National Forum on Drug-Related Deaths in Scotland - Annual Report 2011/12

1. Forum's Work and Progress in 2011/12

1.1 Since the Forum's last annual report, published in November 2011, the Forum has considered evidence and has engaged in discussions with a wide range of colleagues and organisations, and has discussed the findings of a number of publications. Among the former has been a selected group of experts including experts on medical and social issues, as well as those close to public health policy, service provision and opinion makers. This report covers the period August 2011 to November 2012 and during that time the Forum has held five one day meetings and an Away Day in May 2012. These meetings all had themes and were individually designed to explore an issue of importance on drug-related deaths. The topics covered and the presenters are listed in Annex A.

1.2 Also in the quarterly meetings were opportunities to update the Forum on the work of its subgroups. There is currently a Data Collection Sub Group and a Pathology Sub Group. Regular updates were also received from the National Records of Scotland on collating drug-related deaths statistics, the Scottish Prison Service, the Scottish Crime and Drug Enforcement Agency and the National Naloxone Advisory Group. The Forum would like to thank the Chair and members of the Short-Life Working Group on Family Support who looked at the support available to families following a suspected drug-related death. The Volunteer Forum has not met during 2012 and the Forum is keen to continue engaging with service users. Members of the Forum and its sub-groups are listed in Annex B.

1.3 The Forum publishes a bi-annual newsletter, Drug Death Matters^[1], which provides an update on the group's on-going work. The most recent newsletter was published on-line by Information Services Division (ISD) Scotland in December 2012.

1.4 Interventions recommended in previous reports and which have been acknowledged by Ministers, have been pursued this year. Some of these recommendations, such as the national naloxone programme and the drug deaths database, have had results of international significance. In addition, the need to widen the range of opiate substitute prescribing has been recognised as an important part of on-going responses to the problems of mortality and morbidity in this population.

1.5 There were also opportunities to present the Forum's views and findings to the Minister for Community Safety and Legal Affairs. The Scottish Government responded to the Forum's 2010/11 recommendations in May 2012 and this is included in Annex C. A number of these recommendations are work in progress but areas to note are:

• The Forum emphasised that prisons remain a crucial part of the naloxone programme, as the published evidence states that prisoners are particularly vulnerable to opioid overdose in the first 12 weeks following liberation. Monitoring data published by ISD Scotland in July 2012 showed progress, with 715 take home naloxone kits being issued by Health Boards in prisons, to prisoners at risk of opioid overdose on their release in Scotland in 2011/12. The National Naloxone Advisory Group is continuing to work nationally and locally to identify and address challenges, build on progress made so far and ensure that on liberation, prisoners are supported in their transition to the community naloxone programme.
• In addition, following the integration of prisoner healthcare services with the NHS on 1 November 2011, the Forum welcomes the establishment of the National Prisoner Healthcare Network (NPHN). The NPHN comprises all 14 territorial NHS Board leads for prisoner healthcare, Scottish Prison Service, NHS National Services Scotland, Healthcare Improvement Scotland, NHS Education Scotland, the State Hospitals Board for Scotland, Scottish Government and Union and third sector representation. This important group will enable stakeholders to participate in a collective where issues regarding prisoner healthcare can be raised and national solutions agreed. The Forum is interested in this group's work as it progresses.
• We understand that work to revise the National Quality Standards for Substance Misuse Services is underway. This work will allow the standards to fully and robustly evidence the performance of recovery-focused local addiction services. This is in line with the Scottish Government's Road to Recovery strategy and the Scottish Ministerial Advisory Committee on Alcohol Problems (SMACAP) Quality Alcohol Treatment and Support (QATS) report. This work and the findings of the independent expert group on opiate replacement therapies, will help inform thinking on any updates to the Orange Guidelines (Drug Misuse and Dependence UK Guidelines on Clinical Management) in line with recovery, as recommended by the Forum.

1.6 The Forum's Chair also had an opportunity to present the group's work to the independent National Drugs Strategy Delivery Commission. In addition, the Forum was represented by the Chair at an expert group meeting at the European Monitoring Centre for Drugs and Drug Addiction held in Lisbon in November 2012, where the most recent report from the National Drug-Related Deaths Database^[2] was presented (2010 drug deaths).

1.7 It has also been an important year for the publication of evidence and considered opinion. The report from the Department of Health's Recovery Orientated Drug Treatment Group^[3], chaired by Professor Strang, was an important and authoritative document on the position of treatment services. The UK Drug Policy Commission produced two very useful documents, one on stigma^[4] and the other about legal control of drugs and sentencing policy ^[5]. These should both influence the perception of drug users and policy in the area of drug control and legislation. The Home Affairs Committee published the report Drugs: Breaking the Cycle^[6] in December 2012. The Home Affairs Committee took evidence from a wide range of interested experts and presented some recommendations, some of which resonate with our own. On the international stage, the Global Drug Strategy Commission produced a report about the international approach to control of narcotics^[7].