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Screening heroin smokers attending community drug services for COPD

More heroin users now administer the drug by inhalation than by injection, which has led to an increase in respiratory disease in this population. Heroin smokers typically engage poorly with screening and disease prevention initiatives, contributing to poor health outcomes compared to non-heroin smokers including more severe respiratory symptoms, undertreatment and high rates of hospitalisation for COPD exacerbations. In contrast, attendance at key worker appointments remains very high as the receipt of methadone prescriptions is dependent on regular attendance at community drug services. These meetings present an opportunity for increased engagement of heroin smokers in screening and treatment programmes for respiratory diseases.

The aim of this cross-sectional study was to establish whether COPD screening of a large population of heroin smokers at community drug centres is deliverable and whether the initiative would be acceptable to drug users. Furthermore, this study sought to investigate the relationship between heroin inhalation and lung damage.

The study recruited 1,082 heroin smokers who were visiting community drug services in Liverpool between December 2015 and June 2016. Of these, 753 (73% of those approached) completed spirometry screening for COPD and completed questionnaires assessing quality of life, respiratory symptoms and use of other substances.

The study found that most heroin smokers had either COPD (39%) or combined features of COPD and asthma (15%). The length of time that individuals had been smoking heroin, crack and cigarettes were strongly associated with respiratory disease diagnosis; however, spirometric measures were not associated with tobacco/drug exposure. Heroin smokers largely considered combining healthcare appointments with drug key worker appointments to be an acceptable initiative, with 92% responding that they were happy with this arrangement.

In conclusion, pairing healthcare assessments with drug key worker appointments could be an effective measure in increasing engagement with respiratory disease screening in heroin smokers. Such an initiative would provide increased opportunity to treat respiratory symptoms and reduce the risk of long-term respiratory complications in this high-risk population.

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