National mission

In January 2021 the First Minister announced a new national mission to reduce drug related deaths and harms supported by an additional £50 million funding per year.

The aim of the national mission is save and improve lives through:

fast and appropriate access to treatment and support through all services
improved frontline drugs services (including third sector)
services in place and working together to react immediately and maintain support for as long as needed
increased capacity in and use of residential rehabilitation
more joined-up approach across policies to address underlying issues

We have carried out the following actions:

provided £18 million through funds to support the aims of the national mission
publication of Medication Assisted Treatment Standards on access, choice and support
provided details of how the additional funds for services is being used in 2021 and beyond
using digital technology to prevent drug related deaths by keeping drug-users connected with lifeline services

The main focus of the nation mission is:

emergency life-saving interventions – naloxone, safer consumption, non-fatal overdoses, targeting those at risk (including assertive outreach)
implementation of Medication-Assisted Treatment Standards making support consistent, flexible, effective and faster
expansion on capacity in and use of residential rehabilitation ensuring this is available for everyone who wants it
supporting evidence-led harm reduction through OST and other interventions
linking policies on poverty, deprivation, trauma and ACES with work to drug prevention and treatment
empowering people to seek support from services
supporting people with multiple, complex needs - in addictions, homelessness and metal health settings and in contact with the justice systems
improving services – including treatment and recovery to people in justice and care settings
bringing the voices of people with lived and living experience to decision-making and service provision
addressing stigma – including within services
growing and empowering grass roots and community groups to support people and families in their communities
supporting children and families affected by problematic drug use
learning, and improving data/intelligence gathering, sharing and access through surveillance, research, and partnership working
developing resilient and skilled workforce
ensuring and promoting equalities and human rights

Delivery

We published the National Mission on Drugs plan 2022: 2026 in August 2022. This sets out in further detail how we plan to deliver the National Mission over the duration of this parliament.

We also publish annual monitoring reports which set out progress made by national government, local government and third sector partners towards meeting the National Mission aims of reducing drug deaths and improving the lives of those impacted by drugs in Scotland:

Monitoring and evaluation

Planning and delivery of the National Mission is informed by annual monitoring reports. These publications draw on publicly-available statistics and data to analyse progress made against the individual outcomes of the National Mission. The first annual monitoring report, covering the period 2022 to 2023, was published in December 2023.

Governance

The national mission is being driven by an Implementation Group. This group is chaired by the Minister for Drugs Policy and has a membership including other Ministers, Health and Social Care Partnership Chief Officers, Alcohol and Drug Partnership leads, Royal Colleges and people with lived and living experience.

The work of the mission is also supported by the Drug Deaths Taskforce, the Residential Rehabilitation Development Working Group and a National Collaborative representing the views of those with lived and living experience.

Targets

In 2021/22 the Medication-Assisted Treatment Standards will be embedded across all ADP areas.

For 2022/23 treatment targets will be set for the numbers of people in treatment.

Surveillance

On 14 December 2021, the Minister for Drugs Policy announced an investment of £1.17 million in three projects which will support the public health surveillance of drug use. We have worked with Public Health Scotland to develop these projects which will support this surveillance. These are:

the development of a new prevalence estimate for problem drug use - this project will involve a collaboration between Public Health Scotland and the University of Bristol, with £382,000 being committed over three years to deliver an up to date prevalence estimate using a new methodology which has been developed by the University. This will give us an essential understanding of the size and shape of Scotland’s drug problem
a new hospital based toxicology surveillance study - this study will involve the capturing of clinical data for emergency department attendees at Queen Elizabeth University Hospital in Glasgow. Its aim is to establish the feasibility of introducing a toxicology based surveillance system in emergency departments across Scotland. £201,000 over 15 months has been committed to this study, which will be led by Professor David Lowe and Doctor Lisa Dunlop, and sponsored by NHS Greater Glasgow and Clyde
improvement of the National Drug Related Death Database (NDRDD) and drug data quality support - in response to recent challenges, a set of recommendations were made by a short life working group to ensure data collection can play a sustainable role in reducing drug related deaths. One key recommendation made by this working group is that a comprehensive review of the NDRDD dataset should be taken forward by Public Health Scotland. £592,000 over three years has been committed to providing resource to support drug data quality, the appointment of a new National Drug-Related Co-ordinator within Public Health Scotland and the development of a more appropriate IT solution

Medication-Assisted Treatment Standards

Central to the mission is the implementation of the Medication Assisted Treatment Standards (May 2021) which cover access, choice and support. These standards are summarised in the table below.

No	Standard		Comments
1	Same-day Access	All people accessing services have the option to start MAT from the same day of presentation.	This means that instead of waiting for days, weeks or months to get on a medication like methadone or buprenorphine, a person with opioid dependence can have the choice to begin medication on the day they ask for help.
2	Choice	All people are supported to make an informed choice on what medication to use for MAT and the appropriate dose.	People will decide which medication they would like to be prescribed and the most suitable dose options after a discussion with their worker about the effects and side effects. People will be able to change their decision as circumstances change. There should also be a discussion about dispensing arrangements and this should be reviewed regularly.
3	Assertive Outreach and Anticipatory Care	All people at high risk of drug-related harm are proactively identified and offered support to commence or continue MAT.	If a person is thought to be at high risk because of their drug use, then workers from substance use services will contact the person and offer support including MAT.
4	Harm Reduction	All people are offered evidence-based harm reduction at the point of MAT delivery.	While a person is in treatment and prescribed medication, they are still able to access harm reduction services – for example, needles and syringes, BBV testing, injecting risk assessments, wound care and naloxone. They would be able to receive these from a range of providers including their treatment service, and this would not affect their treatment or prescription.
5	Retention	All people will receive support to remain in treatment for as long as requested.	A person is given support to stay in treatment for as long as they like and at key transition times such as leaving hospital or prison. People are not put out of treatment. There should be no unplanned discharges. When people do wish to leave treatment they can discuss this with the service, and the service will provide support to ensure people leave treatment safely. Treatment services value the treatment they provide to all the people who are in their care. People will be supported to stay in treatment especially at times when things are difficult for them
6	Psychological Support	The system that provides MAT is psychologically informed; routinely delivers evidence-based low intensity psychosocial interventions; and supports individuals to grow social networks.	This standard focuses on the key role that positive relationships and social connection have to play in people’s recovery. Services recognise that for many people, substances have been used as a way to cope with difficult emotions and issues from the past. Services will aim to support people to develop positive relationships and new ways of coping as these are just as important as having the right medication.
7	Primary Care	All people have the option of MAT shared with Primary Care.	People who choose to will be able to receive medication or support through primary care providers. These may include GPs and community pharmacy. Care provided would depend on the GP or community pharmacist as well as the specialist treatment service.
8	Independent Advocacy and Social Support	All people have access to independent advocacy and support for housing, welfare and income needs.	People have the right to ask for a worker who will support them with any help they need with housing, welfare or income. This worker will support people when using services, make sure they get what best suits them and that they are treated fairly.
9	Mental Health	All people with co-occurring drug use and mental health difficulties can receive mental health care at the point of MAT delivery.	People have the right to ask for support with mental health problems and to engage in mental health treatment while being supported as part of their drug treatment and care.
10	Trauma Informed Care	All people receive trauma informed care.	The treatment service people use recognises that many people who use their service may have experienced trauma, and that this may continue to impact on them in various ways. The services available and the people who work there, will respond in a way that supports people to access, and remain in, services for as long as they need to, in order to get the most from treatment. They will also offer people the kind of relationship that promotes recovery, does not cause further trauma or harm, and builds resilience.

Alcohol and drugs