Publication - Minutes

Drug Deaths Taskforce meeting: April 2020

Published: 4 May 2020
Date of meeting: 8 Apr 2020
Location: Virtual via Zoom

Minutes and supporting papers from the fourth meeting of the taskforce, held on 8 April 2020.

Published:
4 May 2020
Drug Deaths Taskforce meeting: April 2020

Attendees and apologies

Taskforce members:    

  • Prof. Catriona Matheson (Chair), University of Stirling
  • Neil Richardson (Vice Chair), Turning Point Scotland 
  • Allan Houston, Lived/Living Experience Representative
  • Anthony McGeehan, Crown Office and Procurator Fiscal Service 
  • Carey Lunan, Royal College General Practitioners in Scotland
  • Carole Hunter, Royal Pharmaceutical Society in Scotland
  • Colin Hutcheon, Families Lived Experience Representative
  • CS David Duncan, Police Scotland
  • David Williams, Glasgow City Health and Social Care Partnership  
  • Dr Duncan McCormick, Public Health Medicine 
  • Fiona Doig, Boarders ADP and Health Improvement  
  • Karyn McCluskey, Community Justice Scotland 
  • Phil Mackie, Scottish Public Health Network
  • Rebecca Wood, Lived/Living Experience Representative
  • Dr Robert Peat, Dundee Drugs Commission 
  • Dr Tessa Parkes, Drugs Research Network Scotland
  • Nicola Dickie, Convention of Scottish Local Authorities
  • Cameron Stewart, Scottish Courts and Tribunal Services

    
Attendees:     

  • Joe FitzPatrick MSP, Minister for Public Health, Sport and Wellbeing
  • Liz Sadler, Scottish Government: DD Health Improvement Division
  • Morris Fraser, Scottish Government: Head of Alcohol, Tobacco and Drugs
  • Michael Crook, Scottish Government: Drug Death and Harm Prevention 
  • Mark Lawson, Scottish Government: Drug Death and Harm Prevention 
  • Lauren Ross, Scottish Government: Drug Death and Harm Prevention 
  • Julie da Costa, Scottish Government: Drug Death and Harm Prevention
  • Maggie Page, Scottish Government: Analytical Services
  • Nick Smith, Scottish Government: Alcohol and Drug National Support Team

Apologies:    

  • Iona Colvin, Chief Social Work Adviser 
  • Dr Ahmed Khan, Royal College of Psychiatrists 
  • Susanne Millar, Glasgow City Health and Social Care Partnership
  • Richard Watson, Recovery Community Lived Experience Representative
  • ACC Gary Ritchie, Police Scotland
  • Lesley McDowall, Scottish Prison Service

Items and actions

Introduction

The Chair welcomed members to the fourth meeting of the Taskforce (but the first virtual one) and it was agreed that going forward meetings will be hosted via Zoom (while the current situation persists). This will mean that meetings are shorter in duration with members doing more preparation in advance. This includes the completion of sub-group and individual update forms, particularly where people are working on COVID-19 issues, using bullet points to keep it concise. 

Framework and funding documents had been circulated prior to the meeting with comments requested. These can now be taken as agreed and confirmed as working documents.

The Chair welcomed Carole Hunter replacing Jean Logan from Royal Pharmaceutical Society of Great Britain (Scotland) and Nicola Dickie from COSLA.

The minutes from the last meeting were accepted and published on the Scottish Government website on 11 March 2020.

Action notes

Michael read out the actions from the last meeting and highlighted on-going and to be actioned.

In discussion, the following points were made: 

  • Duncan advised a meeting between Crown Office and Tessa to discuss the next steps for drug checking proposals and service

Actions:

  • part of the Framework document included the need for a Register of Interest to be completed by all members.  Secretariat to collate
  • a previous action had been for Taskforce members to report on progress made in their individual organisations to tackle stigma and use ‘People First’ language. This now to be included on the feedback form in advance of the next meeting
  • on drug checking, it was agreed that PI Claire Miller will put a report together with a proposal to be presented to the Taskforce in due course

COVID-19 – impact and response

In the current climate the Chair asked that the Taskforce and sub-groups consider what actions could be taken to respond to the COVID-19 pandemic, with particular regard to addressing harms or deaths which may arise as a result of, for example, changes to service provision, provision of OST etc.

