Drugs deaths: National Mission Clinical Advisory Group minutes: June 2024

Attendees and apologies

• John Harden, Co-Chair – Deputy National Clinical Director
• Adrian MacKenzie, MAT Standards Clinical Lead, Healthcare Improvement Scotland
• Professor David Lowe, Clinical Director Health Innovation (Scot Gov) and Consultant Emergency Medicine NHS GGC
• Duncan Hill, Specialist Pharmacist in Substance Misuse, NHS Lanarkshire
• Duncan McCormick, Consultant in Public Health Medicine at Public Health Scotland
• Steven Short, Programme Lead, Out-of-Hospital Cardiac Arrest, Scottish Ambulance Service
• Roy Robertson, Professor of Addiction Medicine at the University of Edinburgh and Retired General Practitioner
• Tara Shivaji, Consultant in Public Health Medicine at Public Health Scotland
• Isabel Traynor, Consultant Clinical Psychologist/Head of NHS Fife Addictions Psychological Therapies Service (APTS) and Lead Psychologists in Addiction Services Scotland (LPASS) representative
• Marion Bain, Co-Chair – Deputy Chief Medical Officer
• Dr Trina Ritchie, Lead Clinician, Greater Glasgow and Clyde Alcohol and Drug Recovery Services
• Mandy Ramsay, Head of Clinical and Care Governance, Turning Point Scotland
• Dr Ryan McHenry, Clinical Research Fellow and Registrar in Emergency, Pre-Hospital and Retrieval Medicine
• Saket Priyadarshi, Associate Medical Director and Senior Medical Officer, Glasgow Alcohol and Drugs Recovery Services
• Hazel Torrance, Head of Forensic Toxicology, Police Scotland
• Darren Fullarton, Associate Nurse Director at NHS Ayrshire and Arran and is the Lead Nurse with North Ayrshire Health and Social Care Partnership
• Chanpreet Blayney, Consultant Psychiatrist at Health Improvement Scotland
• Professor Niamh Nic Daeid, Dundee University
• Lindsay Wallace, Police Scotland
• Lorna Nisbet, Dundee University
• Victoria Marland, Clinical Lead and Consultant Psychiatrist/Chair of the Education Committee/ Co-Chair Faculty of Addictions Psychiatry
• Alison Byrne, Head of Drugs and Alcohol Policy Division, Scottish Government
• Maggie Page, Scottish Government
• Iain Wilson, Scottish Government
• Anniek Sluiman, Scottish Government
• Chloe Poole, Scottish Government
• Georgie  Alford, Scottish Government
• Paul Sutherland, Scottish Government

Items and actions

Welcome and introduction

The Chair welcomed members and attendees to the fifth meeting of the National Mission Clinical Advisory Group. 

Board governance

The minute of the fourth meeting on 13 March 2024 was approved.

Members were advised that previous meeting minutes have now been published online on the Scottish Government website.

Presentation: drug checking and clinical governance

Tara Shivaji (Public Health Scotland) delivered an update on Drug checking and clinical governance.
Points to note

• drug checking and testing remains a gap, but the new drug checking sites provide the chance for individuals to make risk informed decisions. They will also improve public health surveillance for patterns and there are also locally developed plans through stakeholders. 
• thinking regarding the need of robust clinical governance for the drug checking sites to ensure that point of care testing is done with some consistency across Scotland.
• outlining work underway to better understand the efficacy of drug testing strips
• discussion: Drug checking and clinical governance 
• John Harden opened the discussion to the floor focusing on 2 questions

Questions put to the group:

How do we ensure the balance of benefits and risks to the people using the service are managed appropriately?
How do we ensure that people are provided with appropriate information to make informed choices and there is oversight and accountability?

