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What is the Drug Liaison Service?

This nurse-led community-based resource is available to assist acute service delivery and care to drug users who are at high risk of harm
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Linda Smith describes a Drug Liason (DL) service based in Lothian and what they find that helps.

The DL service was established as a nurse-led community-based resource available to assist acute service delivery and care to drug users who are at high risk of harm. The service would provide a key link between acute and community, ensuring continuity of care and seamless transition to primary care.

What does it do?

The DL service assesses patients who have dependent (daily) or erratic and hazardous drug use, some of whom have not had previous or recent engagement with community treatment services.

Key priority objectives include early access to Opiate Substitution Therapy (OST), retention in treatment to avoid early or self discharge, and identify current and new diagnosis of Hepatitis C virus (HCV) and refer for treatment.

The Drug Liaison Nurses (DLN) role focuses on improving the patient experience and outcomes, commencement of OST where appropriate and discharge management while supporting the patient through this process.

A visit to the acute hospital setting is often unplanned within this patient group. People who inject drugs (PWID) and people who use drugs (PWUD) attend the emergency department for treatment of conditions either directly related to or coincidental to their substance use.

Admission types

reasons for admissions: - Intoxication, overdose or withdrawal - Soft tissue injections - Bacterial infections due to poor hygiene and injecting - Injuries sustained whilst intoxicated

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We aim to improve this patient groups hospital experience. They may have had an unsatisfactory experience in hospital. Within health services stigma often remains a huge issue. Untreated pain and opioid withdrawals contribute to the high rates of discharge against medical advice, which is between 11 to 12% amongst people who use drugs (Fanucchi and Lofwall, 2016).

Intervention

Admission to hospital gives an opportunity for diagnosis, intervention, treatment and care for patients who may have complex, unrecognised or untreated health conditions.

A range of interventions are available, including rapid access to ORT. Our patient group’s initial objective and priority is not to experience any withdrawals.

Therefore if unable to recognise withdrawal symptoms, patients may self discharge, abscond to ‘sort themselves out’. We want to ensure that their drug use is appropriately assessed, and a good history and assessment is taken.

Patient profile

  • PWID-injecting behaviour (frequent or infrequent), location of site used (groin and neck higher risk), drug of choice, frequency of use, tolerance (higher risk when liberated from prison, discharged from hospital, period of abstinence)
  • Non-fatal overdose. In 2019, 1,264 people tragically lost their lives to a drug overdose
  • Chaotic polysubstance misuse including illicit, prescribed medication and/or alcohol
  • Co-morbidity directly/indirectly as a result of drug use (vascular issues, pulmonary, systemic infection, BBV diagnosis)

Interventions available

  • Drug history including BBV testing/status
  • Initiation of Opioid Substitution Therapy in carefully selected patients
  • Advice on management of withdrawal in the hospital setting
  • Liaison with community Substance Misuse Teams
  • Facilitation of early follow-up-assertive outreach follow-up
  • Naloxone training and take-home kits for patients
  • Harm reduction advice and interventions (clean equipment for discharge)
  • Psychosocial interventions

Remember: - Priorities of patients differ from staff - Offer support available whilst inpatient - If going to remain inpatient for period of time, offer meaningful activities - Offer take home naloxone - Offer to attend follow-up appointment - Don't give up

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