their response. Examples include:

• Training up frontline staff in screening, brief intervention and how to give tailored harm reduction advice
• CPR training for friends and whānau
• Adapting existing harm reduction services, like drug checking or Needle Exchange, to account for new and emerging drug trends
• Providing advice for people using drugs on how to taper their dose over time.

Hazardous drug use can be connected to wider factors going on in someone’s life. We need to change the system so people can get the help they need. This means reducing barriers and transforming treatment and service delivery.

Provide wraparound support

Wraparound care can work with clients where they’re at and if they are in crisis. They can provide the range of support needed, and work with clients on what is most important to them at the time. This can include addiction treatment, mental health, housing and/or employment support, and peer support.

Provide low threshold services

Low threshold services (or one-stop-shops) are open to anyone who requests support, with no entry criteria. Any door is the right door. These services can immediately work with clients in some capacity with no expectations of continued engagement.

These services can provide immediate relief from crisis and facilitate people getting longer-term help.

Adapt detox services for different substances

Detoxification services help people get through the effects of drug withdrawal. Social detox will work for some people. But others using large amounts of certain drugs require medical assistance.

Detox services need to adapt for different drugs. For example, most social detox programmes are only 5-7 days to cater for alcohol or opioid use. But the peak of synthetic cannabinoids withdrawal is 4-7 days, symptoms can last up to 2 to 3 weeks, and there is a very strong desire to use again.

Download the Matua Raki Substance withdrawal management guidelines.

Build the workforce

Thread peer support through all services

Peer support can engage people much earlier in their recovery journey and provide expert advice on how services need to adapt to cater to these vulnerable populations.

Provide substance-specific training to frontline staff

The effects, harm and withdrawal from different drugs can be extremely varied, particularly new psychoactive substances. But knowledge gaps shouldn’t be a barrier for effective responses.

Make use of the free ‘Addictions 101’ training offered by Matua Raki. But others will need more specialised knowledge. For example, paramedics and ED staff will need to know substance specific clinical best practice on how to stabilise, treat and refer someone to get further support.

A number of providers could help develop and provide training:

• Matua Raki
• NZ Drug Foundation
• Local alcohol and other drug services
• Acute drug harm community of practice.

Provide appropriate housing solutions

The right housing can make all the different for people facing acute drug harm. When someone who doesn’t have a home is given one, they are able to focus on more than mere survival.

Advocate for laws to be based on public health principles

Criminalising drug use doesn’t stop acute drug harm. To make sure the law isn’t a barrier for people getting help, we need to make sure we have a supportive legislative framework in place.