1. Scotland faces a crisis from the continued rise in drug-related deaths. We are not alone in this, but the scale of the rise each year in Scotland is almost unparalleled elsewhere. This steep rise in numbers each year means that it is everybody's responsibility to tackle this problem head on as a national and local priority.
2. The primary role of the Drug Deaths Taskforce is to co-ordinate and drive action to improve the health and wellbeing outcomes for people who use drugs, reducing the risk of harm and death. The Taskforce members are also involved in monitoring, supporting and facilitating the delivery of key commitments and actions set out in Rights, Respect and Recovery and the related Action Plan 2019-21.
3. This work is underway, and Integration Authorities, ADPs and other organisations have already started making plans for short-to-medium term local strategies in advance of many of the recommendations that the Taskforce will be making. This paper provides direction from the Taskforce on the strategies which are known to help avoid drug deaths, and so we think it is vital that partners consider how far these are already being reflected in local planning for 2020/21.
4. How we care for the most vulnerable and most at risk in our society is a measure of our compassion as a nation. We need to be innovative and ambitious in our response to this emergency.
5. This paper draws on evidence of what works to summarise what our emergency response to this crisis must be. The evidence, crucially, comes from three equally important perspectives. Similarly our responses must be shaped and continuously informed by each of these perspectives:
a) High-quality, research and evidence;
b) The professional opinions and experiences of clinical, public health and other practitioners; and
c) The preferences, priorities and values of the people who are most at risk and their families.
6. The Drug Deaths Taskforce is taking great care to ensure a balance is struck between these perspectives. It is unlikely that recommendations made based only on research or practitioner experience, but which do not take account of lived or living experience, would be as successful as recommendations made based on all three perspectives.
7. The evidence-based strategies set out in this paper focus on the local initiatives and changes required to tackle drug deaths, for which, with the exception of in justice settings in a few parts of the country, Integration Authorities are responsible. However, where appropriate there will be national and regional initiatives and changes required as well. These will need a more coordinated response, which the Scottish Government must be geared up to support and facilitate.
Context: Rights, Respect and Recovery
8. The starting point for developing and implementing Our Emergency Response is that we already have a national strategy to reduce the use of and harms from alcohol and drugs: Rights, Respect and Recovery. That strategy was published in November 2018, and the first detailed, three-year action plan for implementing it was published in October 2019.
9. The strategy provides a vision and a set of guiding principles based on everyone having the rights: to health, free from harms; to be treated with dignity and respect; and to be fully supported to find their own type of recovery. It aims to make improvements so that: fewer people develop problematic drug use; more people benefit from effective, integrated, person-centred support; children and families will be safe, healthy, included and supported; and vulnerable people are diverted from the justice system where appropriate and those within justice settings are fully supported. The strategy set out commitments to help achieve these aims and the action plan sets out actions and milestones for completion by the end of 2021.
10. The creation of the Drug Deaths Taskforce is one of the key milestones in the action plan, along with milestones on developing assertive outreach and reviewing the need for residential services. The members of the Taskforce are now ensuring that these are being made high priorities within their own respective organisations. This paper is being made available to all national and local organisations as a summary of what is needed from them to help tackle the increasing rate of drug deaths in Scotland.
Context: Staying Alive in Scotland
11. In 2016 the Scottish Drugs Forum, with support from the Scottish Government, published Staying Alive in Scotland. Thisreport was produced from engagement with Alcohol and Drug Partnerships. It identified Good Practice Indicators. The indicators were refreshed in a new edition of Staying Alive, published in November 2019, to provide a self-assessment tool for ADPs to develop strategies to tackle the growth in drug deaths.
12. Staying Alive 2019 sets out fourteen topic areas which ADPs should consider as forming part of their on-going local strategies:
- Drug-Related Death Monitoring and Learning
- Access to Services
- Opioid Substitution Therapy and Low Threshold Prescribing
- Retention in Services, Continuity of Care, Trauma and Assertive Outreach
- Information Sharing
- High Risk Injecting, Wound Care and Bacterial Infections
- Blood Borne Virus Testing and Treatment
- Prison Throughcare and Police Custody
- People Aged 35 and Over Who Use Drugs
- Dual Diagnosis and Suicide
- Homelessness, Housing and Rough Sleeping
- Women Who Use Drugs
- Poly-drug Use and Prescribed Medications
Context: Keeping People Safe
13. The most recent evidence review carried out in Scotland into drug-related deaths was carried out by NHS Health Scotland (Dickie et al 2017). Keeping people safe was published in 2017 and remains relevant. This rapid evidence review raised the following key points:
- There is review-level evidence that the health of individuals with opioid dependence is safeguarded while in substitution treatment.
- It is important to consider which medications work for whom.
- The first 4 weeks of treatment and the first 4 weeks after leaving treatment are critical intervention points to reduce mortality risk.
- One size does not fit all. Treatment approaches and services need to be tailored to the individual to support them to stay in treatment.
- Psychosocial interventions in conjunction with medication-assisted treatment have been shown to contribute to improving outcomes for people with opioid dependence.
- Complex psychological and social barriers must be addressed to support individuals to access services.
- A holistic approach, designed and tailored to the health and social needs of individuals, will improve the effectiveness of interventions, help increase motivation and prevent drop out.
- Treatment and harm-reduction services are effective in reducing the transmission of blood-borne viruses.
- Take-home naloxone programmes have been demonstrated to increase the odds of recovery from overdose and improve knowledge of overdose recognition and management in the community.
Context: Drug Death Statistics for 2018
14. The most up-to-date statistics published on drug deaths are as follows:
- There were 1,187 drug-related deaths in 2018 (up 27% from 2017 and more than double the total in 2008);
- In 2018 Scotland's rate of drug-related drugs per 100,000 of population was the highest in Europe and around 3 times the rate of the UK as a whole;
- Three quarters (74%) of decedents were over 35 years;
- Opiates or opioids were implicated in, or potentially contributed to 86% of deaths – nearly always alongside other drugs and/or alcohol;
- There has been a significant increase in illicit benzodiazepines, gabapentinoids and cocaine being implicated in deaths last year.
- 94% of deaths involved more than one drug.
15. We also know from recent data from 2016 that:
- Three quarters of decedents were known to have used drugs for at least ten years and over half were known to have used for 20 years or more;
- 63% were known to inject drugs;
- Over half (54%) had previously experienced a non-fatal overdose.
Context: Definition of "Drug-Related Death"
16. The definition of a 'drug-related death' is not straightforward. For the work of the Taskforce we are using the classification as reported on by National Records of Scotland since 2008. The definition here of a drug-related death is where any drugs were implicated in, or potentially contributed to, the cause of a death registered in Scotland.