Catriona Matheson Chair, DDTF Professor in Substance Use, - - PowerPoint PPT Presentation

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?

Hamilton E. (2018) A Theory of Isolation and Loneliness in older men who inject drugs in Glasgow. Masters thesis, University of Glasgow.

(male early forties)

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

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.

Remit

Drug Deaths Taskforce: work strands

Medication Assisted Treatment

• Standards for optimal

delivery of care

• Rapid access
• Choice
• Trauma informed
• Psychosocial support

Public Health Surveillance

• Developing a

responsive, national public health surveillance system Multiple Complex Needs (those most at risk)

• Mental health

comorbidity

• Physical co-morbidities
• Housing/welfare

Criminal justice and legislation

• Treatment
• pportunities in CJS
• Transitions from

criminal justice

• Legislation changes

Emergency Response

• Maximise naloxone distribution
• Rapid response for non-fatal overdoses (NFO)

Stigma strategy Covid recommendations

Strategic Evidence Based Approach

naloxone Non fatal

• verdose

pathway Medication assisted treatment Addressing complex needs Public health surveillance Changes to legislation? or diversion to treatment? Addressing stigma

Emergency management Reducing risk Reducing vulnerability

People experiencing an overdose People who use drugs Families Communities workforce

• 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 Distribution: what is being done

Naloxone supply

Health board specific initiatives

LA statement of prosecution guidance

Source: Public Health Scotland management data

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 Related Initiatives - Naloxone Supply

COVID – Impact on People who Use Drugs

• Taskforce recommendations
• Consider PWUD a ‘vulnerable’ group
• Use of safe storage boxes
• Home delivery service
• Increase naloxone supply (including all prisoners on

release)

Concerns of Increased risk Pre-existing health conditions Large volumes of drugs

• Drug and alcohol services a priority
• No staff re-deployment
• Phones and data supplied
• Prioritise outreach

Services Impact Staff: Less staff Delivery: Less face to face

No evidence of increased DRD or increased susceptibility to Covid

Covid Good Practice Initiatives

Edinburgh Partnership Initiative Edinburgh Access practice, Spittal St wellbeing centre, NHS harm reduction team

• Support the most vulnerable during covid
• no-wrong door policy: - rapidly addressing

patient identified care needs

• outreach clinical service
• someone who had a non-fatal overdose was

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

• f depot buprenorphine (Buvidal)

“We start by seeing the person”. A

person centred, trauma informed, coordinated co-production partnership approach to complex human needs.

Taskforce funding to support the continuation of this service.

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)

Participants spoke of having to wait significantly longer for dealers, who would give times and locations for transactions but then push times back. Dealers’ concerned about surveillance amid deserted streets.

A common experience was being ‘bumped’ - sold something other than what was agreed. Desperation (due to withdrawal) coupled with the hurriedness of transactions led to multiple individuals being sold soap and/or candle wax. Mask wearing by dealers to avoid identification rather than Covid. Quality of heroin reportedly decreased. Crack could be a NPS rather than cocaine. Cannabis quality the same.

After a dip in April, supplies returned to normal in May.

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 the woman actually, it was [CPN name] that actually went up where he was sitting begging, and she give him a drug test, like he went round the back of the bank, gave a urine sample………… R: Did you refer him? M: ………..I told her where the guy had sat….…..and she went up and started him on a prescription that day……………that stopped him begging and he’s in [Hostel name], he’s doing alright now. Well I’m on a script now,….so …

• n the heroin side of it, I’ve

never had a script, it was heroin every day as you know, but now I’m on a script, it’s not heroin every day, it’s only heroin if I feel like treating myself, 46 yr old man 50 yr old man

• 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

Moving Forward: what else we could do

Brit itis ish Colu lumbia DRD data: tim ime from decla laring a Public lic Healt lth emergency to im impact

(s (sou

• urce: 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/