Scotland has been blighted by an ongoing rise in drug related deaths for many years and Glasgow has been one of the areas which has suffered most.
The Alcohol and Drug Partnership has developed many initiatives in the city that deliver tailored support to people who use drugs in ways that are more flexible and responsive to people's needs and seek to reduce drug related harms and the risk of drug related death.
The Glasgow Drug Death Prevention Action Plan was developed in response to the unprecedented rise in drug related deaths in the city in 2019. The Alcohol and Drug Partnership (ADP) Harms group was tasked with building the action plan. Partnerships across the ADP coordinate a variety of activities developed to mitigate the harms caused by drug use. This is a working document that grows and evolves as new trends emerge and we learn from the outcomes of each stand of work and crucially from listening to those who use our services and have lived or living experience in this area.
The Scottish Government established a Drug Deaths Task Force (DDTF) in July 2019. You can find more information on the task force on the Scottish Government website.
Rapid Access to Medication Assisted Treatment (MAT)
A sub-group of the DDTF is specifically focussed on improving the access to and quality of Medication Assisted Treatment (MAT) across Scotland. The information below describes some of the work underway to improve the range and quality of medically assisted treatments available in Glasgow city.
An audit in June 2016 found that the average time from referral to MAT start was 34 days (range 10-71) with almost half of individuals being 'lost' before being seen by doctor and accepted into treatment.
A revised fast track system has been designed and implemented in North West Glasgow which can on occasion result in same day (or next day) access onto treatment pathways MAT.
A rapid re-audit in the early stages of the Covid Pandemic lockdown in 2020, confirmed that despite the restrictions in place, most new treatments were started within 8 days, and that some teams were able to start treatment for 50% of new services users within 1 day. However, other teams were not able to deliver a service at this speed. Therefore, taking learning and best practice from the teams offering same day prescribing, a citywide Standard Operating Procedure has been introduced and an audit of time to access to MAT will be repeated in the coming months.
- Increasing Choice of MAT
Methadone and Oral buprenorphine have been the mainstays of MAT in Glasgow for a number of years. However, recently Buvidal is a welcome addition to treatment options for people who are using heroin and other opioids in Glasgow.
Buvidal is a new, long-acting injectable formulation of buprenorphine, available in weekly and monthly depot-type preparations has been introduced in Glasgow Alcohol and Drug Recovery Services (GADRS) since March 2019. During the Covid Pandemic, when restrictions limited capacity to supervise methadone and oral buprenorphine in pharmacies, Buvidal has proved to be a popular choice for service users starting or restarting MAT. There are now over a hundred such service users across the city.
Experience of Buvidal in Glasgow has been very positive. Outcomes include increased retention in treatment, reduction in self-reported drug use, an increased uptake of daily interventions including recovery activities, volunteering and employability and increased engagement in mental health interventions.
During the pilot, Buvidal was described by some service users as "the most positive change in my life for many years" and "it feels like I've got a normal life".
Heroin Assisted Treatment has also been introduced in a pilot basis, co-located with Homeless Health Service, Heroin assisted treatment is the prescribing of diamorphine by licensed doctors in licensed facilities for heroin users who have not benefitted from other MAT services. The treatment is offered to a small number of the most complex needs population through referrals and is being evaluated.
- Barriers to Optimal MAT Dosing
The evidence base for methadone and buprenorphine suggests that best outcomes are achieved at "optimal doses". However, service audits have often demonstrated many patients on MAT are prescribed "sub-optimal" doses. Anecdotal feedback has been that staff and patient attitudes are often barriers to optimal dosing. Therefore, the Glasgow City ADP and Glasgow Alcohol Drug Recovery Services worked with the Scottish Drug Forum to explore staff and service user attitudes to optimal methadone and buprenorphine dosing, to inform practise. We developed a service user questionnaire and analysed 150 peer volunteer interviews with people who use services. We also conducted a staff survey with 115 responses and conducted focus group sessions to gather further evidence from prescribers, medical and nursing staff who can provide rich data and significant information to inform practise and procedure.
We continue to undertake literature search and reviews of relevant published papers in the field. We continue to monitor the dosage of MAT in the city's GP practices and specialist services.
