#28 - Elly: Harm Reduction, Crack Use, Snowballing, Safer Injecting, Cannabis, Ketamine & Drug Myth Busting

Matt and Elly embark on an exploration into the realm of harm reduction. 

With nearly three decades of invaluable experience in the Drug & Alcohol sector, Elly provides insightful perspectives that shed light on the complexities of the subject.

Listeners are treated to Elly's discussion on her new bitesize training sessions, where she demystifies crack use, examines the associated risks, and offers guidance on safer injecting practices. 

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🎵 Music: “Jonathan Tortoise” - Christopher Tait (Belle Ghoul / Electric Six)

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🎙️ Facilitator: Matthew Butler
🎛️ Producer: Robbie Lawson
🏢 Network: ReNew 

Transcript

SPEAKER_01 0:00

This is a Renew original recording. Hello and welcome to the Believe in People podcast. My name is Matthew Butler and I am your host, or as I like to say, your facilitator. Today I have with me Ellie, our harm reduction worker at Renew, and we talk about normal acute and crack use and the importance of effective prescribing and therapeutic recovery. First of all, will you please introduce yourself?

SPEAKER_00 0:21

Yeah, I'm Ellie Mortimer. I'm a harm reduction recovery coordinator based within the duty team at Trafalgar House.

SPEAKER_01 0:29

Ellie, thank you for coming on. A second time, actually. You're our second returning participant. Real nice to have you on. Obviously, you've worked in this field for going on 30 years next year

SPEAKER_00 0:39

as well. Yeah, next week.

SPEAKER_01 0:41

And the job that you're doing now, you've done for 17 years. 17

SPEAKER_00 0:43

years next week.

SPEAKER_01 0:44

So the amount of experience that you've got in this makes you the perfect person to talk to and ask these questions. Now, obviously, the reason why we've asked you on today is because... We're focusing, or we're going to be working on a project that's focusing on non-opiate and crack use. Which, for what we deliver at Renew, I think there's often an emphasis on the work that we do with opiate users, crack users, and obviously alcohol as well. But the non-opiate and crack use often gets forgotten about a little bit. And with your experience, I think you're the best person to have on. So what I have is a list of questions that I'm going to be asking you today. Cool. Because, again, you're going to be the best person to know this stuff. Or so I hope. I'll make it up if you don't know it. And to be fair, I wouldn't even know if you was. That's the awful part.

SPEAKER_00 1:29

I'm going to try and put a big fat porky in here somewhere then.

SPEAKER_01 1:33

You could bamboozle me completely on this. But please don't. Please be as honest as you can with it. My first question for you is, could you explain the purpose of focusing on prevention and harm reduction for non-opiate and crack use clients as individuals, particularly those using substances like cannabis, ketamine and others?

SPEAKER_00 1:50

So, as you said, we really do focus on opiate users and alcohol clients. And I think a big part of that is we cannot, there isn't a prescription that we can give to clients cannabis user as such that's a replacement for that and for my particular interest crack and stimulants that there isn't any substitute in the past people have argued different stimulant medication that stimulates should be prescribed but there is very little evidence that medication is a good what sort of medication would they so anything so um it's anything that gives that same effect as an amphetamine okay um so um it's it's medication that is often or has been prescribed for um kids that are overactive ADHD I don't know the chemistry behind it but it gives the reverse effect and calms people down but with stimulants particularly it's There isn't such a, well, they say there isn't such a physical dependence. It's much more of a psychological dependence. You could argue with crack. There is certainly a physical dependent there because of how crack works in the body. It's very similar to nicotine. You need to fill up your nicotine and crack bottle hot inside you every 10 minutes because it's all depleted it's

SPEAKER_01 3:44

gone

SPEAKER_00 3:45

so every 10 minutes you get the urge the craving to use again but it's the psychological sides that I think is the most damaging with these drugs and potentially you can argue with cannabis too, I mean arguably there is very clear evidence there that cannabis has a lot of positive benefits when used. Say, for example, when people have got MS or I've seen evidence where ecstasy has been given in a trial for people with Parkinson's. And when, like I've seen this trial where the guy had some pharmaceutical MDMA and he could control his body without the jerks and the uncontrollable effects that Parkinson's can cause. And he was doing acrobats, basically, in perfect control of his body because of the effect that the MDMA had on him. You talk about mushrooms and hallucinogenics. These were used... thousands and thousands of years ago as medicinal. And you could argue that if people had carried on using hallucinogenics safely, if there is such a thing, but with harm reduction, you could argue that using hallucinogenics expand the mind to a point where you become a... I don't know, it's like a better human being potentially. Some people

SPEAKER_01 5:27

say they feel more in touch with the world and with the air if they use hallucinogenic drugs. Absolutely. To be fair, I don't like the argument that people give often for using things like cannabis and hallucinogenic drugs because they say, well, it's natural so it can't be bad for us.

SPEAKER_00 5:43

Yeah, I mean, it can.

SPEAKER_01 5:44

But the argument being like the opium poppy is one of the most natural

SPEAKER_00 5:48

resources out there

SPEAKER_01 5:50

and obviously it can be very harmful.

SPEAKER_00 5:51

Very harmful and I mean, you could just look what's happening in Afghanistan now where the Taliban are destroying all the plantations when previously they encouraged it because it helped fund whatever they were doing. Yeah. We're not getting too

SPEAKER_01 6:10

political. No, no. Someone that I work with within the organisation was in the army years ago and he was talking about how part of one of their operations was to... Burn the opium farms to stop, you know, obviously funding. And he was saying, you know, they're burning all this opium and I don't think they realise how powerful it was. And obviously they're all stood around it while it's burning. Absolutely, yeah. It was all off the tits within about five minutes.

SPEAKER_00 6:35

Absolutely. Just from being around it. You hear about when there's been a raid and a cannabis farm has been confiscated or shut down. You hear of police officers in a similar situation when obviously they're destroying that. So it just reflects how potent some of these natural drugs really are. But I think what I've been... Focusing on more recently post-COVID is tools to help and support our crack using clients.

SPEAKER_01 7:14

What specific substances will you be covering in the context of prevention and harm reduction then for non-OCU clients? And why have you chosen to focus on substances like, again, cannabis and ketamine?

