Important Factors for the Scottish Task Force on Drug Related Deaths to consider

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15 October 2019

Scotland's Governmental Drug DeathsTask Force aims to drive action to improve the health outcomes of people affected by drug use. Here we share what we believe to be the the urgent steps that should be taken.  

 

 

Important Factors for the Scottish Task Force on Drug Related Deaths to consider

 

What urgent steps should we be taking to reduce the level of drug related deaths in Scotland?

 

 Summary

 1) Follow the evidence base on how to engage and treat people at risk as a result of their drug use.

 2) Fund services adequately and ensure that the full range of services proven to engage and treat are available in all ADP areas.

 3) In areas of high levels of drug related deaths create a mechanism for effective multi- agency multi-disciplinary working to understand the trends and risks and to create local tailored solutions to them.

 4) Avoid politicising drug treatment and provide effective leadership to galvanise the substance misuse sector to work in consensus on addressing this health issue

 

1) Follow the evidence base on how to engage and treat people at risk as a result of their drug use.

The most effective way to reduce the risk of death from drug use is to engage someone in effective targeted person-centred treatment.

The evidence base for treatment is set out in the UK Drug Misuse and Dependence Clinical Guidance [1] and Nice Guidance [2].

There are, in both of those documents, a range of interventions and approaches that can be used to support people at different stages of their drug use and addiction and to suit the myriad of care needs amongst  people seeking treatment. Broadly we can segment the treatment approaches into pharmacological interventions and psychosocial interventions, both equally important to any treatment approach.

Evidence Based Pharmacological Interventions

  • involving medication either to substitute for and reduce the harms associated with the drug they are using

  • part of this approach can also be used to over time reduce peoples’ use of any type of drug or substitute

Evidence Based Psychosocial Interventions

Many people who come into treatment want to change some very entrenched behaviours requiring concerted effort and a range of internal and external resources.

That requires other interventions, in addition to the pharmacological approaches, to support people with that psychological and social change including

  • support with motivation to change

  • highly structured interventions that support people with some of the factors that may have caused their substance misuse

Social interventions can be as basic as providing food and housing to supporting people to develop positive relationships with friends and family within their community.

These psychosocial interventions are critical to someone sustaining their treatment gains and building a life they want in recovery after treatment.

The 2017 version of the Clinical Guidance responded to the changing drug use and provided

‘a more explicit focus on individually defined recovery journeys with an enhanced focus on keyworking and care planning that integrates support for pharmacological and psychosocial interventions, and peer engagement and mutual aid.’[3]

The comprehensive evidence base approach contained in the Clinical Guidance establishes a clear ‘manual’ on how to engage and support people in treatment. As the UK Guidance itself points out;

One of the challenges during the lifespan of the 2017 Clinical Guidelines will be for planners and commissioners, with assistance from clinicians, to continue to deliver the different forms of appropriate treatment as well as to improve outcomes, when resources may be more limited.’

We are aware that in the first meeting the Task Force considered pharmacological interventions however we would urge them, in line with the UK clinical guidance, to consider the psychosocial interventions that are crucial to any approach to reduce drug related deaths.

2) Fund services adequately and ensure that the full range of services proven to engage and treat are available to everyone and in every region

It is clear there has been a reduction in the amount of money being spent on treatment nationally and locally. Some regions are more adversely impacted than others and we would urge the Task Force to take a close look at the reduction in treatment spend across Scotland.

The additional funding identified by the Scottish Government is welcome. Targeting this spend on evidence-based treatment and filling in the gaps of current provision in local areas would be the best use of resources.  For example,

  • outreach and needle exchanges are effective ways of engaging people into treatment and are not consistently available across the country

  • some of the additional funding has been identified for addressing homelessness and Housing First approaches. Whilst there is a growing evidence base for the value of Housing first on most homeless populations there is no evidence to date to show that this approach supports people who use drugs to reduce risk.

    Some approaches have been cut disproportionately. There have been claims in the press [4] in the last few months that drug spend has been cut by 6% over the last 5 years. However, funding for accommodation-based drug treatment has been cut by 30% in Glasgow in the last year and abstinent based accommodation is now only available to 14 people at any point, through 1 residential rehab.

    This severe cut in capacity, choice and person-centred treatment duration is entirely at odds to the evidence base. Increasing numbers of people in need of treatment have complex physical issues and have experienced trauma. This requires specialist services to deliver the appropriate programme of support. As funding has been reduced these specialist approaches are being restricted locally and nationally.

3) Create a mechanism for effective multi-agency multi-disciplinary working in areas of high levels of drug related deaths, to understand local trends and risks and to create local tailored solutions.

In 2017 an expert group of clinicians, third sector providers and researchers established a set of good practice principles to support the sector to respond to the increasing levels of drug related deaths.[5] This document creates a set of best practice principles with some practical suggestions on how to overcome the blocks in implementing evidence-based practice. The key recommendations from that work include

1) Drug treatment services should review their information systems to enable data relevant to risk of overdose to be captured and deployed to inform individual treatment plans.

2) Treatment plans should be consistent with the 2017 Clinical Guidelines and should be individually tailored to balance the protective benefits of OST with the opportunity to safely progress towards recovery. Providers and commissioners should guard against forced reductions or premature removal from treatment in a desire to achieve targets.

3) All providers should establish clear protocols for managing the risk of overdose and ensure their staff are competent to implement them. This should include ensuring naloxone is widely available.

4) Commissioners and service providers have a responsibility to maximise their contribution to addressing all the physical and mental health needs of service users, ensuring these are met either within their own services or by effective engagement with timely and appropriate access to primary care and specialist services in the NHS. This includes ensuring that more people are tested and treated for hepatitis C.

5) Commissioners and treatment systems need to increase local penetration rates to reduce deaths among those who are currently not engaged in treatment or in contact with harm reduction services. Fundamental to this is promoting and expanding access to needle and syringe programmes.

In many of the areas affected by high level of drug related deaths we need to improve

  • the support offered to people with co-occurring mental health and drug problems

  • our multidisciplinary approach to older people using drugs and experiencing the physical health impact of sustained use

  • our response to people affected by trauma – which needs focus and specialist support to develop new approaches based on latest evidence in this area of practice.

Again, there is a wealth of good practice guidance and evidenced based approaches on how to address these specific issues.

 

4) Avoid politicising drug treatment and provide effective leadership to galvanise the substance misuse sector to work in consensus on addressing this health issue

People who use drugs (in ways that present significant risk to themselves and others) are some of the most stigmatised people in our communities. The issue of drug use has become incredibly politicised, it is the issue that at a national and local level is used by all political parties to score political points in an effort to get traction with the electorate.

However, problematic drug use is a health condition. The causes of problematic drug use often derive from people’s experience of poverty and social deprivation. People who need support for their drug use deserve the same human rights, respect, dignity and attention as people experiencing any other health condition.

We are hopeful the Task Force will provide effective leadership to galvanise the sector in Scotland to achieve a consensus.

 

It is vital the experiences of people who are directly affected by drug related deaths including people use drugs, bereaved families and loved ones and people who are in recovery, should equally be respected and valued as they would be in any other public health crisis.

The sector division evident in much of the public narrative currently only gives licence for disinvestment and lack of focus on this serious health and social issue.  

 

We hope that our suggestions are useful to this important work and we wish the Task Force the very best in their endeavours.

Phoenix Futures is a registered charity in England and Wales (No 284880) and in Scotland (No SCO39008); Company Limited by Guarantee Number 1626869; Registered Provider of Social Housing with Homes England (H3795).