Non-Fatal Overdose Pathways and their
importance in tackling drug related deaths.
There is clear evidence that many who ultimately suffer a fatal overdose have a history of previous non-fatal episodes. It is therefore vitally important that those coming into contact with health, justice or social services following a non-fatal overdose are monitored and engaged to prevent further overdose incidents, and to prevent any future overdose – if it cannot be avoided – becoming a fatal one. We categorise the work in this area as belonging in Emergency Response – and with gains in understanding here as having the potential to save lives in the immediate term.
Evidence also clearly demonstrates that engaging with a treatment programme significantly reduces the risk of a fatal overdose and that those who are outside or disengaged from treatment services are those with the highest risk. A non-fatal overdose incident therefore should be treated as a potential touchpoint with which to engage or re-engage someone with the pathway away from life-threatening risk.
Anything we can do to remove the barriers – real or perceived – between the pathway away from further overdose and the person whose life depends on engaging with that pathway, makes a major impact on that individual, and the situation around them.
The Taskforce is urgently working to build the evidence base on what works best – breaking a repeat cycle of overdose incidents, engaging or re-engaging people with the pathway that can help them best. At the same time, we hope that the Tests of Change (TOC’s) we commission to inform this can also have an immediate positive impact in the areas, communities, and client base they are concerned with.
We seek frequent updates and visibility of insights as they emerge, in order to put learnings immediately to use across the range of Taskforce stakeholders – putting evidence into action without delay.
The Continuum of Recovery for Near-Fatal Overdose (CoRNFO) project is targeted directly towards those people most at risk from drug related death who have experienced a near-fatal overdose. The project will launch in South Lanarkshire in May 2021 and run for 2 years.
This approach supports people into an immediate response pathway for non-fatal overdose which combines the community-based response with a residential rehabilitation service. This is the first time this has been done in Scotland.
This is a pro-active partnership approach involving local planning and commissioning, community treatment services, residential rehabilitation services and the individual at risk.
It provides rapid, flexible and person-centred care, led by frontline staff and the person at risk, and includes a planning and commissioning approach designed to respond to individual cases in a timely, coordinated and empathic manner.
The project is a unique collaboration between national and local third sector residential rehabilitation services and private residential services who have come together to support an initiative facilitated by the Scottish Recovery Consortium. This brings locality treatment and support closer to rehabilitation services for the benefit of individuals at risk of drug related death.
The pathway takes a three phase approach which intensively supports the individual through an initial assessment and preparation process and into residential rehabilitation where appropriate, throughout the period of residential rehabilitation and then on discharge during resettlement back in the community.
Glasgow Overdose Response Team (GORT) is a 12-month test of change developed by Turning Point Scotland and Simon Community Scotland and funded by the Drug Deaths Taskforce which pioneers an on an assertive outreach approach in Glasgow to find answers – and help save lives in the process.
The response team have been operational from Mid November 2020 and has been formed in response to the high level of drug related deaths in Glasgow. This follows consultation with frontline workers and people with lived and living experience to identify the most significant actions that could be taken immediately to reduce the high level of drug deaths.
This engagement identified evidence of key gaps and vulnerabilities within current provision including:
The Taskforce are funding a research project that is linked to the work being done in Dundee. around Non-Fatal overdose. The project titled Designing a Behaviour Change Intervention to Reduce the Risk of Overdose started August 2020 and it will run over the next 18 months.
This is a pilot study led by the University of Dundee to develop a novel behavioural change intervention and test, via a small-scale trial. Researchers are with people with lived experience of NFOD to inform the design of a behaviour change intervention to reduce 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.
Work is ongoing with the Scottish Ambulance Service (SAS) to develop a national non-fatal overdose pathway. The SAS are developing a proposal for the Taskforce and Scottish Government to consider.
They are using the Taskforce funded regional naloxone leads to map the existing pathways and services and to inform the understanding of the connections that could be made with existing projects.
The intention is for paramedics to have a single point of contact when encountering a non-fatal overdose. This would be in the form of a single number which contacts an SAS team. This team will then direct paramedics to services, where possible taking an individual to the identified service, and where this is not possible, referring them to support services.
This model will need to adapt as work continues to improve the access to data within the SAS and as national improvements improve the availability of services.
The major work that Taskforce is progressing on MAT Standards is outlined here on this website. There is a clear overlap between these two areas of focus, particularly in developing and implementing standards which address the range of pathway choices available to those who would benefit from them, the accessibility of services, and the tailoring of services to meet particular needs. Evidence suggests that these factors influence the degree of engagement in pathways by those whose risk to life would be heightened otherwise.
The Taskforce now has Tests of Change and Research projects focussed specifically on assertive outreach and optimising its chance of success. This is real progress in what has to be a priority area.