SPEAKER_00 7:24

Yeah. So I think, well, my first focus is crack. Yeah. And the reason why I'm focusing on that, and I've created some tools that we can either do in a group or workers can take to their own appointments, because like I said, there isn't a... Here's your methadone. That doesn't do anything for crack users. And the crack use, the reason why I'm focusing on that first before everything else is... The majority of our crack users are injecting it along with heroin. So it's what we call snowballing. So it's when they put heroin and crack in the same pin and inject it together. It's one of the most risky. The crack is... in ancient times, was used as an anaesthetic for operations. So before someone had an operation, cocaine would be applied to the area where they were going to have the surgery on, and that would numb the area. And so if you imagine someone injecting crack, where it's a precise action where you want to inject inside a vein, if you inject crack... along with the heroin, you are numbing the area straight away, making it more likely that you're going to miss the vein, because you've numbed the area, you don't always feel the damage that you're doing, and veins collapse a hell of a lot quicker if they're using injecting crack before anything else.

SPEAKER_01 8:56

As someone who's obviously done this job for 17 years, can you recall... The worst case of snowballing that you've heard of or seen?

SPEAKER_00 9:05

Well, yeah. In particular, it's with injecting harm. So I've seen holes in people's groins big enough to get my fist in where they've had a massive abscess appear through poor injecting and injecting crack along with the heroin. I suppose the worst case scenario, not quite as... Badder's death is amputation. And in the time that I did my first podcast, I think we spoke a lot about injecting harm, but the number of clients having amputations in the last year has gone through the roof. And I attribute that, a lot of that, to snowballing.

SPEAKER_01 9:51

Why do you think people who do... Obviously, I mean, I've worked in services for eight years. I remember one chap who lost his leg and then... started injecting into the other and became eventually

SPEAKER_00 10:04

double amputee. Absolutely.

SPEAKER_01 10:06

Why do you think people do that from a professional perspective?

SPEAKER_00 10:09

That, I think, is the best reflection of the power of addiction. Because regardless of what you might lose in your life, a leg, an arm, a hand, that often, very rarely... Unfortunately, it's not enough to stop someone. I mean, I do make light of it. I mean, I've got someone who I've known for many years, and he said, what have you got to tell me today, Lee? And I'll always come out with, I remember you when you were tall.

SPEAKER_01 10:45

I like that one. That's a good

SPEAKER_00 10:46

one. And we can laugh about it. I mean, he was tall, he was a good-looking lad, and he's still that. Really nice fella, but the damage and disability he's now living with for the rest of his life is... Do you know what? If you break a bone, how that incapacitates you for however six weeks while you've got a pot on is such a pain in the arse. I mean, I struggle to even empathise with... the loss of a limb. We've got a woman who I've worked with for many years and she was, and she still is, but she was absolutely stunning inside and out. And she's just had a second leg amputated. And I think she has just been given a eviction notice for the supported housing that she's in because of the chaotic drug use that she's taken into putting other people at risk. So it's the addiction. I

SPEAKER_01 11:50

always say this, and I've had this conversation on this podcast before, about how everyone's rock bottom is different. And if losing a leg isn't that moment for you to think, right, I've got to sort myself out, then you kind of wonder, what will it be? What will it take for the light bulb to go off and think, I've got to make some changes? For

SPEAKER_00 12:08

some people, it will be nothing until either... something changes in their brain and makes them think like addiction does with all of us who've had an addiction. So smoking, cigarette smoking for me. You know, when it was time for me to stop, I stopped without any aid or help. But that time sometimes never comes for people. You just have to look at our memorial tree on the front desk on reception at Trafalgar House. These are family, friends, loved ones, partners, sons, daughters. Often people still using the service.

SPEAKER_01 12:52

Yeah.

SPEAKER_00 12:52

And even that isn't enough. Isn't

SPEAKER_01 12:53

enough, yeah. Because, and this was a conversation that I had with John where we said about that, I suppose them feelings of not being good enough or, you know, you kind of live up to the stereotype. If everyone's saying that you're just a no-good smackhead sort of thing, these were his words. Labelling really works. The labelling.

SPEAKER_00 13:12

Yeah.

SPEAKER_01 13:12

you're going to just believe that and it's just going to reinforce those beliefs and you're just going to continue that pattern of behaviour.

SPEAKER_00 13:17

Yeah.

SPEAKER_01 13:18

And you're just going to live up to those. Because that's all everybody ever thinks of me anyway,

SPEAKER_00 13:21

so why not just continue? And no amount of prescriptions, whether it be for methadone or, do you know, like parents nagging or your partner nagging you, nothing is going to stop that until you are... ready to stop even going to prison doesn't stop people

SPEAKER_01 13:38

no no no it doesn't and again like you said the rock bottom moments everyone can be different and I think the one that I always found interesting was when a woman said I forgot to pick up my kids from school and I knew I had to get myself sorted and it's like the disparity between forgetting to pick up your kids from school one day and losing both legs

SPEAKER_00 13:54

yeah

SPEAKER_01 13:55

it shows that the spectrum of that rock bottom moment is so vast and far between that it can be anything that can change. So how do you envision the integration of harm reduction practices into non-opiate use behaviour changing that's currently being planned?

SPEAKER_00 14:12

Well, we have to be, I mean, it's always been there, but... During COVID, we lost some of that really invaluable contact with face-to-face eyes on that person. And... What we found during COVID was crack was flooded into the city, for one example of drugs. Lots of other drugs were flooded in as well, like illicit pregabalin, illicit benzodiazepines, all the drugs that are causing so many deaths at the moment. And so the harm reduction's always been there, but we're now back in a position where we can see people. Well, hang on a minute, you were telling me like for the last two years when I didn't see you or hardly saw you that you were drug free Everything was going dandy. And then you clap eyes on people. So it's about being reactive to the changing drug trends in Hull. We had one time in the 90s where crack was in Hull. It didn't last very long. But during COVID... like i said in the needle exchange in the needle and syringe provision if i have someone who isn't injecting crack then that is that that's unusual now so recognizing that drug use is changing drug use is becoming much more damaging both physically and particularly um psychologically because crack doesn't crack is amazing if you want to you know, F up your mental health. It is absolutely amazing, you know. So better than any breakup, better than any traumatic effect, just have a crack a few times and that's it. Not because a crack might cause your partner to walk out on you or a crack might cause you to experience unbelievable debt that you've never known before in your life. Crack effectively, in layman's terms, destroys or it stops the happy chemicals in our brain working because it moves the happy chemicals. Say one crack pipe, you've got a pot of happy chemicals in your brain, very lame in terms, and our happy chemicals drip through nice and steadily and this keeps us on an even keel. Crack, you would not really feel crack at all if it wasn't for... your happy chemicals because they work that's what makes them work so you use crack once the pot of happy chemical floodgates opens and they get stuck at the back of the brain where they don't work it can take and this is just you know this is mind-boggling and when I tell clients sometimes they're like well why anyone else told me this and I'm like why don't you know this and then I think well I didn't know it

SPEAKER_01 17:09

yeah

SPEAKER_00 17:10

six months to a year

SPEAKER_01 17:12

To get back to where

SPEAKER_00 17:13

they need to be. To fill that pot back up.