In discussion, the following points were made: 

  • the Minister emphasised that the work of the Taskforce must not be de-prioritised during this period, neither should the essential work being carried out by drug and alcohol service workers
  • Carole Hunter advised that the ACMD published recommendations on proposed legislation changes (published Tuesday 7 April) on how to maintain the supply of controlled drugs during any pandemic with an impact on drug related deaths
  • Allan highlighted the concern over the possibility of increased numbers of overdoses as a result of the larger quantities of OST being prescribed during this time
  • Neil stated that Taskforce needs to continue to be focused on specific actions and guidance which will minimise the chance of contributing unnecessary ‘noise’ which could undermine primary effort. Focus on the immediate and short term priorities
  • David Williams confirmed that the Cabinet Secretary for Health has received mobilisation plans that the Health Boards compiled e.g. for acute hospital care and ICU provision. Health and Social Care Partnerships also have a requirement to set out what they can do to maintain existing services e.g. staffing, deliveries
  • Duncan highlighted the need to send out a letter with strategic recommendations from Scottish Government and the Taskforce. The Minister confirmed that discussions to this effect had already taken place, Liz noted that this had been discussed with the previous CMO who was in agreement that this work should remain as a priority at this time
  • Nick added that SDF and SHAAP have both issued guidance on contingency planning to develop a programme of work, sharing good practice and in contact with ADP’s
  • it was also agreed that up-to-date information/intelligence was really important and Phil was going to look at how more precise approach to key issues
  • Carey requested that GPs be kept appraised around OST prescribing. She also noted concern around the removal of oral toxicology and that testing should remain a priority
  • Becky noted that there had been a good level of positive feedback following the change to weekly pickup of prescriptions. She also mentioned the plans to distribute phones with data to vulnerable individuals in the community so that they can stay in contact with services/recovery groups
  • Karen advised there are between 100 to 150 prison releases weekly flagging that there were already issues for these individuals on liberation (access to GPs, naloxone etc.) and that this would become even more challenging if numbers were to increase
  • Duncan suggested a policy change to legislation to allow organisations e.g. Salvation Army to distribute naloxone. An online forum to discuss good practice for Nick to consider
  • Maggie raised that the guidance on use of naloxone be changed re administer naloxone and call for ambulance?
  • Carole stated that currently Nyxoid (intra-nasal naloxone product) is currently available on prescription only. The Chair suggested writing to the manufacturers to request this be changed to over the counter

Actions:

  • taskforce to put out a clear message around prioritising drug and alcohol service, liaise with Duncan to produce
  • taskforce to re-emphasize how naloxone can be distributed to individuals and family members following prison release
  • secretariat to produce a document summarising suggestions and recommendations on rapid response to COVID-19 for sending to Minister
  • secretariat to draft letter to send on behalf of Taskforce to Nyxoid manufacturer
  • to confirm with Ambulance Services that the protocol around administration of naloxone on calls and non-COVID emergencies is still in placep

Sub-group updates – summary and questions

MAT group

Duncan advised that the group will continue to maintain momentum on the Standards being developed for MAT. They also planned to create webinars to continue engagement and to receive feedback. The test of change around MAT standards will continue with new innovations around current circumstances and those in line with the MAT objectives. The role of the Public Health Special Interest group, which will be to provide information around the health needs assessment in Dundee, will be sent to Public Health and ADP’s. He added that continuing surveillance on non-fatal overdoses was a priority. They also planned to collate existing data from boards to obtain a national picture, while also doing the same with the Scottish Ambulance Service.

CJL group

Neil said that progress had been good, including visits, until the COVID outbreak curtailed them. They have also engaged with the Scottish Government Quality Improvement team to develop a test of change, though the next stage has been put on hold for the present. The work of the group has been interrupted, particularly the plans around tests of change, and hopefully will be picked up once there is some return to normality. Initial discussions on through-care issue is of pressing concern because of the vulnerability associated with prison releases. Facilities and services under the current situation are very limited to those individuals being liberated. 

PHS group

Phil shared the feedback form, noting the deliverables and action of the group. They have an action plan in place and have resources agreed from Scottish Government to support this work. Public Health Scotland has established a new Drugs Team which is developing but which has also been challenged by COVID-19 work. He agreed that he would provide a slide-pack for sharing with the wider taskforce which would summarise the overall approach and vision of the group and expectations.

