Drug Deaths Task Force: Research Fund

Aileen O’Gorman (University of the West of Scotland) and Anne Whittaker (University of Stirling)

Aims and Objectives: To examine how Primary Care Teams in areas of extreme deprivation respond to drug-related harms, in order to inform future policy, practice and research on the prevention of drug deaths.

Background and Methods: ‘Deep End’ GPs provide universal health care for individuals, families and communities in areas of extreme deprivation. This study combines complex systems mapping and interviews with GPs, patients, family members and other stakeholders to explore models of care and interventions delivered by two Deep End GP practices. In-depth case studies will illustrate the role and potential of Primary Care in the prevention of drug-related harms and deaths, as well as the impact COVID-19 has had on how GPs provide care for people who use drugs.

Research team: Aileen O’Gorman; Anne Whittaker; Alison Munro; Stewart Mercer; Roy Robertson; Betsy Thom; Andrea Mohan; Joan Love; Wesley Steele.

Andrew McAuley (Glasgow Caledonian University)

Aims and Objectives: To measure the risks of mortality related to problem drug use in Scotland, and determine to what extent specific interventions Medication-Assisted Treatment (MAT) and Take-Home Naloxone (THN) are protective against drug-related deaths.

Background and Methods: This study adopts a quantitative approach to estimate the extent to which MAT is protective against DRD in Scotland, and how this effect varies over time and by key factors such as age, sex, homelessness, injecting, co-morbidity, co-prescription, MAT episode duration, and MAT engagement. This is a secondary data analysis using a pre-linked dataset by PHS which includes prescription data, treatment waiting times, acute hospital inpatient and psychiatric data, deaths and laboratory diagnostics data. For THN, a quantitative time-series analytical approach will be used to estimate the impact of Scotland's National Naloxone Programme in preventing (a) drug-related hospital admissions and (b) deaths related to opioid-overdose.

Research team: Andrew McAuley; Sharon Hutchinson; Matthew Hickman; Peter Vickerman; Hayley Jones; Hannah Fraser; Lee Barnsdale; Saket Priyadarshi; Dave Liddell

Mathew Smith (Glasgow Caledonian University)

Aims and Objectives: To understand the impact of the Naloxone Peer Training and Supply Programme (NPTSP) at the individual and community level, and develop good practice learning to inform scale up of peer to peer naloxone supply across Scotland.

Methods: This study adopts a mixed methods approach. First, secondary data analysis using NHS data of naloxone distribution to describe: the sites of supply; number of naloxone kits supplied; numbers of people supplied to; and type of person supplied (person at risk, family member etc.) Second, focus groups and semi-structured interviews will be carried out with programme facilitators, peer workers, and programme recipients to explore: training experiences; programme effects on participants; strengths and weaknesses of the peer approach; what works and does not work for whom, where and why; potential programme improvements and key aspects for scale up; and adaptation of the programme in the context of COVID-19.

Research team: Mathew Smith; Andrew McAuley; Hannah Carver; Kirsten Horsburgh

Rebecca Foster (University of Stirling)

Aims and Objectives: To Identify 1) how DCRs are perceived, and what factors shape such perceptions; 2) whether/how such factors influence (potential) decision-making (e.g. if decision-makers would support implementation; if family members would encourage their loved one to use DCRs); 3) barriers/facilitators to implementation of DCRs in Scotland; 4) for strategic decision-makers, exploring anticipated workforce needs/adjustments within organisations to ensure such factors are addressed in readiness for potential implementation.

Background and Methods: This is a piece of primary research which collects qualitative data from semi-structured interviews with strategic decision-makers from relevant disciplines/structures (e.g. Substance Use & Mental Health Treatment, Alcohol & Drug Partnerships, Health & Social Care Partnership Commissioning, Police Scotland, Community Justice, Community Planning Partnerships, Integration Joint Boards) as well as affected family members closely related to people likely to use, or directly benefit from, DCRs, namely those who are actively using drugs, particularly those who are injecting drugs.

Research team: Rebecca Foster; Tessa Parkes; James Nicholls; Andy Perkins; Wulf Livingston; Tracey Price; Josh Dumbrell; Kirsten Trayner; Harry Sumnall

George Provan (Simon Community Scotland)

Aims and Objectives: To conduct a pilot randomised controlled trial (RCT) of the PHOENIx intervention, generate sufficient information on recruitment, intervention fidelity, retention, sample size, resource use, outcomes and perspectives of patients, to demonstrate an impact on non-fatal/fatal overdose, and inform a subsequent definitive RCT.

Background and Methods: This is a pilot RCT with embedded qualitative and economic evaluation which builds on previous feasibility work. A mixed methods approach is taken which includes both quantitative, qualitative and economic perspective on an intervention. The assertive outreach intervention is centred around the relationship between pharmacist independent prescribers working in partnership with Simon community partnership (SCS) workers and patients who are homeless and have overdosed on drugs. The intervention ensures wrap around and out of hours care is provided, after hospital/Emergency Department discharge, through assertive outreach, acting as a bridge back to mainstream care. Specifically, a pharmacist or nurse prescribes, treats, refers, and the team take the patient to Alcohol and Drug Recovery Services for same day re/initiation or dose increase, and follow up. Full harm reduction interventions. SCS worker addresses housing, benefits, advocacy, social prescribing.