SPEAKER_01 17:14

Bloody hell.

SPEAKER_00 17:15

And that's just after one use. Yeah. So if you keep on using crack, and we know a lot of people in Hull are, it's just going to delay that time when things start to feel a little bit better.

SPEAKER_01 17:32

What's the most expensive illicit drug then that people, obviously because crack is more expensive than heroin, is it? Well,

SPEAKER_00 17:38

you need to use crack regularly. if you were feeding your addiction, a hell of a lot more than you would do heroin. And that's another risky area because we're seeing so many people who are snowballing at the moment. Heroin will last for a lot longer. Well, crack, the levels have been depleted after 10 minutes. So it's that urge to use again to get back to where you were. Obviously, massively.

SPEAKER_01 18:05

So even if it's... Maybe cheaper to get singularity, the cost would be more, I don't know, because you've got to use it more, haven't you, to keep that up. I get

SPEAKER_00 18:14

that, yeah. I mean, with our people, well, it's not just women, but our service users who are working in the commercial sex industry, so like selling sex for the drug use, the harm we're seeing with this, cohort of service users is absolutely horrific. Do you know, both the psychological health but also physical health. Because you don't, if it's between eating and using, you aren't going

SPEAKER_01 18:50

to eat.

SPEAKER_00 18:51

So yeah, it's about being reactive to what the trends are and the trends are pretty horrific at the moment and it's the same all over the country. You just do not find it quite mind-boggling that Everywhere, all at once, was flooded with crack in places where it never was before. Whitby. Wow. Whitby has got such a significant... I

SPEAKER_01 19:13

can't imagine Whitby having a drug

SPEAKER_00 19:15

problem. I mean, there's always been a drug service there.

SPEAKER_01 19:17

I

SPEAKER_00 19:18

just

SPEAKER_01 19:19

imagine they inject, like, fish and chips into the veins of Whitby. Absolutely, absolutely. I can't imagine having a drug problem. But

SPEAKER_00 19:24

we've got, with county line dealing, drugs are everywhere. Yeah. Because they're taken everywhere. Mm-hmm. So, you know, it's about reacting to what the clients are using. And at the moment, the biggest thing is snowballs.

SPEAKER_01 19:40

Speaking of data, is there more female-to-male crack use? No.

SPEAKER_00 19:45

Everyone. Like I said, if I get someone in the office who is not snowballing, it's fine. Do you know the exception? It's very, very rare now. Most

SPEAKER_01 19:58

people are doing

SPEAKER_00 19:58

it. I'm like, my God. I'm usually over the moon when I hear it. Or the smoking, at least the smoking, the crack, they're not injecting the crack. So... Yeah, yeah, it's very scary.

SPEAKER_01 20:11

And continuing with the data, can you elaborate on the data that led to the decision to address prevention and harm reduction for clients using substances other than, obviously, the opiates? And I guess you've already touched on this, but the trends of finding and which prompted the approach to it.

SPEAKER_00 20:26

Well, it's the reported drug use where we get that information from and the evidence in... How clients are presenting. I mean, the injecting harm that we're seeing is going through the roof. It really is. But also the uptake in people using our needle and syringe provision has gone through the roof too. So it's not unusual where we're to try and keep people as safe as we possibly can for the clients. Yeah, yeah. Yeah, yeah. In my experience, I suppose if you were reporting to social services, you might have more reason to be not completely honest with what you're telling us, but we don't see that. I was

SPEAKER_01 21:28

going to say, obviously you've said about, going back to what you were saying about throughout lockdown, you're talking to service users, you're not laid eyes on them for a while, they're saying, oh, I'm doing well, this is good. If there was ever a service that you didn't need to lie to, It's us as a drug and alcohol treatment service. Why do you think, obviously, I know you mentioned then social services, I understand the need to lie when families have social service involvement, but for those that don't, why do you think that they still continue to lie about the drug use and the drug habits when there is no judgment from us as a drug and alcohol treatment

SPEAKER_00 22:03

service? Well, it could be with probably a lot to do with what they will lose later. what they're at risk of losing if they are completely honest. So it could be from children, access to the children, to employment. And we see that an awful lot. So when people are at risk of losing something that is absolutely... essential for them to carry on living, then people will like. And also, if you're using illicit drugs, it's an illegal activity. And I think sometimes people... lied before they actually maybe put the brain in gear and think it's okay to actually tell the truth yeah I

SPEAKER_01 22:51

think obviously I mean I've again I've been at Renew for eight years now I've seen a lot of changes over those eight years particularly from when we was just a criminal justice only service to what we've got now which is much more community focused and treating substance misuse more as a health care problem as opposed to a criminal problem so maybe it's something to do with the way the services have been linked with criminal justice services and probation and and the law in general as to why people just instinctively lie yeah and because it's all even I guess people before they do a drug test, like, oh, have you, you know, and it's like, no, I've only had this. And then you drug test them and it's like, there's this, this,

SPEAKER_00 23:30

this and this. What we call a full house. Yeah, yeah. Oh, well, yeah, I did like this three days ago. And then they're honest

SPEAKER_01 23:36

afterwards, yeah.

SPEAKER_00 23:37

Yeah.

SPEAKER_01 23:38

So it's one of the things where I think, like, I was talking to Peter about this before when he was on the podcast and he said it's just in the culture to instinctively lie because of that fear of judgment.

SPEAKER_00 23:51

And self-preservation. Yeah,

SPEAKER_01 23:53

self-preservation.

