Worcestershire: Peer outreach support for people with substance misuse issues

Worcestershire is a largely affluent county which includes a mix of rural and urban areas. There are significant health inequalities in the county’s most deprived areas, where life expectancy is on average 7.9 years lower for males and 5.6 years lower for females. 

It is estimated that there are more than 2,000 opiate and crack users across Worcestershire. As in the whole of England, the number of deaths from drug misuse has increased in recent years. In the two-year period 2013-15 there were 59 drug deaths in Worcestershire; in 2020-22 there were 80 deaths. Just over 50 per cent of drug users in the county are thought to engage with community treatment services.

As well as improving the health and wellbeing of individuals, the benefits of increasing the number of people accessing substance misuse services extend to the wider community. Dr Lisa McNally, Worcestershire’s Director of Public Health, explained: “These individuals are often socially excluded, especially if they have a history of offending. That exclusion pushes them more towards the companionship of drug gangs and other criminal groups, so our success in reaching out to them benefits the whole community.” 

In line with the national drug strategy ‘From harm to hope’, Worcestershire is taking steps to increase the number of people in contact with treatment services. This includes recognising that some people do not trust the ‘system’ or feel alienated from services due to difficult past experiences. 

Rather than expecting people to come to a service, the focus is on taking services to people. Trusting relationships are key to success, so this outreach is particularly effective when provided by someone who has lived or living experience of substance misuse.

In Worcestershire, public and voluntary sector partners came together to design a new service model with a focus on engaging individuals who might not ordinarily access treatment services. The interventions were co-produced by service users, providers and commissioners. 

Peer delivery is a critical part of this model. One element involves volunteers with lived experience supporting others in similar circumstances as ‘recovery champions’. These volunteers have completed their own treatment and resolved their problematic substance use. 

Another element is the PACKS project (peer assisted community and knowledge). Run by Cranstoun Worcestershire, this involves service-user volunteers who are still involved in their own treatment. This ‘living experience’ means they have close connections with the drug-using community – connections that professionals, for reasons of trust, would struggle to achieve. 

The PACKS volunteers can use these trusted connections to engage with people who might not usually access, or be aware of, support services. A small group of three volunteers were identified who were in treatment and wanted to give something back to the community. When asked why they had got involved, one volunteer explained that they were ‘sick of my mates dying’. 

Following training, they provide harm reduction advice in the community and deliver naloxone, a medication used to restore breathing after opioid overdose. They distribute naloxone to the friends and family of drug users and have supported with distribution of naloxone packs, which also include gloves, a face shield, a brief instruction card and a torch. 

Their harm reduction outreach activity can be as simple as providing a bottle of water on a hot day to prevent dehydration, or providing some food to someone who has been street-drinking. They can also link people to other support such as the outreach and engagement nurse, outreach clinics and outreach recovery workers. 

The PACKS volunteers receive ongoing support and supervision from Cranstoun and can access other training and development opportunities. They have shared that being involved in the project has made them feel part of something meaningful and boosted their self-esteem. 

The volunteers have representation at the local substance misuse oversight group, which feeds into the region’s Combatting Drugs Partnership. They have supported with the training of other partner agencies and attended national conferences. Being involved provides them with an opportunity to learn new skills that they can use outside of their involvement in the PACKS project. 

In the first year of the PACKS service: 

• 1,259 naloxone kits were distributed by Cranstoun to service users, family members and professionals following harm reduction training. 
• 75 naloxone kits were distributed directly by the PACKS team to individuals not known to services. 
• At least five of the PACKS-distributed naloxone kits have been used in life-saving overdose response. 

Matt Burke, County Manager for Cranstoun, said the volunteers reach people who would not otherwise engage with services but will accept training, harm reduction advice and intervention from a peer. 

In some cases, the overdose prevention kits have been used and a replacement requested. Each request could indicate a life saved. The volunteers have responded to overdose situations and provided crisis interventions with individuals during their community outreach activity.

The project prioritises supporting the recovery of the PACKS volunteers, particularly their personal and professional development. Andy Boote, Worcestershire Council’s Head of Service for Safer Communities, said: “These are people that are still using but are receiving support. This ‘giving back’ is part of their recovery. What is unique here is the liaison between peers and clinical services. It has given us the ability to get to communities that would otherwise not engage with us.”