Substance use - treatment target: letter from Minister for Drugs Policy

Substance Use Treatment Target Letter to Integrated Authorities and Alcohol and Drug Partnerships

Ms Angela Constance

T: 0300 244 4000

E: MinisterDP@gov.scot

To: Integration Authorities

Cc: Alcohol and Drug Partnership Chairs; Alcohol and Drug Partnership Coordinators

16 March 2022

Dear Integration Authority Chief Officer

On 21 February I wrote to you setting out our priorities for the National Mission to reduce drug deaths and our focus on supporting more people into the treatment and recovery that is right for them. The purpose of this letter is to set out expectations in relation to the delivery of the Substance Use Treatment Target.

Evidence tells us that treatment is a protective factor against drug-related harms and deaths. Yet there is also evidence to suggest that too many people in Scotland at risk of a drug related death are not accessing the treatment they need. We must make sure that treatment is available as soon as someone asks for help or support. Easy access through same-day treatment and assertive outreach to enable people to remain in treatment must become the new normal. The Substance Use Treatment Target is designed to increase the number of people in protective treatment and to complement the existing work to improve the availability and quality of services through the implementation of the MAT Standards.

The data tells us that almost 90% of all drug-related deaths in Scotland currently involve opiates. As a result we must focus our efforts on increasing the number of people in Opioid Substitution Therapy.

The Substance Use Treatment Target will ensure that by 1 April 2024 there will be at least 32,000 people with problem opiate drug use in community-based OST treatment in Scotland. This target equates to approximately a 9% increase on the current baseline.

The national target increase has been applied equitably across Integration Authority areas in Scotland. It is recognised that the target will present different challenges, and require different approaches, in different areas. Further information on targets for each Integration Authority is available in Annex A below.

I have included an Information Pack in a separate Annex B which sets out how the target has been set and how it will be measured. It also provides an overview of the methodology which underpins this.

This pack also includes further information on a series of Balancing Indicators which will contextualise the target. These indicators cover access, retention, availability of services and treatment completeness. I expect you to use these indicators alongside other information to ensure that the target is implemented in a way that ensures more people are able to access the services that they need for as long as they need them. I expect you to ensure that the delivery of this target is built into your existing plans to deliver the MAT Standards and to reduce drug / alcohol harms and deaths.

I intend to expand the target so that from 2024 it will cover treatment for all drugs and alcohol treatment. We know that alcohol harms and deaths remain concerningly high and other drugs such as cocaine and benzodiazepines are becoming more prominent in our drug-related deaths.

In response to the growing number of drug-related deaths from multiple substances we are working with Scottish Drugs Forum, alongside other stakeholders, to scope the scale of use and the associated harms around cocaine injecting and the use of crack. We will also be working with ADPs to develop resources and training for frontline services to ensure they are best prepared for responding to clients using these substances.

On 15 March 2022 we published an Evidence review of current trends in benzodiazepine use in Scotlandand convened an expert group on the use of benzos as part of a harm reduction approach. The expert group met in February 2022 and agreed that treatment for problems related to benzos should be included in the MAT Standards more explicitly and that on-going tests of change would be used to inform future treatment models.

We have been working with the UK Government and the other devolved administrations on reviewing and updating clinical guidelines for alcohol treatment (UKATG). The guidance is expected to introduce new approaches to treatment and will apply to a broad range of settings including primary care, hospital and justice settings. It is important that any target aligns to the forthcoming UKATG, which we expect to adopt. To ensure that any target developed is effective a short-life working group will be convened with representation from a range of experts.

The development of the Substance Use Treatment Target is an important step in the delivery of the National Mission to reduce drug deaths. I appreciate the work that you are already undertaking to reduce drug/alcohol related harms and deaths and look forward to hearing about your progress in ensuring that more people are able to access the protective treatment that they need.

If you have any queries, please contact alcoholanddrugsupport@gov.scot