SPEAKER_00 23:53

You know. I think we see much less of that in the role that me and John do, you know, because we're actually giving people clean and safe injecting equipment to keep that. So, you know, the injecting drug use is right out there in the open. Plus, we'll also be asking to see sites. Very rarely does someone leave the... the room without showing us the sites where they're injecting on a regular basis. And from that, we can see that there's really significant harm going on, and a lot of it because of the new changing trends in drug use.

SPEAKER_01 24:36

Is a part of what we're to do in terms of harm reduction, obviously it's to keep the individual safe, but we've got to think the knock-on effects of that. If people are, you know... injecting to the point where they're then having to go to A&E afterwards and things like that. Is that part of what we're responsible for is to try and stop them getting to that point to nip it in the bud earlier

SPEAKER_00 24:55

on? Is that anything to do with it at all? That's a huge part of what we're doing because reducing the harm covers every single aspect of the work that we do with Change, Grow and Live. So if people are still using drugs, what we need to do is work with them and provide them with the equipment to make that using safe, when they're ready to stop, to work with them to get whatever they need to make it as smooth a ride for them as it possibly could be. So having that approach where we look at every single area of someone's life is absolutely vital. We had... We had. And mental health is a common thing running through that. And you'll find that an awful lot with stimulant users, that mental health is always badly affected.

SPEAKER_01 25:52

I imagine crack users will go into what you're saying about the chemicals of happiness going to the back of the brain and then show that mental health is going to play a major part

SPEAKER_00 26:00

in that. Absolutely. And there's a condition called excited delirium.

SPEAKER_01 26:04

and

SPEAKER_00 26:05

when you talk about excited delirium it sounds like you're having a really good time it's also known as agitated delirium it doesn't sound as fun when you say it like that both the same and none of them are fun so when we hear about deaths in police custody when people are being restrained so when someone has had been using huge amounts of crack for example and They can experience what we call excited delirium or agitated delirium. They are at severe risk or very high risk of heart attack and death. So when you put someone in handcuffs or restrain someone when their heart is beating way faster than it should be already, and they'll be at risk of hypothermia because they can't control the temperature, And if you then restrain that person, to frighten them to the point of... Often when we hear about deaths in police stations, when there's been, or any situation, when there's been a massive crack binge, it's often to do with agitated delirium. So that fun, excited delirium can often lead to death, unfortunately. And just recently we had a very, very unwell... woman in the service. I'd only seen her a week before. I think I'd done a blood-borne virus screen for her. She was in really good spirit. She was, you know, really chatty. She regularly comes into the service, like comes in for something to eat and a drink in our re-brew area. And she presented, I mean, it was an all-day awful event, really. And she presented and what I would probably put all the money in the world on was she was experiencing agitated delirium after a really significant event in her life, which led to having a binge of whatever stimulants it was that day. She was not... We're sitting in the room together. She was not in the room. She was hallucinating. She was hearing. She was having auditory hallucinations, visual hallucinations. And it was absolutely terrifying. I mean, she must be sick stone wet through, really. But another symptom of agitated delirium is... Strength that you would expect to come from an Arnold Schwarzenegger bodybuilding. Yeah, yeah, yeah. Yeah, so... And she was clearly experiencing an awful psychotic episode, obviously influenced by this awful event that she'd experienced in her life, but also because of drug use, which she'd been really stable previously.

SPEAKER_01 29:17

So do you know what drugs it was? Was it...

SPEAKER_00 29:19

Well, I... It was definitely stimulants. I haven't had confirmed. I've not looked to see if it was amphetamine or crack. But both can cause this. She'd not slept for days. And I believe her dad brought, I mean, the parents just didn't know what to do with it. a doctor suggested to bring her to renew instead of maybe making that...

SPEAKER_01 29:49

Appropriate referral. Appropriate referral to mental health services. Just turn up there and see what

SPEAKER_00 29:53

happens. Yeah, and, I mean, very, very detailed, but at the end of the day, she assaulted four members of staff. Like, punched four members of staff. She lifted, managed to lift one... one of my female colleagues basically off the floor um she saw a guy coming to the front door with his baby in a pram and um i don't know what she who she thought that person was because she wasn't you know she was hallucinating she ran out the room and i ran after her and she tried to take the baby, push the guy aside and try to take his baby. She was just shouting, oh, no, not you. So she obviously thought it was... And that child was at risk. And you can do this job a lot of years, like I have done it a lot of years, but I have never seen anything like that, you know, in my life. Because while people do come in under the influence, that was... That was a mental health, psychotic breakdown as well. Obviously led through lack of sleep, this awful event in her life. And then when the police finally did come, she assaulted one of the officers. And as sad as it is, that sort of... seemed to get the help she needed straight away. She was taken straight away to a mental health acute unit. Why that couldn't have happened hours before, you know, I've got nothing but admiration for everyone that was involved in that. We've got some really new staff, and there were a couple of them, including her worker, who were just absolutely fucking amazing. For newish starters, you think, wow, you are what that client needs, and you are what this service needs, because where that woman would have had... All sorts of stuff, if this had happened out in the streets, if it had happened in town, you can just imagine, Facebook posts, they're sharing on Facebook, with absolutely no care or concern about that woman's situation and how severely poorly she was. People are so quick to judge. And that was... Do you know, I think if there hadn't been a binge of stimulants for the few days prior to that, that wouldn't have happened. I mean, obviously she was having an awful time anyway. Yeah. But she's still in... She was sectioned. She's in... a secure unit on a section where she can't just... So she's getting the help she needs now. And

SPEAKER_01 33:10

you'd never really get that with an opiate user, I don't think, would you? That sort

SPEAKER_00 33:14

of

SPEAKER_01 33:14

behavior or...

SPEAKER_00 33:16

Well, you can. You can because if there's already mental health issues, like a mental health condition going off for someone, and they use any drug, cannabis included, that can lead... to psychotic so it's

SPEAKER_01 33:32

not directly a result of the stimulant then is it or the drug that they use it's what's already going on

SPEAKER_00 33:37

yeah and we don't often hear about it with cannabis but the stronger that cannabis gets and it is getting stronger um the strengths are getting stronger then people are more likely to experience an adverse effect from it um so because you've got nothing like a there's no such thing as an honest dealer

SPEAKER_01 33:57

no

SPEAKER_00 33:57

no this one's fine yes this one's really although they do say that that's how they people

SPEAKER_01 34:02

back in. Yeah, of course, yeah. I trust him more than the other dealers, yeah. He's getting the same stuff from everybody else that everyone else is getting it from. So, obviously, talking about the differences there, I guess, you know, that incident in itself was, you know, you talked about her, do you know, what was it called again?