MCN group

Further to the update paper circulated, Robert noted the paper that Josh and Tess (DRNS) are working on will be updated, with 50+ papers to be reviewed (national and international). He also asked for volunteers to support the areas identified in the paper; there has been some response but once the updated paper received it would be useful if members of the group can advise on the areas they can support. This will be discussed further at the next MCN meeting in April.

In discussion, the following points were raised: 
•    Catriona is keen for rapid interim (PHS) surveillance received around increased drug deaths; 
•    Michael advised that Scottish Government is getting requests to capture change in drug trends, supply, quality and how finances will have affect;
•    Carole asked if there is a role for IEP data and the national recording system and drug trends be used;
•    Colin asked if the next steps section (PHS) included family lived experience as well. Phil confirmed it does.

Actions:

  • Phil to circulate slide-deck summarising PHS sub-group work
  • secretariat to work with members around collection of IEP related data and how this can be used by Public Health Scotland

Updates

Scottish Ambulance Service

Catriona updated on behalf of Gary who confirmed the ambulance pilot in Springburn, Glasgow, is going well despite their current COVID response undertakings. Further information will hopefully come soon.

Police Scotland

David Duncan advised that main drugs team work is continuing. The Naloxone Steering Group will continue work in the background during COVID. There has also been a first meeting of the Police Scotland Strategy Board, Chaired by Gary Richie, which will start to gather intelligence on drug user trends and illicit supplies. Drug related deaths are flagged on a daily basis on initial enquiry with toxicology to follow. He also confirmed that they will continue to monitor and track COVID related deaths. National trends will be reported to the Taskforce.  

Stigma document

Catriona advised that this will be circulated in the next two to three weeks. 

In discussion, the following points were made: 

  • Allan suggested that a record of all non-fatal overdoses be recorded
  • Catriona acknowledged the update from the Families reference group from Colin. Will hear from the families group at the next meeting

Action:

  • secretariat to circulate the stigma paper in coming weeks
  • ensure Families Reference Group have space on next meeting agenda

Lived experience reference group-proposals

Becky spoke to the proposal paper (circulated in advance) on residential rehabilitation options in reducing drug deaths. This paper was well received by the wider group with general agreement that this be taken forward. It was agreed that there was some more work to do on this, SG colleagues will pick this up with Becky and Jardine separately to further develop the proposal. 

Allan spoke to the National Recovery Advocacy Network (NRAN) paper (also circulated in advance). While well received by the taskforce, it was felt that this work wasn’t a priority at the moment but worth pursuing once the COVID pandemic is over. 

In discussion, the following points were made: 

  • Nick noted that work has been proposed around residential recovery with Scottish Recovery Consortium to come together as a coalition for funding pathways and improve access to residential rehab. Put a test of change in place
  • Carole highlighted there are different systems across the country and need to benchmark access to residential rehab
  • Colin reiterated that residential rehab is essential, especially at a time of crisis and services should be available as soon as possible
  • Catriona advised that Corra recently funded £150K to the NRAN network to further the reach of the SRC advocacy project. This work will remain on the agenda for future meetings and MCN and MAT sub-groups will have also have an interest

Action:

  • taskforce members agreed that the proposal around residential rehab. be pursued and that Nick will work with Becky and Jardine (SRC) on this

DDTF Comms

Catriona confirmed that Chris Wallace has conducted interviews with a number of taskforce members with an aim of learning more about members experience with the group so far, but also to discuss how, going forward, we can communicate pro-actively. Chris will be running a number of Zoom webinars in the next two weeks, members of the taskforce should try and join one of these. 

Action:

  • Catriona to circulate details of Comms webinars to members and all to try and participate

Any other business and date of next meeting

Colin raised the Drug Summit and noted he was very disappointed that no time was allocated to the family lived experience voice. Joe confirmed that this is a lesson learned for any future summits.

Morris advised that Ministers have agreed to instruct health boards to switch to Buvidal in prisons and National Pharmacy Advisers to confirm the manufacturers have enough supply.

Date of the next meeting to be confirmed.

Scottish Government 
Drug Deaths and Harm Prevention 
April 2020