Treatment complete?

Dr Steve Brinksman writes the regular “Post-its from Practice” articles for Drink & Drugs News (DDN) Magazine. The most recent Post-it (Nov-2014) appears below with kind permission from DDN.

There is yet a lot of – sometimes heated – debate about whether drug services should be recovery or harm reduction based and some people seem determined to pursue this as a doctrine of dichotomy rather than as part of the same spectrum. Yet I rarely hear the same passion when we talk about treating viral hepatitis. Services will talk about high levels of BBV screening and uptake of hepatitis B vaccination and yet have tiny numbers of service users going into hepatitis C treatment. Now I admit that I am biased – a good friend and colleague, who did more than anyone else to show me how important it was to treat drug users, died of hepatocellular carcinoma, caused by his hepatitis C. To my mind the failure to get people into treatment that will not only potentially save their lives but also save large amounts of NHS funding, is a travesty.

We have effective and ever improving curative treatments and yet many people languish in primary care and community based services knowing they have chronic hepatitis, without referral or with high “DNA” rates for those who do get a referral. Perhaps we should stop talking about hard to reach patients and start accepting that we have hard to access treatment services instead.

We need to acknowledge that the current provision of BBV care for those who are in drug treatment is failing. And if we can’t get those who are being seen regularly and supported by clinicians and key workers into treatment for their viral hepatitis then what hope of treatment is there for those who aren’t on substitute prescribing and who are not in established treatment?

Treating people who inject drugs has been shown to be effective and reducing the pool of people with chronic infection can help lessen the spread. We need to create systems to support people into and through treatment and these are the sorts of outcomes that should appear in primary care and community based drug treatment tender specifications. Public Health, Primary and Secondary care all working together – perhaps we could call it something radical like a National Health Service! – to design a service that delivers effective, evidence based treatment that saves lives, reduces disability and saves money.

At the SMMGP conference in Birmingham during October we heard about a pilot project in Birmingham where the specialist hospital staff will be going out into primary care and delivering treatment alongside service users’ regular reviews and key working sessions. I know similar services exist in Newcastle, Nottingham and London.

The newer anti-viral treatments are producing cure rates of over 90% even in the more difficult to treat genotypes of hepatitis C. Even newer treatments promise “tablet-only” therapies that will minimise many of the side effects and adverse events seen in current treatment, albeit at greater financial cost but yet these will still be cost effective interventions. The only way we can advocate for these treatments to be available for our service users is to have the right systems in place to make sure that they are screened, referred and supported through treatment. The health gains for someone who has successful viral hepatitis treatment are immense and at least as important as them being “discharged treatment complete”.

– Dr Steve Brinksman
Birmingham GP, SMMGP Clinical Director, RCGP Regional Lead in Substance Misuse for the West Midlands

Note: Previous Post-its from Practice can be found in the Resource Library on the main SMMGP web site.