SPEAKER_00 34:17

Agitatedomics. I know they said adrenaline delirium. Excited delirium, yeah.

SPEAKER_01 34:23

What other, I guess, what other, what other What are the needs of that non-opiate use group then and how does it differ to opiates?

SPEAKER_00 34:33

So there isn't a medication that we can give to ease. I mean, medication doesn't do everything. Yes. You know, we know we can put someone on a methadone course, but that doesn't, you know, it's not the best part. It's all the psychosocial stuff that comes with it. It's the psychosocial activities that we can offer. And I think, you know, in previous services, we've used a lot of alternative therapies, which were absolutely amazing. And I think there's definitely space and a growing need to bring back. Is that things

SPEAKER_01 35:05

like

SPEAKER_00 35:06

the black box? So the black box, yeah, so acupuncture with electricity. And this box was specifically designed for drug use particularly. Stimulant users. It's a wonderful piece of kit.

SPEAKER_01 35:22

Why don't you think substance misuse services use the alternative

SPEAKER_00 35:27

therapies? I think a lot of them do. I think we're all still on catch-up from COVID, you know, and that's a massive piece of work that I think is going to take several years yet to undo the damage that COVID did. It wasn't just like a... a virus, it affected every single part of people's lives, didn't it? So, but I think if anyone is going to bring alternatives just to script into our service, then it'll happen at Renew sooner than later because the services...

SPEAKER_01 36:05

You'll be a champion in

SPEAKER_00 36:06

it as well, won't you? Well, I'd absolutely love it. I'd be really interested in learning how to do auricular acupuncture. I mean, it's the most ancient... It's one of the most ancient treatments for illnesses. How does it work then? So it works on, we've all got meridians like running through our body. So these are like electric currents going through our body and your meridians can get blocked. So they can get blocked through a mental health system. issue or they can get blocked through a physical health issue. When I used the black box in previous surgeries, if I was giving someone a treatment, one of the first things that they would comment, because obviously it was assessed how effective it is, is how brilliant it is on pain relief. So they might come in with like, I had toothache. It's gone. It's 10 minutes. Yeah. You know. Interesting. I was set up at a recovery fest in Leeds, Roundhay Park, a few years back. And I was doing 10-minute treatments. I didn't leave that tent. No. The word was travelling around the festival. You know, we really need to utilise every single trick in the book and alternative therapies of... absolutely a part of that and I think that should be part of the treatment we offer people who are using heroin

SPEAKER_01 37:38

or using alcohol. Because that's one of the things, talking about like engaging, engagement with our service users, it's quite easy, I won't say easy, but it's easier with our opiate users because there's a reason for them to come in for a methadone prescription. Spot on, yeah. How do you plan on engaging those which don't have, you know, there's no medication to replace, you know, crack

SPEAKER_00 38:03

use. Absolutely, absolutely. And that's why, well, engagement with users, like say stimulant users, is particularly hard. One. Because they don't have a prescription. You're right. We use that carrot to get people in to get involved with everything else that's going on. But stimulant use turns your life upside down. The need to use more of it, the damage that it does to your physical and your mental health, it happens really quickly. And it makes you probably the most unreliable person in the world because you are not going to be able to get... to an appointment. So I developed these tools where the first part of it is, particularly for crack users, it helps someone identify everything that's a risk or a potential trigger. So I ask things like, where do you score? Do you always go to the same place? How much money do you need in your pocket before you're thinking about using? Who do you use with? And then from all the answers that they give you, and it's much more comprehensive than that, but with all the information that they've identified, then the next part of the plan is then you develop your own safety plan. You develop your own... which I call cracking it.

SPEAKER_01 39:41

Nice. Yeah. I like

SPEAKER_00 39:43

that. That took a while to think of. But it could be, don't walk that way home. It might mean that you walk an extra mile out of your way, but walk that way. Don't go to see that person. And that person is often a family member. That could be a partner. Because when you're using alongside someone else, it's doubly hard to crack it. Yeah. So we sort of identified the people in the service who, you know, report as using crack only. So, you know, I attempted to make contact with these people and I had zero response. Not one. Not one. Not one, which is part of the crack. So we didn't have any responses. So what I thought I could do next is... put that tool out, share it with everyone at Trafalgar House, and they've got options. They can use it with the service user themself, or they can invite me along to the one-to-one appointments because that is a group. You've got three people in a room, you've got a group. Because a lot of it is around anxieties. And if you're using a drug that really damages your mental health quicker than any other drug, like crack, Feeling safe and able to come to an appointment is a massive deal. I've got the beauty of, I'm based in duty, I'm based downstairs, I don't have a caseload. So someone can come through the door and work, Ellie, I've got so-and-so in there, we'll try and do it. So it's really difficult, but I think I've been described lately as a dog with a bone. And do you know what? It couldn't be right. It couldn't be more right. So it's just about not giving up because crack's not going to go away. The other drugs are not going to go away. And I think the next thing I might target is ketamine because I think if anybody has been to a festival this year, they will have seen how... The increase in ketamine use.

SPEAKER_01 41:57

It's very popular between

SPEAKER_00 41:58

that

SPEAKER_01 41:58

18 to 25 cohort at

SPEAKER_00 42:00

the

SPEAKER_01 42:00

moment is ketamine.

SPEAKER_00 42:01

It's like I'm watching one of my favourite Romero zombie films. It's really not a pretty sight. Is

SPEAKER_01 42:10

it really cheap to get ketamine?

SPEAKER_00 42:13

I suppose it... It depends. It's probably going to be sold very much like cocaine, powder, ecstasy, MDMA. It seems to

SPEAKER_01 42:22

have replaced that sort of thing. You're talking about the rave scene in the 90s and young people on MDMA and other drugs like that and stimulants. Ketamine seems to be the thing now.