Points to note

• members agreed that establishing national protocol will be important to ensure a consistent approach across all sites
• details were given about the ongoing work in establishing national test sites and collaboration with universities to ensure high quality research and testing standards
• the model for testing was outlined and it was discussed how test results will be shared nationally and fed into national trends through RADAR
• concerns were raised about the reliability of rapid test strip results, but assurances were given that test strips are undergoing further research

Presentation: Emerging Drugs and the role of MAT and MIST 

Duncan McCormick delivered a verbal update on Emerging Drugs and the role of MAT and MIST

Points to note

• Duncan McCormick delivered an update from PHS which covered, drugs implicated in Drug Related Death’s (DRD) in Scotland, current risk and system challenges, MAT standards informed response for benzodiazepine harm reduction and a proposal for delivery and measurement of services for benzodiazepines (& stimulants) plan. 
• It was explained that poly-substance use remains a major concern and there continues to be a rise in novel substances. This has had an impact and reduced the effectiveness of onsite testing (OST).

Discussion: Emerging Drugs and the role of MAT and MIST 

John Harden opened the discussion to the floor focusing on three questions

Questions put to the group

Should MIST support ADPs to implement the PHS MAT standards guidance on Benzo harm reduction – i.e. applying the same standards of care: timely access, choice, proactive identification and outreach, retention in care, holistic care? If so, how? 

Points to note

• concerns were raised about placing further strain on already stretched resources both within MIST and within services
• concerns were also raised about adding any further requirements to the MAT standards before they are fully implemented, potentially risking the progress that has already been made
• the numbers of people on MAT who also are also impacted by illicit benzodiazepines means that supporting local services to provide care for both in line with the MAT standards was the correct approach from a clinical perspective
• it was agreed that local services should be supported to implement the SG guidance on Benzo treatment in line with MAT standards
• it was recommended that in 2024/25 MIST should focus on scoping out what additional support local services would require and what services could learn from existing good practice for people impacted by opiates and benzos before assessing performance against the MAT standards themselves

Presentation: decreasing hospital admissions

Anniek Sluiman delivered a presentation on decreasing hospital admissions. 

Points to note

• it was reported that acute drug related hospital admissions had fallen and this did not seem to match the data in drug related deaths, which is on the rise
• Scottish Government analysts were keen to understand the reasons for this mis-match of data

Discussion: decreasing hospital admissions

John Harden opened the discussion to the floor focusing on two questions.

Questions put to the group

Is this being experienced on the ground?

Where could additional analysis have most impact?

Points to note

• members discussed the reason for the drop in the figures of hospital admissions. It was suggested that Emergency Departments do not often see people presenting with overdose symptoms, but more problems related to their drugs use, i.e. wound care
• it can often be the case when people do present with these issues, in the time it takes to either be seen or be admitted, they will feel better and then simply go home
• it was suggested, that unless urgent care is required, people will more often be directed to drug services and not admitted to hospital (therefore not accounting in the hospital admissions number)
• it was also suggested that a lot of hospital settings do not have toxicology facilities and due to this, comorbidity may be underreported

Any other business and close

Update - Chairs meeting with UK Government clinical expert group chairs.

Points to note

•    Marion Bain reported that she and fellow co-chair John Harden met with the UK Government clinical expert group chairs on 10th May 2024.
•    The meeting was set up to allow them compare notes and view their Terms of Reference (TOR). 
•    it was noted that their scope is much narrower than of the CAG

Update - Officials meeting with UKG Policy Officials on Orange Guidelines

•    This was update was postponed until the next meeting as the presenter had to leave for another meeting.

Supplementary papers and written updates provided flagged: 

•    Xylazine RADAR Alert.
•    MAT 7 Update (inc. East Lothian and Dundee examples).

The next meeting is scheduled to take place Wednesday 18 September 2024 at 1.00 pm.- 3:00 pm. This meeting will be in-person in St. Andrews House.

Subsequent meeting as follows: 

•    Wednesday 11 December 2024 1 pm – 3 pm*

(*Scheduled to be in-person meetings in St Andrews House and are subject to short notice change)