Essential Harm Reduction

Posted 4th May 2020 by Dave Cross
The King County COVID-19 quarantine site in Washington, USA, drew many complaints for providing patients with cigarettes, beer and marijuana edibles. Meanwhile, at home, the Sheffield Health and Social Care NHS Foundation Trust has been forced to apologise for allowing patients to smoke in their bedrooms.

A spokeswoman for the King County COVID-19 quarantine site said the facility is a "harm reduction" site for patients with dependency issues who have contracted COVID-19. Defending the policy of providing alcohol, tobacco and cannabis, she said that this prevents patients from absconding back into the community.

Sherry Hamilton said: “While harm reduction is proven practice, it has also been clear from the beginning that public funds may not be used to purchase alcohol, tobacco, or cannabis products, even though those products may be legal for use by persons who are of legal age.”

"It is for that reason the department director used his own personal, non-government money to cover costs of the initial harm reduction supplies, until a more sustainable source was identified. While this quick reaction was important in the beginning of the emergency response, it was also not sustainable, and the county is in the final stages of securing private foundation funding as a more sustainable approach to funding moving forward. No taxpayer money is used to purchase these items."

What is clearly a policy based on supporting those with addictions and helping to protect the local community from risk of contracting the COVID-19 virus wasn’t good enough for the moralists.

One local resident told reporters: “I didn't like the idea, I don't care who's paying for it. It just seems like a bad situation, although I don't want them running around loose either. That was my concern when they first put this place in here. Are they going to be able to walk away?"

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The only question that ought to be posed is if this facility is committed to harm reduction then why are the patients not being encouraged to switch to vaping?

The UK government and Public Health England have been clear that mental health trusts should be doing more to help patients switch to electronic cigarettes. Instead, Sheffield Health and Social Care NHS Foundation Trust has been allowing patients to smoke in their ward bedrooms on 47 occasions.

The Care Quality Commission (CQC) carried out unannounced visits and rated its services as “Inadequate”. CQC has now placed the mental health service into special measures following a report that states some wards were not fit for purpose and care plans included "punitive or insensitive language".

The Care Quality Commission’s brief guide on smokefree policies in mental health inpatient services recommends: “E-cigarettes should not routinely be treated in the same way as smoking. It is not appropriate to prohibit e-cigarette use in health services as part of smokefree policies.”

The Mental Health and Smoking Partnership has previously advised: “To help smokers to stop smoking and stay smokefree, a more enabling approach to vaping should be considered to make it an easier choice than smoking. Vapers should not be required to use the same space as smokers, as this could undermine their ability to quit and stay smokefree.”

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Public Health England has told mental health trust they should: “Encourage patients to stop smoking or to abstain temporarily and offer behavioural support and prescribed smoking medications in support of any quit attempt. Ensure patients have access to vaping products and consider whether to provide them proactively to patients who smoke. Do not discourage patients using their own e-cigarettes in a quit attempt or when trying to abstain from smoking temporarily (unless an individual risk assessment suggests it is unsafe to do so).”

Related:

  • Using electronic cigarettes in NHS mental health organisations, Public Health England – [link]


 Dave Cross
Article by Dave Cross
Freelance writer, physicist, karateka, motorbikes, and dog walker
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