SPEAKER_00 42:33

And the issue with ketamine is... It's

SPEAKER_01 42:36

a festival

SPEAKER_00 42:36

drug. Absolutely, but people don't know how to use it safely. You've got to microdose with ketamine. Less is more and you tell someone who wants to get off the tits at a festival less is more that ain't gonna that ain't gonna work and there's a guy who I've got do you know one of the people that you hold up there he's called Matt Southwell Matt used to be an advisor with the government and one day thought do you know I'm I'm going to do this. And he came out as a recreational drug user with ketamine being his drug of choice. Obviously, very quickly lost his job. But... The things that I've learned through going to one of, there's things called Hot Topics, and I went to one of his, that's where I met him, and he works for, he was freelancing for HIT, another, an organisation originating in Liverpool, and it was on ketamine. So the harm reduction work you can do with a ketamine user, for fares, can save them losing the bladder. Because losing the bladder is one of the first things that can happen if you're using too much. I mean, ketamine scares the life out of me. I think because if you see people on ketamine, it's not a pretty sight.

SPEAKER_01 44:01

I worked with a girl who had a ketamine addiction, now in recovery, and she regularly got... What's the thing that they fit into it? It's like a stoma or something? Yeah. So she had to regularly get one fitted, and then I think... Then at the other side or something, I remember her telling me about all this. And only young, mid-20s, but absolutely hammered Kermit when she was, you know, in her teen years. Physical harm has happened for the rest of her life. For the rest of her life, yeah. So she has to go regularly to... hospital to have checks done and monitor things and sometimes she went for an appointment not so long ago and then ended up being there for six weeks or something she ended up being in hospital for a very long period of time and obviously she's in employment so that affected her work and I don't think people understand the long-term effects of it. Of how it affects not just your life and not just your health, but your entire life afterwards of care

SPEAKER_00 44:58

and abuse. And you find someone who's going to start using drugs. You find someone who actually does the homework before the start. The few and far between. I've met one, you know, and... You

SPEAKER_01 45:11

would think that, wouldn't you? Putting something into your body like that, you'd think more people would research. But I think it's often, from my experience, it's often done when they're already under the influence anyway.

SPEAKER_00 45:23

They've had a few

SPEAKER_01 45:24

drinks, so ketamine seems like a good

SPEAKER_00 45:26

idea. Absolutely, yeah. They're already under the influence. So, yeah, use this without even knowing it's

SPEAKER_01 45:33

originally

SPEAKER_00 45:34

anaesthetic for horses.

SPEAKER_01 45:35

Yeah. It's mental, isn't it? Yeah. sounds much less appealing it's like you said you want some ketamine oh that sounds nice do you want this anesthetic for horses no i'm all right actually yeah

SPEAKER_00 45:45

yeah and you can imagine how powerful the drug is when it's

SPEAKER_01 45:47

well yeah if it's to put a horse down yeah absolutely

SPEAKER_00 45:51

yeah

SPEAKER_01 45:51

so what strategies or approaches will you employ to ensure that the information provided about substance misuse and harm reduction effectively translates into meaningful behavioral change for for those who'll be attending this this sort of project yeah when they attend yeah when they attend yeah so

SPEAKER_00 46:09

what we need because people are frightened about anything that's new so a group like more than one people in the room anything I'm anxious I've got anxiety I can't possibly do that so if you take it to that service user you give them what we call bite size or taster session for example of the cracking it pod the cracking it workshop then Once you do that way, you take it to where they are, then you can get them in. You know, you can get them to bite. So I recently did a home visit with a colleague of a service user I've known for donkeys whose crack use has gone through the roof in recent months. And someone was trying to... cuckoo a flat as well so someone was trying to take over her flat and deal and deal from her flat um which often results work more work you know worse for the person who lives whose flat it is rather than the person who's cuckooed it and so we took it to her and we spoke about what i could specifically offer her what I could provide her with to work on herself at home or with a mum who she spends lots of time with. So it's not reinventing the wheel and it's not rocket science, but it's a hell of a lot easier trying to reach that service user in the place that they're most comfortable than it is asking a service user to walk through the door of a drug service where someone might be trying to sell in drugs. the drug that they've got an issue with. Yeah, yeah, because it

SPEAKER_01 48:00

happens as well, do you know what I mean? I remember near the top of Beverley Road, Hull Daily Mail.

SPEAKER_00 48:05

Yeah.

SPEAKER_01 48:06

I was walking up and someone tried offering me drugs. I just put my land here, I don't want... Yeah. Got the wrong person here, mate, do you know what I mean?

SPEAKER_00 48:13

Yeah. I find it so... And I know it goes along with the territory, I know it does, but it just seems to have... Because people are dealing... People who we work with regularly, they're dealing because they need to deal because the cost of their drug use has gone through the roof with the crack. People are running for people. But I just find it so rude when they do it in work.

SPEAKER_01 48:39

Yeah,

SPEAKER_00 48:40

yeah. They do it in a place where people should feel safe coming to. And I think we're doing really well at nipping that in the bud. But... You know, a client a few weeks back, he went, Ellie, I've just scored 10 quid in the Rebu area. And luckily he came to us, he went, you're not going to take it off me, I'm not, but you're not going to use it, are you? Of course he's going to use it, but, you know, that's twice in a row that he, two visits for appointments that he's come to a drug service and someone has used that opportunity. to offer him drugs and it's survival i know people have to

SPEAKER_01 49:27

because it's a bit of a catch because you you want you want to give people autonomy and responsibility and you don't want to look like you sort of you know we're talking about the links between criminal justice and drug use inviting people into the re-brew area to have a cup of tea and a coffee You don't want to be standing over everyone's shoulders all the time, do you? You want them to feel like this is a place where you can come and relax. But at the same time, you hear stories like that and you go, oh, but now it needs to be staffed or there's more things like that's going to happen. So it's striking a really perfect

SPEAKER_00 49:53

balance to it. I mean, I think this is one of the reasons that we're working on bite-sized activities. So the hope is where I could be in the Rebrew area or another member of the team could be in there. And without... Anyone actually realising what happens, they're engaging in a therapeutic activity about their drug use. You go in there and you do it opportunistically. It's not just a place where people can come in and sell whatever or score or whatever. Because it doesn't happen very often. I've got to say that, but... people have got to do what they do to survive and to make what they need to make so they can use drugs but we've also got a very good cctv system so

SPEAKER_01 50:43

no one's going to get away with it are they really but i like that because again it's kind of i remember delivering a pod before uh you know there was about there was only about four or five of us in there and there was somebody saying i don't do groups i don't do groups i was like you're in one now so you're absolutely you're doing fine so you're absolutely fine um and obviously and but it's that realization like oh I am, and I guess this is no different. So if anything, it's probably better to come to a group because there'll be more structure.

