National Drugs Mission Oversight Group minutes: June 2022

Attendees and apologies

Group members:

• Angela Constance MSP - Scottish Government Minister for Drugs Policy (chair)
• James Docherty - Lived and Living Experience Representative
• Sandra Holmes - Lived and Living Experience Representative
• Dr Michel Kazatchine - World Health Organisation Regional Office for Europe (WHO/Europe)
• Billy Watson - CEO of Scottish Association for Mental Health
• Belinda Phipps - We Are With You
• Dave Liddell - CEO of Scottish Drugs Forum
• David Strang - Co-Chair, Drugs Death Taskforce
• Eddie Follan - COSLA Representative, Convention of Scottish Local Authorities
• Jardine Simpson - CEO of Scottish Recovery Consortium
• Susanna Galea-Singer - Royal College of Psychiatrists Committee Member
• Professor Thomas Kerr - Dept. of Medicine, University of British Comumbia
• Dr Catriona Morton - Deputy Chair, Royal College of GPs
• Dr Sharon Stancliff - New York City Health Department

Attendees:

• Claire Morrison - Director for Royal College of Pharmacists (deputising for Laura Wilson Policy and Practice Lead Royal College of Pharmacists
• Sarah Peat - CREW (deputising for Emma Crawshaw CEO CREW)
• Orlando Heijmer-Mason - Scottish Government
• Maggie Page - Scottish Government
• Alison Crocket - Scottish Government
• Michael Crook - Scottish Government 

Observers:

• Paul Sutherland - Scottish Government
• Martin Shanahan - Scottish Government
• Keegan Schmidt - Scottish Governmenet
• Gerald Ellison - Scottish Government
• Alice Burling-Brown - Scottish Government
• Martin Shevlin - Scottish Government

Apologies:

• Prof. Tessa Parkes - Director for the Salvation Army
• Dr Andrew McAuley - School of Life Sciences, Glasgow Caledonian University and Health Protection Scotland
• Justina Murray - Lived and Living Experience Representative 

Items and actions

Welcome and introductions

The chair welcomed members and attendees to the first meeting of the National Drugs Oversight Group. Apologies received and nominated deputies were listed.

All present members introduced themselves and what organisation they were from.

Terms of reference discussion

Minister opened up a discussion on the Terms of Reference (TOR). During the discussion the following points were made:

• Belinda Phipps – raised that phrasing of ‘promoting accountability’ isn’t strong enough and suggested we strengthen to ‘ensuring or implementing’ accountability
• Billy Watson – welcomed further information about the infrastructure and the mechanics of the group and how it engages with others to be made clearer
• Michel Kazatchine – sought confirmation that this a temporary mission in response to the current mission and not a commission to look at drug policy reform. The Chair confirmed it was an immediate emergency response, but with a further outlook in longevity
• the chair - restated the purpose of this group is to hold her and Scottish Government to account and provide scrutiny. It was highlighted that this mission focused on what we can do now with our current resources and powers
• Susanna Galea-Singer – raised that we should consider including families and significant others into our references of lived and living experience

Election of steering group

The chair welcomed nominees from the group for the 3 members of the steering group as per the ToR. Following discussion in the group, several candidates nominated themselves or others and it was agreed that four members could represent the steering board in the first instance. Action: review membership and number at the next Oversight Group in September.

Billy Watson suggested that is it highlighted in the appointment letters from the Minister whether attendees are speaking on behalf of themselves, or the organisations. Action: update TOR

Action: oversight group secretariat to engage with the steering board to support selection of next agenda items.

Introduction to the national mission plan 

Maggie Page gave a presentation on the national mission plan for members to gather their initial thoughts. Key points discussed included:

• brief oversight of the context in Scotland
• the outcomes framework that we are working towards
• duration of the mission, as well as resources available
• plans for governance and publications of reports and plans for the next year

Several key publications and documents were mentioned. Action: OG secretariat to collate the documents and links on our published work and share with the group.

Sandra Holmes - welcome the walk though of the national mission but raised that having spoken with families, they feel things are not going quick enough. Sandra also highlighted that the telephone number for the community hotline was not working. She noted that families are in crisis and are not getting answers fast enough leading to frustrating with the speed on the ground. Sandra commented that the National Mission looks good but it is complicated and hard to relay back to the families. Action: policy officials to follow up on the community hotline issues.