Research team: George Provan; Tricia Imrie; Richard Lowrie; Chris Johnson; Andrew; McPherson; Kate Stock; Megan Knapp; Sharon Lucey; Cian Lombard; Ruth Spencer; Laura Sills; Andrea Williamson; Margret Montgomery; Jenifer Hislop; John Campbell; Lynn MacDonald; Dave Liddell, Donogh Maguire; Vibhu Pauydal; Frances Mair; Steven Wishart; Clare Duncan

Niamh Fitzgerald (University of Stirling)

Aims and Objectives: To describe the nature, circumstances, paramedic experiences, and management of drug overdoses presenting to Scottish Ambulance Service, to inform future practice, and local and national interventions to reduce drug-related deaths in Scotland.

Background and Methods: This study adopts a mixed methods approach by carrying out a descriptive analysis using secondary data to summarise the characteristics and outcomes of overdose-related ambulance call-outs, including geographical variations, patterns in terms of time of day/day of week, and changes over time. Semi-structured interviews with Scottish Ambulance Service staff will contextualise this data; capturing views on barriers and facilitators to optimal clinical care and patient outcomes, and on local approaches to service provision and information sharing.  Finally, the team will explore opportunities to do further analysis of existing ambulance and Public Health Scotland data to add to understanding of fatal and non-fatal overdoses, care provided, and opportunities for earlier intervention.

Research team: Niamh Fitzgerald; Jim Lewsey; Joe Schofield; Allison Ford; Gary Rutherford

Joe Schofield (University of Stirling)

Aims and Objectives: To describe the prevalence, characteristics, and patient outcomes associated with benzodiazepine (BZD) prescribing among people receiving opiate replacement therapy (ORT) in Scotland.

Background and Methods: This is a piece of primary research, using data gathered from a retrospective cohort of people who are representative of those who received ORT from a specialist addiction service in four Health Boards (Lothian, Ayrshire and Arran, Greater Glasgow and Clyde, and Tayside). Health board data on patient characteristics and outcomes will be securely linked to national data on prescriptions, hospitalisation, DRD and all-cause mortality. A survival analysis and modelling exercise will explore differences between exposed and unexposed groups.

Research team: Joe Schofield; Roy Robertson; Catriona Matheson; Federico Andreis; Josh Dumbrell; Daniel Mogford; Trina Ritchie ; Fiona Cowden; Dr Duncan; Dr Kessavalou; Dr Woolston

Rebecca Foster (University of Stirling)

Aims and Objectives: 1) To create a novel Intranasal Take Home Naloxone (ITHN) intervention overdose prevention package for the prescription opioid overdose risk (POOR) population attending community pharmacies in Fife; 2) To explore mechanisms to move elements of the intervention to an online/postal format to create needed flexibility in respect to Covid-19 restrictions; 3) To determine whether it is feasible to recruit community pharmacies to be involved, and for these community pharmacies to recruit patients and their family members; 4) To test the ITHN intervention within a sample of community pharmacies in Fife to access the feasibility and acceptability of this for patients, family members, and community pharmacies/pharmacists via quantitative measures and qualitative interviews.

Background and Methods: This is a piece of primary research, which builds on previous work carried out in 2019 by the same team who found high levels of comorbidities and co-prescribing that increased overdose risk for this group. This study adopts a mixed methods approach using - longitudinal online survey data and semi-structured interviews to aid the development of a novel ITHN package intervention (which will include a combination of ITHN kit distribution, patient information, pharmacy training) and to establish how this intervention would work in practice, prior to testing this in a randomised controlled trial.

Research team: Rebecca Foster; Deborah Steven; Tessa Parkes; Catriona Matheson; Joe Schofield; Wesley Steele; Tania Browne; Alex Baldacchino; Andrew McAuley

Amy Malaguti and Fabio Sani (University of Dundee)

Aims and Objectives: 1) To understanding the psychosocial factors associated to Non-Fatal Over Dose (NFOD) among people who use drugs (PWUD).

2) To identifying intervention strategies that will have an effect on rates of NFOD, thereby reducing the incidence of DRD.

Background and Methods: This is a pilot study for the development and small scale trial of a novel behavioural change intervention. A literature review and primary qualitative interview based research involving people with lived experience of NFOD will inform the design of a behaviour change intervention aimed at reducing the risk of overdose. The intervention will be piloted to assess acceptability and fidelity of the intervention providing evidence to pilot an appropriately powered trial which will inform policy and practice.

Research team: Amy Malaguti; Fabio Sani; Jennifer Breen; Fiona Cowden; Emma Fletcher; Ann Eriksen; Donna Thain

Alison Munro (University of Dundee)

Aims and Objectives: To inform current and future responses to coronavirus outbreaks by identifying and critically appraising the extant literature relating to the impact of novel coronavirus outbreaks of the 21st Century on problem drug users, with a particular focus on COVID-19, on drug related deaths and other drug-related harms, as well as on service responses to problem drug users (PDU) including any evidence of the effectiveness of such responses.

Background and Methods: This is a systematic review that will identify, summarise and critically appraise the current international evidence around the impact of COVID-19 on PDU. It will do so by drawing on published literature relating to COVID-19 as well as evidence from prior coronavirus pandemics/epidemics to inform ongoing practice and policy responses to the COVID-19 outbreak. This will be done using the Evidence for Policy and Practice Information and Co-ordinating Centre five stage approach: extensive scoping of the literature, development and implementation of a systematic and extensive search strategy, screening and selection of literature for inclusion, a descriptive mapping of all papers included, and a quality and relevance appraisal.

Research team: Alison Munro; Steve MacGillivray; Nicola Gray; Andrea Mohan; Ms Hazel Booth; Joan Love