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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