SPEAKER_00 51:12

And very rarely does a prescription solve the reason why people walk through our door. It's the psychological interventions that we can use are the most valuable things that we can use with people because people aren't just using because of the way... It physically makes them feel. It's much more because of the effect it makes to how they're feeling, where they are and the buzz and all

SPEAKER_01 51:45

the rest of it. All the stuff that they've got going on. Actually, in general, how do you measure the success of the prevention and harm reduction advice you give? Is it about seeing people less as they come to

SPEAKER_00 52:03

you? Well, it could be that, but you would hope... One of the big aims of having bite-sized groups, therapeutic groups on a variety of topics, one of the main reasons we're doing it is to make attending... a group that maybe goes for 12 weeks. We've got such a fantastic group offer, but I think, again, COVID really put a spanner in the works with engagement with that. But if someone feels comfortable with a bite-sized taste of what a group can do for them, I mean, sharing and listening to what other people are experiencing and giving advice to them as a user yourself and also taking advice is... is one of the most powerful things that we can do at Renew. And our hope is that engagement and interest in the groups that we have on offer is going to bring more people in, bring more footfall, because we know the evidence is there, black and white. Attending a group is absolutely up there when it comes to interventions with drug users. Given a script, you... Sometimes it's just like pissing in the wind. What's the point of that if you're not looking at everything that's going on in here or at home or with your work or with your family? It's very frightening for people to open up because to disclose everything that their drug or alcohol use is. Done. Laying it

SPEAKER_01 53:45

bare in front of them, yeah. It's quite a daunting thing

SPEAKER_00 53:48

to look at, isn't it? Absolutely, but it's also a really brave thing to do. But same what you said, like, you're in a group.

SPEAKER_01 53:54

Yeah.

SPEAKER_00 53:55

So, yeah, and I'm really, really confident that that will do that because if you're giving knowledge, it's such a powerful thing. And if you're giving our service users knowledge a better depth of knowledge around what they're doing, the damage it can do to them, the long-term effects, the short-term effects, then you're giving them, hopefully, what they need in here to start making the real changes. And we see it. It works. I often get asked by friends, family, well, does anyone actually ever get off drugs? Well, of course they do,

SPEAKER_01 54:31

dickhead. Of course they do.

SPEAKER_00 54:34

You know... Like Dame Carol Black, the 10-year strategy, putting more money, time and investment in a drug service and not changing it every three years so that service can develop and grow and get things right.

SPEAKER_01 54:50

Yeah. Because the service that's being delivered now is much different to what was being delivered, you know, four or five years ago. There's a lot of changes. And I was explaining this to someone recently talking about all those things that come within drug use in terms of employment, family relationships and mental health and all the other things is the provision that we offer has grown substantially now, hasn't it? Yeah. have a little chat make some goals here's your prescription on your way now we've got clinical psychologists in post we've got mental health nurses in post in terms of employment there's about three or four different types of employment offers at the moment there's housing workers it's all changed so much and it's all those things that are intrinsically linked with with substance misuse a question for you i suppose as a harm reduction worker because I mean you hear a lot of slang and a lot of lingo and stuff like that so heroin is heroin and obviously there's there's different terms for it but as a harm reduction worker how do you stay on top of this but this is more for the non-opiate and you know crack you sort of things when someone comes in and says I've been taking some bombay sapphires and it's like where do you even start when you're hearing all the slang like how how do you work out

SPEAKER_00 55:59

I ask them

SPEAKER_01 56:00

Okay. Just ask them what it is specifically?

SPEAKER_00 56:03

How do they know what it is specifically? You very rarely get that. But we didn't have MCAT at one point. And then we got MCAT or Meow Meow or whatever. So you ask. You ask the question. Do

SPEAKER_01 56:17

you have to ask what sort of effects it has in order to categorise it into a different category of depressant, stimulant, hallucinogenic

SPEAKER_00 56:24

sort of thing? But then if it's something that's been made in an underground lab... which a lot of our illicit drugs are being done now. We've got a massive rise in synthetic opiates and opioids. Stuff that can be made in someone's kitchen, that is a hell of a lot more prevalent than just your bog-standard heroin user. So we have no... And they have no idea what is in. So they say, I'm using pregabalin. And... We know for a fact that pregabalin, the illicit pregabalins that are being made and manufactured in underground labs and totally flooding every city in the country at the moment, you can't say that there's those ingredients in that one and it's definitely a depressant and then you take the next one that kills you.

SPEAKER_01 57:21

Yeah.

SPEAKER_00 57:23

Because you're not in a pharmaceutical lab. You can't control how much of each ingredient ingredient is going in there and they won't

SPEAKER_01 57:33

give a shit will they when they're packaging

SPEAKER_00 57:36

them and putting them together yeah well they're killing people every single day yeah well yeah and that's the scary thing

SPEAKER_01 57:47

i think that was the thing when looking at obviously the the you know the epidemic of like novel psychoactive substances you know even you know seven eight years ago the packaging made it look like candy and it did things that you used to get as a kid over at the corner shop yeah you know for 50 people had a kale eye they made it look real appealing

SPEAKER_00 58:07

absolutely but from working with people when legal highs were legal compared to now when you know all the laws change Me personally, I have seen a hell of a lot more damage caused by that law changing.

SPEAKER_01 58:26

Oh, really?

SPEAKER_00 58:27

Because when the substance was a legal high, there were hardly ever any reports made to me of overdose death. So you'd get legal ecstasy. And you could buy it in a sex shop. Because under, I suppose, manufacturing laws and clinical laws, everything that is in that tablet or powder or synthetic cannabis, if it was spice, we need to know, it has to be exactly the same. The harm that we're seeing came... after the law changed, and things were then made.

SPEAKER_01 59:14

Because it was illegal, so they didn't care what they put

SPEAKER_00 59:16

in it, do you mean? Look at the Spice epidemic. That

SPEAKER_01 59:20

did get worse after it was made

SPEAKER_00 59:22

illegal, didn't it? It did, because what was being put in it completely changed, making it a hell of a lot more unsafe. I mean, I'm a massive advocate, and obviously these are my views, not necessarily change, grow, live, but decriminalising A lot of the drugs that are killing people when they're made in underground labs, it's not rocket science. Yeah. It's going to save, that would save lives. Yeah. But unfortunately we're not living in that sort of world in this country. Other countries are a little bit more forward thinking. Yeah. But reported harm and reported deaths to drug use reduce when laws change.

