Catriona Matheson Chair, DDTF Professor in Substance Use, University of Stirling Freelance Research Consultant
Where are we now? • In the midst of a public health crisis of avoidable drug related death • In the midst of a global pandemic
Plan • Describe the work of the Drug Death Taskforce • Share some research findings related to drug use since COVID • Share examples of good practice from across Scotland • Consider what else we should and could do to tackle drug related deaths • Where are we now?
I hated my life. I was suicidal. I was as low as you could get. And if I hadn’t got brought in here, [homeless hostel] it was a daily thought about buying loads o’ Valium, getting a tenner bag o’ heroin, waiting until the valium are fully on me, … and inject the heroin, and hope… hopefully, overdosing. And that’s how low my life had got. And I’d actually tried it a few times but I just kept wakening up". Deaths of despair (male early forties) Hamilton E. (2018) A Theory of Isolation and Loneliness in older men who inject drugs in Glasgow. Masters thesis, University of Glasgow.
Remit A Ministerial Taskforce – report to the Minister for Public Health, Sport and Wellbeing. Examine the key drivers of drug deaths, Advise on further changes in practice and/or changes in the law that could help to save lives and reduce harm. Approach Public Health, Evidence Based: Evidence into Action Membership Leads from organisations and professional groups – people who have power to drive change across NHS/criminal justice/public health/police/ ambulance/ COPFS/RCP/RPS/RCGP People with lived experience /Third sector representation/ Alcohol and drug partnerships.
Drug Deaths Taskforce: work strands Emergency Response • Maximise naloxone distribution • Rapid response for non-fatal overdoses (NFO) Multiple Complex Needs Medication Assisted Public Health Criminal justice and Treatment Surveillance legislation (those most at risk) • Standards for optimal • Developing a • Mental health • Treatment delivery of care responsive, national comorbidity opportunities in CJS public health • Rapid access • Physical co-morbidities • Transitions from surveillance system criminal justice • Choice • Housing/welfare • Legislation changes • Trauma informed • Psychosocial support Stigma strategy Covid recommendations
Strategic Evidence Based Approach naloxone People experiencing an overdose Emergency management Non fatal overdose pathway Medication assisted People who use drugs treatment Reducing risk Addressing complex needs Public health surveillance Families Communities Reducing Changes to legislation? or diversion to treatment? workforce vulnerability Addressing stigma
Naloxone Distribution: what is being done • Winter shelters and homeless hostels • Peer to peer distribution • Ambulance pilot in Glasgow, now also Aberdeen, Lothian, Borders – rolled out nationally • Community pharmacy distribution • Police pilot – planning a pilot for Police carriage of intra-nasal naloxone • Lord Advocate Statement of Prosecution Advice – COVID • Nyxoid (intra nasal) from POM to P
Naloxone supply Health board specific initiatives LA statement of prosecution guidance Source: Public Health Scotland management data
COVID Related Initiatives - Naloxone Supply Since the Lord Advocate statement (April) 39 outlets registered to allow 440 more people to distribute naloxone. Not aware of any adverse reports relating to inappropriate naloxone administration. Scottish Families Affected by Alcohol and Drugs started a postal service 139 kits supplied so far – 60% were first supplies
COVID – Impact on People who Use Drugs • Taskforce recommendations Concerns of Increased risk •Consider PWUD a ‘vulnerable’ group Pre-existing health conditions • Use of safe storage boxes Large volumes of drugs • Home delivery service • Increase naloxone supply (including all prisoners on No evidence of release) increased DRD or increased susceptibility to • Drug and alcohol services a priority Covid Services Impact • No staff re-deployment Staff: Less staff • Phones and data supplied • Prioritise outreach Delivery: Less face to face
Covid Good Practice Initiatives Edinburgh Partnership Initiative Edinburgh Access practice, Spittal St wellbeing “We s tart by seeing the person”. A centre, NHS harm reduction team person centred, trauma informed, • Support the most vulnerable during covid coordinated co-production partnership approach to complex human needs. • no-wrong door policy: - rapidly addressing patient identified care needs • outreach clinical service Taskforce funding to support the • someone who had a non-fatal overdose was continuation of this service. tracked down and offered to start treatment • - direct help with food, clothing, benefits, GP liaison, GP registration, essential medical care, liaison with housing, social work or community policing, arranging intermediate care. • virtual psychosocial groups, virtual one to one therapy, home visits for titration or provision of depot buprenorphine (Buvidal)
Research into the Impact of Covid on PWUD • 29 interviews (Edinburgh, Glasgow, Stirling and Dundee) • Explored the impact of covid restrictions on supply, use of services, and health • Impact on Drug Markets CSO funded research Universities of Stirling (Matheson, Parkes, Schofield) and Edinburgh (Bancroft)
COVID - Impact on Supply (research findings) A common experience was being ‘bumped’ - sold Participants spoke of having to wait significantly longer for something other than what was agreed. dealers, who would give times and locations for transactions but then push times back. Desperation (due to withdrawal) coupled with the Dealers’ concerned about surveillance amid deserted hurriedness of transactions led to multiple individuals streets. being sold soap and/or candle wax. After a dip in April, supplies returned to normal in May. Mask wearing by dealers to avoid identification rather Quality of heroin reportedly decreased. than Covid . Crack could be a NPS rather than cocaine. Cannabis quality the same .
Impact on PWUD Aye, there was a few of us that got rapid prescribed, the same day, or the following week, and one of my pals, it was Well I’m on a script now,….so … the woman actually, it was [CPN name] that actually went up on the heroin side of it, I’ve where he was sitting begging, and she give him a drug test, never had a script, it was like he went round the back of the bank, gave a urine heroin every day as you know, sample ………… but now I’m on a script, it’s not R: Did you refer him? heroin every day, it’s only M: ………..I told her where the guy had sat….….. and heroin if I feel like treating she went up and started him on a prescription that myself, day……………that stopped him begging and he’s in [Hostel name], he’s doing alright now. 46 yr old man 50 yr old man
Moving Forward: what else we could do • Drug testing capacity – plan in development • Safe drug consumption sites – not legally possible at the moment • Tackling the availability of large quantities of very ‘cheap’ street supplies of benzodiazepines – pill press licensing/ clinical intervention/ education • Opportunities to access treatment/support via criminal justice system
Brit itis ish Colu lumbia DRD data: tim ime from decla laring a Public lic Healt lth emergency to im impact (s (sou ource: pres esen entation B B Pauly ly, Du Dundee ee March 2019)
Where are we now? • In the midst of a public health crisis – strategic programme of measures being implemented or tested ( there is no single magic bullet!) • In the midst of a global pandemic – embrace the opportunities
https://drugdeathstaskforce.scot/
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