Health Care Assessments
An early assessment of the general health of a person with a drug problem is an important part of drug treatment. This section contains the best practice guidelines on general health care assessments.
This section has been adapted from the Drug Misuse and
Dependence UK guidelines on clinical management, 2007 edition
(otherwise known as the Orange book).
An early assessment of the general health of a person with a
drug problem is important and may best be done by the person doing
the first assessment. This person is not always a GP or a clinician
in the drug treatment service. The drug treatment prescriber
should make sure that health care assessment, screening and
management are given for each patient-especially where drug
treatment is being provided for a person who is not registered with
a GP.
It is good practice to do a general health care assessment and
to decide whether or not an intervention is appropriate and also if
it is urgent. Sometimes it will be appropriate if there is a
need, for urgent treatment of a medical condition which may be
caused by the persons drug use, but not always. If the person
doing the assessment has concerns, a referral to a medically
qualified person or a specialist clinic can be made.
This clinic may be a drug or alcohol service or a clinic dealing
with, for example, liver problems, cardiac (heart) and vascular
(blood vessels which are part of the circulatory system), problems
or respiratory (breathing) diseases.
The main aim of the general health care assessment is to find
out if the person has some needs that have not been met. This
will also give the service more information about how to ensure
that the drug treatment does not make any condition worse. A
general health care assessment provides the person with an
opportunity to have health care treatment for an illness that could
have been a problem for some time. Better general health will
have a positive effect on the drug treatment process for the
person.
Using drugs over a long period of time may have a negative
effect on health; it would not be comfortable for the person, or
possible for the worker to cover all the areas in one
assessment. Drug treatment provides drug users with on-going
access to medical and social help; this means that the less urgent
health issues can be followed up. Accessing treatment also
gives people the opportunity to learn more about reducing the risks
to their health in the future.
What to expect
Health Questions:
There is an overlap between the questions asked specifically in
relation to health needs and those addressed as part of a full drug
assessment. When a person attends a general health care
assessment these are some of the questions they will be asked to
get a good understanding of their health needs.
- Presenting symptoms and why the person feels the assessment is
taking place, e.g. why are they seeking drug treatment
- Past medical problems such as operations, injuries and time in
hospital
- Psychiatric history and current symptoms
- Drug-related problems such as abscesses, venous thrombosis,
septicaemia, endocarditis and constipation
- History of accidental and deliberate overdose
- HIV or Hepatitis infection current or in the past. It is
important to find out if the person is, or has put themselves at
risk by sharing injecting equipment or had a homemade tattoo
- Contraception history and cervical screening, menstrual and
pregnancy history in women. Drug use can interfere with
periods for women, so talking about this issue is important
- Sexual health and sexually transmitted infections in the
past
- Oral health
- Current and non prescribed medications including cigarette,
cannabis and alcohol consumption, and over the counter
medicines
- Any allergies or sensitivities
For the person seeking drug treatment this is a lot of
information to give to someone they may never have met
before. Giving honest and full answers will enable the drug
treatment team to ensure that any health issues are treated.
Physical examinations and assessments
The following examinations and assessments take place early in
the assessment process.
- Assessment of the person’s mental health
- Assessment of injection sites in all limbs and inguinal
(groin), if injecting or injected in the past. This may not be very
comfortable for the person, but drugs can mask injuries as the
person does not feel the pain when using drugs. Vein care is
important as veins do not grow back and it is possible to get
advice and support about vein care during and after this first
assessment
- Measurement of weight and height
- Urine testing for common conditions such as diabetes and
infection. During drug use a person may not be aware of some
of the symptoms of a condition like diabetes, but finding out about
these conditions is an important step as they can be treated
- Blood pressure measurement
- General impression of respiratory (breathing), cardiovascular
and other systems, paying attention to symptoms offered and
complaints given.
Initial management of general health and drug-related
problems
Listed below are the interventions which may take place with a
drug user; this may be a single session or an on-going
process. Opportunities to treat or prevent illness should not
be missed, as drug treatment and health care treatment can be
interrupted due to events in the drug user's life.
- Treatment of acute episodes of illness
- Information and advice about Hepatitis B
- Immunisation against Hepatitis A and B
- Counselling and advice about testing for a blood-borne virus
infection
- Testing for blood-borne virus infections and referral for
treatment if required
- Cervical cancer screening
- Point of contact for general health information
- Treatment of direct complications of injecting, including deep
vein thrombosis and abscesses
- Safer injecting advice and provision of injecting
paraphernalia
- Contraception advice
- Safer sex advice and referral to sexual health
services.
It should be remembered that drug users, like others, are at
risk from all diseases and should be included in screening
programmes and health assessments. They are, in addition,
susceptible to an increased range of problems and early onset of
some degenerative diseases because of their lifestyle and risk
activities.
Drug misusers may suffer from poor nutrition but should receive
oral nutrition support only if there are clear medical reasons to
do so. Advice on diet and nutrition should be given,
especially if they are drinking heavily.
Supporting Documents