Although smoking-related respiratory disease contributes to the excess mortality in drug and alcohol addiction, screening for lung disease is not routinely offered in community drug and alcohol treatment services. We have established a Lung Health Clinic in our Community Drug and Alcohol Team (CDAT) in Lambeth.
Over 80% of alcohol dependent patients smoke and rates in opioid dependence approach 100%. This marginalised group struggle to access health care in both primary care and acute secondary care settings. However, addictions services struggle to meet the complex physical health needs of this group. We brought smoking cessation and respiratory care to addiction patients in an environment where these patients felt comfortable. This was with the aim of improving their quality of life, reducing drug related deaths and reducing the use of acute hospital settings.
Mr M is a man in his mid-fifties with a life long history of nicotine dependence who was the main carer for a disabled partner. A lifelong user of opioids, no longer using illicit drugs, but stabilised on methadone. Struggling increasingly with breathlessness.
What was involved?
Reuben Cole, non-medical prescriber at Lambeth Addictions Treatment consortium who led this project from an addiction perspective, said:
We engaged Mr M around both his smoking and investigated his lung function through specialist assessment. He was prescribed nicotine replacement therapy and was able to reduce his nicotine dependence.
Specialist assessment of his lung function on site in the addictions service allowed the diagnosis of COPD and appropriate treatment, for the first time in Mr M’s case.
What works well?
- collaboration between addictions and respiratory clinical staff
- the delivery of physical healthcare where patients are, rather than where health services want them to be
- the co-location of smoking cessation services with community drug and alcohol services
- collaboration between different commissioners - CCG and local authority
- co-design of services with service users
What could be better?
We need to break down further the barriers between primary and secondary care for groups of service users who struggle with this traditional model:
- drug and alcohol dependent
- severely mentally ill
All relevant patients are offered smoking cessation, and harm minimisation advice including e-cigarettes. Those exhibiting signs and symptoms of respiratory disease are offered assessment by a lung health service.
Contact: Dr Michael J Kelleher or Reuben Cole, South London and Maudsley NHS Foundation Trust.