Kindness, Compassion and Hope
Blog following meeting 3 in Dundee, January 2020
The title of the Dundee Commission report that laid bare the failings of treatment and care and monitoring of these services which led to the tragedy of escalating drug deaths in Dundee. After an intensive period of scrutiny and self-reflection it seems like local leaders, and those working in key positions, are now making the changes required. Representatives of the Dundee Commission and The Dundee Partnership came together to share their learnings with the Drug Death Taskforce when we met in Dundee this week. Key messages that other parts of the country must take on board are strong leadership and self-reflection at a personal, service and system level.
We heard of positive developments in Dundee on targeting non-fatal overdoses through active outreach, moving towards low threshold treatment and using other models such as non-medical prescribers, which is essential given the lack of general practice involvement in that area. Also the ability to rapidly analyse toxicology samples in a recent cluster of cases was crucial in identifying a new benzodiazepine on the illicit market. This underlines the need for a rapid and responsive surveillance system. The Taskforce will be working closely with Dundee moving forward for mutual learning.
A draft of a Taskforce strategy document was also shared which covers a number of areas the evidence tells us should be prioritised. These are:
1 – Targeted distribution of naloxone
2 – Immediate response pathway for non-fatal overdose
3 – Medication Assisted Treatment
4 – Targeting the people most at risk (multiple complex needs)
5 – Public Health Surveillance
6 – Equity of Support for People in the Criminal Justice System
Under naloxone distribution the decision was taken at the last meeting to ensure naloxone was distributed through winter shelters and peer to peer outreach. This was actioned and thank you to the homeless service providers for their cooperation. We are currently writing to health boards to speed up the training and supply of naloxone in the whole community pharmacy network across Scotland.
This strategy will be shared with Integrated Joint Boards and Alcohol and Drug Partnerships shortly, along with the message that they need to focus on maximising naloxone distribution, reaching out to people who experience a non-fatal overdose and preparing for no barrier access to medically assisted treatment (MAT) that puts the person, not the service at the centre. Standards for MAT are being consulted on at present – these national standards will be shared (soon) in a blog by Dr Duncan McCormack who leads that sub-group for the Taskforce. However the principles of kindness, compassion and hope have been central.
A number of Taskforce test of change projects are in different stages of development. One that got the go ahead at this meeting was to trial a new service in Glasgow that provides a rapid outreach response for non-fatal overdoses. This includes the use of a safe space for people to go to recover after an overdose and get appropriate support. The intention is to get this started in April 2020 with ongoing evaluation and preparation for roll out in other areas. This project proposal came from a reference group of front line workers who identified a gap in service out of hours. Data sharing agreements between the Scottish Ambulance Service and local health boards are crucial to this type of initiative. These agreements exist in 7 of 14 health boards and the remaining 7 must seek agreement as a matter of urgency.
An ongoing challenge is the availability, and use of street benzodiazepines, particularly etizolam (at the moment). Understanding the reasons for this are crucial. We have some insight through research and consultation that indicates self-medication for mental health problems, cheap prices and widespread ‘pushing’ to vulnerable people are factors. Research is starting (facilitated by the Drugs Research Network), to explore this further as well as working with clinicians to consider appropriate treatment and support responses.
Other work progresses on a strategy to address stigma, developing a national public health surveillance system and criminal justice alternatives. Details will be given in future blogs.
In other business the Taskforce were encouraged to hear that Police Scotland have a revised drug strategy with an emphasis on public health. We are hopeful this will lead to some specific actions.
Professor Catriona Matheson