- Management of Benzodiazepine use and MAT
Street benzodiazepines, particularly etizolam, are major cause of rising drug related deaths and complicate MAT. The ADP and GADRS have several developments to address the needs of service users and improve clinical monitoring and treatment of benzodiazepine dependence. These include:
- Analysis of novel Benzodiazepine-type drug use in opiate agonist clinics in Glasgow to estimate extent of use of street benzodiazepines in patients on MAT
- Funding of additional NHS Greater Glasgow and Clyde laboratory toxicology analysis on the breakdown of novel benzodiazepine-type drugs and gabapentinoids
- Guidance on the Principles of Benzodiazepine Prescribing with Concomitant Opiate Dependence, August 2019
Glasgow Alcohol and Drug Recovery Service (GADRS) Outreach
GADRS Assertive Outreach Posts
We have created outreach posts across the sectors of the city to assertively engage with people who are struggling to engage with treatment. They may have missed appointments, feel unable to leave the house, feel frightened about meeting other people. These workers will visit people in their homes and check on their welfare, accompany them to appointments and deliver harm reduction advice and care until they are able to re-engage with the local Glasgow Alcohol and Drug Recovery Service (GADRS).
GADRS City Centre Assertive Outreach Team
We have created an assertive outreach team for the city centre that works in partnership with the Enhanced Drug Treatment Service. This is a street work initiative and supports individuals who frequent the city centre and have a number of complex needs, often including public injecting, non-fatal overdose, injecting wounds and infections. They deliver harm reduction advice, health interventions and encourage individuals to engage with services and treatment.
The Glasgow Alcohol and Drug Advocacy Service (GADAS)
A new advocacy service to help people in Glasgow having problems related to alcohol and drugs was launched on Tues 26 March 2019.
The Glasgow Alcohol and Drug Advocacy Service offers independent, professional advocacy services to people with alcohol or drug issues, supporting them with a variety of issues including housing and homelessness, access to treatment and care options and children and families concerns.
If you are having problems related to alcohol and drugs and unsure what support is available Glasgow Alcohol and Drugs Advocacy Service can help. The service can give you information on support and your rights, assist you to work with other services and support you at meetings.
You can contact the Advocacy Project by phone on 0141 420 0961, Email firstname.lastname@example.org or find more information on their website at www.theadvocacyproject.org.uk
Injecting Equipment Provision (IEP) Van
Our IEP Van is out every evening in the city centre delivering harm reduction support to people who use drugs. People can access injecting equipment, Naloxone, condoms and needle bins as well as engage with workers who will give harm reduction advice and link them to other supports services.
ADP Developments with the Drug Death Task Force
The primary role of the taskforce is to co-ordinate and drive action to improve the health outcomes for people who use drugs, reducing the risk of harm and death. Glasgow Alcohol and Drug Partnership was successful in its application to the DDTF for funding for the development of the following initiatives:
- Non-fatal overdose crisis response team
We are currently developing a new GADRS team that will work in the evening and weekends, supporting people who use alcohol and drugs and find themselves in a crisis at a time when other services are closed. The team will work jointly with mental health staff and closely with acute colleagues to support and identify people experiencing distress and comorbidity relating to poor mental health. A priority for this team will be supporting people who have had a near fatal overdose, reducing the risk of drug related death from further incidents of near fatal overdose, addressing other high risk behaviours and engaging with the appropriate supports in the community.
- A second Injecting Equipment Provision Van
A second IEP van will allow us the flexibility to deliver Injecting equipment and related paraphernalia, harm reduction support including overdose prevention and supplies of naloxone, BBV testing, wound management and general health interventions across the city where demand is identified
- Homeless Addiction Outreach team
This city centre outreach team was developed to support homeless people who use drugs in response to covid restrictions. We will continue this model of support post as it has increased engagement and improved the quality and range of work delivered to individuals.
- Alcohol and Drug Partnership Intelligence Hub
We are developing a new multi-agency data intelligence hub to enable a more informed partnership view of the impact of alcohol and drugs in the city. Staff are being recruited by the NHS Board and Police Scotland to work alongside existing data support services within Glasgow City Council and wider ADP members to create and maintain the Hub. The Hub is expected to provide relevant and timely information for the ADP to allow more enhanced coordination and prioritisation of our collective resources to tackle areas of greatest concern.
- Prison Healthcare Harm Reduction Team
A dedicated team of staff within prison healthcare will be created to coordinate and deliver a range of harm reduction interventions to people in prison, reducing risk of overdose post liberation.