UNKNOWN 1:00:11

Mm-hmm.

SPEAKER_01 1:00:11

So as a harm reduction worker, coming up with different types of harm reduction strategies and much like the one we're talking about today, what are some of the challenges that you face when putting these things together?

SPEAKER_00 1:00:25

When people are using, for example, again, stimulants, they are the most unreliable people and you will often organise something And like what I'm experiencing now, people aren't responding or getting in contact. While we know there is a massive need for the interventions to be there. What was the question again?

SPEAKER_01 1:00:51

I guess just around the challenges that you face with these strategies.

SPEAKER_00 1:00:55

It's the nature of the beast. Clients who are chaotically using drugs are not reliable. So you can't book a time, a date and a place. It's better to be responsive to them as soon as they walk through that door. Yeah. And I can do that with my role. We can do that. And I think the duty team that I sit with, the beauty of the duty team is we respond to what's walking through the door. That's one of our main roles and responsibilities. So where we don't succeed with... People not turning up or people changing their mind or, you know, all the rest of it. When they do walk through the door, I'm ready for them.

SPEAKER_01 1:01:38

Yeah. That makes sense, doesn't it? Yeah. I think that's obviously the benefit of having the duty team. I know you often take on things that aren't necessarily your job description or in your responsibilities. Yeah. But such as like, I mean, do you know what? I find it weird that we used to just have one duty

SPEAKER_00 1:01:52

worker. How did we manage?

SPEAKER_01 1:01:55

I was thinking that. How did we manage? Now we've got an entire team. Yeah. It can still be a struggle,

SPEAKER_00 1:01:58

can't it? Absolutely. Yeah. But no, it's a fantastic team and I think we do, there's a lot of firefighting that goes on. I think when I was talking about that very poorly young woman, that incident from a few weeks ago, you know, duty as well as the other workers are involved, you know, It could have been worse.

SPEAKER_01 1:02:21

Yes, absolutely. Especially if it was just dealt with one person.

SPEAKER_00 1:02:24

Yeah, but it could have been worse. And, you know, we all pulled together, I think, there. Yeah, she's safe now.

SPEAKER_01 1:02:31

Good. And then lastly, can you give us a brief overview of the timeline and the steps involved in integrating these prevention and harm reduction approaches into the non-opioid use behaviour change group and the overall service offerings?

SPEAKER_00 1:02:43

So, there isn't a time frame. Because it will... It'll be continuous. It'll be continuous because until... And drug trends do change. Yes. You know, we didn't have crack like we did. But, you know, until a number of things change, the drug use we're talking about isn't going to change. And so it started and it ain't going to stop.

SPEAKER_01 1:03:09

Yeah.

SPEAKER_00 1:03:09

So there isn't a time frame because it's going to go on and it's going to go on and go on until we've got an all-singing, all-dancing, fantastic... option and offers for people when they come through the door and we're looking at their their need not what we need but what they need and we're ready to pounce

SPEAKER_01 1:03:29

sort

SPEAKER_00 1:03:29

it out

SPEAKER_01 1:03:30

Robbie anything you want to ask or add yeah just an opportunity for Ali to speak but anything particularly she wants on topic regarding any questions that we've missed out I guess is there anything I can't think of anything. Top of my head. To be fair, I think we've got quite a lot there. Obviously, I missed the first five minutes. No, that was fine. Everything else seems pretty on it. I'll just double check on the notes here one second. That's fine. Can you pass my phone, Robbie?

SPEAKER_00 1:03:59

Yeah,

SPEAKER_01 1:03:59

where is it? Prevention handbook. I don't know which one's yours or which one's Ellie's.

SPEAKER_00 1:04:04

It's in my bag.

SPEAKER_01 1:04:05

Oh, is it? Right, prevention, yeah, harm reduction, yeah, non-OCU, yeah, future bite-sized sessions, data we've discussed, you did that at the start, cannabis, ketamine, you've talked about the future of that, more information, no, that's it, I guess. Fabulous. Perfect. So, Ellie, I'm going to... I'm going to ask you ten questions again. I know we've done this before. Yeah, I'll come up with different answers. That's the interesting thing. See if your answers change. I like options, yeah. Because I can't remember what you said last time. Can you? I think for a couple. Let's see how we get on anyway. What's your favourite word?

SPEAKER_00 1:04:46

Shenanigans.

SPEAKER_01 1:04:48

Least favourite word?

SPEAKER_00 1:04:50

Brown or beige.

SPEAKER_01 1:04:51

Tell me something that excites you. Life. Tell me something that doesn't excite you.

SPEAKER_00 1:04:57

People who wear

SPEAKER_01 1:04:57

brown and beige. What sound or noise do you love? Wood pigeons. Sound or noise do you hate?

SPEAKER_00 1:05:08

Telephone ringing in duty.

SPEAKER_01 1:05:11

That tends to fat out. What's your favourite curse word?

SPEAKER_00 1:05:14

The C word.

SPEAKER_01 1:05:16

What profession other than your own would you like to attempt?

SPEAKER_00 1:05:19

I would, I know this is the same. I would like my own funeral parlour where I do the make-up and the only option is festival.

SPEAKER_01 1:05:27

Nice. If you come to this funeral parlour, you're getting festival. Yeah. Brilliant. It'll be called glittered up to fuck. Yeah, nice. You can see that on the top of the door. Tell you what, what profession would you not like to do?

SPEAKER_00 1:05:42

Oh, cleaner.

SPEAKER_01 1:05:44

Cleaner. Yeah. Fair. And then if heaven exists, what would you like to hear God say when you arrive at the pearly gates? About fucking time. Brilliant. Brilliant. Ellie, thank you so much for coming on. Always appreciate it. You've been absolutely wonderful. Thank you. And if you enjoyed this episode of the Believe in People podcast, don't forget to check out our other episodes and hit that subscribe button. Follow us on Facebook, Twitter, Instagram, and TikTok. Our name is CGL Hull. That's C-G-L-H-U-L-L. We're on iTunes, Spotify, Amazon, and Google Music. So please like and subscribe to receive regular updates. You can also search for Believe in People podcast on your favorite listening device. And if you could leave us a review, that will really help us with getting our message out there and rising up the daily podcast charts.