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

2. Forum's Observations on Key Priority Areas of Work

2.1 With reference to the Forum's recommendations from last year (and previous years), and the Scottish Government's response to these, the Forum recognises the challenges in progressing these recommendations. However the Forum would like to re-iterate that the following remain key priority areas of work to reduce drug-related deaths:

• Hepatitis C treatment in community settings has been difficult to develop and further efforts are required to allow shared care models to achieve significant impact. Health Boards should report difficulties encountered and strategies for overcoming these.
• Throughcare for those leaving prison and relocating in communities is slow to develop. This is a central strategy in addressing the risk of death from overdose in the months after leaving custody. Transfer of health care to the NHS is now complete and liaison with community health and social care services needs to be improved and developed.
• Data on drug and alcohol treatment waiting times within prisons has not been published to date. Publishing this information would be valuable in ensuring that there is continuity in the care arrangements of those requiring drug treatment, especially given the increased risk of a drug related death within the first 12 weeks of release from prison.
• Alternatives to methadone remain available to a minority of drug dependent patients. These alternatives are other pharmacotherapies and non-pharmacological interventions such as detoxification and residential rehabilitation. Successful recovery depends upon increased capacity in projects designed to address the longer term problems. One specific example is the possibility of methadone and other opiate substitute therapy maintenance being part of a recovery package in residential recovery agencies.
• Community pharmacies remain vulnerable to criticism and to (lack of) capacity problems. Support and adequate resources are required to maximise the role that optimal pharmaceutical care can play in promoting recovery for individual patients. The Forum recommend that the document Prevention and Treatment of Substance Misuse-Delivering the Right Medicine: A Strategy for Pharmaceutical Care in Scotland which was published by the Scottish Executive in 2005, is updated to reflect current strategies to help prevent drug-related deaths.
• The roll out and reach of the national naloxone programme needs to be significantly enhanced. Specialist addiction services need to provide training and provide naloxone to their clients. The Scottish Government should explore how best to deliver this including the possibility of a target for Alcohol and Drug Partnerships (ADPs).
• More work needs to be done by the Scottish Government and ADPs to investigate the specific needs of older drug users (35+years) with a view to improving services for this population.
• In the event of a further prolonged delay by the Home Office including foil in the list of exempted items in section 9a of the Misuse of Drugs Act 1971, the Forum request that the Lord Advocate issue a Letter of Comfort in Scotland, to allow drug treatment services to supply this item of paraphernalia.