Dr Catriona Morton - welcomed the plan and commented positively on the structure and context of the plans. She raised additional points:  

• under our objective to achieve fewer people developing problem drug use, does this need to be linked to poverty and early life experiences?
• for the circle in the outcomes framework, do we need arrows pointing both ways?
• highlighted the importance of flagging the issues raised on workforce and the need to work across the board on that issue
• as the age of death has gone up, physical health needs to be taken into account more
• chronic pain is a huge issue that is very common amongst people who use drugs. Should this be acknowledged in the plan?

Jardine Simpson – suggested we link the national mission plan to the ongoing policy and publications:

• raised the topic of differentiation between lived and living experience. Suggested this as a potential substantive topic for the group to discuss at a later point. Action – steering group to consider lived and living experience definitions as an agenda item

Belinda Phipps – commented that MAT standards are less clear than they could be:

• suggested accountability should be raised more, where does this fit in the plan. Noted that we need to be very clear about verifying, auditing/checking/inspecting to make sure that what is being reported is really happening
• importance of pathways from first day to receive help, right through to recovery. Although everyone knows the route, should be clearer who is responsible for that. Typically, one organisation leading on this to deliver works best. Should we include structural pathway information in the plan?
• welcomed lots of recognition of mental health aspects, but questioned if we are moving to recognise if you can resolve the underlying trauma. Noted that addressing underlying trauma helps people be in a position to take advantage of other support. Should we be heading towards further trauma resolution as our aim?

Susanna Galea-Singer – raised that point 2 in the framework (risk is reduced for people that use harmful drugs) should have a broader definition and focus on more than just naloxone, but more about mental health and considering vulnerable groups:

• pleased to see the word compassionate regularly through the plan. Important, working to targets but the point is compassionate

Michel Kazatchine - from an international perspective as plan aimed at intending harm reduction it is fine, but harm reduction needs to be comprehensive, including safe injection rooms, drug checks, HAT, and scaling up those aspects of harm reduction:

• noted that it is missing the details on substance use.  Overdose are more regularly caused by complex mixtures of drugs including new, synthetics and homemade. Would welcome an additional area of research, or intensive search, into the experiences across the world of synthetic drugs and the impact on the overdoses to enrich the programme. Action: OG secretariat to consider research opportunities
• section 1 reducing supply of harmful drugs should consider more strategies to reduce supply and what is meant by harmful drugs? Looks like a conventional approach, but how much does Scotland engage on drugs in Europe and internationally to address supply?  [highlighted ministerial conference on July 15 in Luxembourg.]
• when discussing HAT , substitute therapy (OST),Michele prefers to only call it therapy. Raises issue, but calling it OST makes it 'special', the therapy shouldn’t be considered a luxury, just a basics of needing. Should we review the wording?

James Docherty – noted that there needs to be a clear definition of what is meant by lived and living experience.

Thomas Kerr – acknowledged and appreciated the overall goal of the Outcomes framework:

• there is a hidden epidemic of injury of behind 'non-fatal overdose'. Questioned if there should an outcome be to reduce the harm and morbidity arising from non-fatal overdose
• suggested more emphasis on timely access. Do we need to do more to create the system mechanisms to support fast delivery?
• we have enough evidence to know that when we offer MAT. Raised the progressive step in British Columbia - majority of people who are dying are at home and alone so integrating harm reduction into housing based settings - situating SDCS within poorer housing areas

Sarah Peat - noted that the term ‘harmful drugs’ enforces stigma - can we change? As well as part 6, effected by substance use or support should be changed to drug use. Action: OG secretariat to review.

Clare Morrison – suggested more variation in access to spaces including a section on improving pathways. An example noted was working with people within prisons, and a pressure point is when people come out of prison, so pathways afterwards critical too.

AOB and close: 

• officials will circulate an invite to the next meeting (September 2022) in the next couple of weeks
• officials will also get in touch with the steering group to help inform the agenda for that meeting
• offer for a session on the context in Scotland for our international participants
• getting the right information to people and at the right time, that conveys the detail of what we are doing - potential topic for the steering group
• demonstrate and report how people’s views and comments have been taken on board and addressed