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

3. Forum's 2011/12 Recommendations of High Priority

Drug Treatment as a Core Service in Primary Care

3.1 The Scottish Government and Health Boards should develop a clear strategy and commitment to providing support for evidence based interventions. These commitments include ensuring the normalisation of drug treatment in general practice and secondary care, by including work with drug users as core services and the responsibility of all medical and nursing qualified professionals. Despite previous recommendations, health care workers in primary care, secondary care and community pharmacies may still offer a service to drug users which is less sympathetic and supportive than that to other patient groups. This is based on an inappropriate stigma associated with addiction and sometimes erroneous beliefs of the efficacy of treatment.

3.2 The opportunity to establish treatments for dependency problems as central to the contract should not be overlooked. Guidelines for all specialist care providers should recognise that addiction problems are increasingly associated with chronic disease. The population of dependent patients with co-morbidity is increasing as time passes and all specialities need a knowledge and expertise in dependency. As previously recommended, training at undergraduate and postgraduate levels is a consequence of these changes.

3.3 The recently published document by the British Medical Association (BMA) titled Drugs of Dependence: The Role of Medical Professionals^[8] highlights many of the issues which are germane to the views of the Forum and is highly recommended to Ministers and Health Boards as well as those working with drug dependent patients in the NHS (BMA Board of Science 2013).

Data Analysis of Drug-Related Deaths in Scotland

3.4 The Scottish Government is in a strong position to lead discussion on drugs policy and, in many ways, is in a position to recognise the need to change in a direction suggested by various advisory authorities. The European Monitoring Centre on Drugs and Drug Addiction (EMCDDA) and other international groups recognise the investment made on issues such as gathering data on the details of drug related deaths, and scrutinising these data for possible interventions which might prevent deaths in this group.

3.5 Significant achievements in recent years have included reducing waiting times for treatment and standardising the post death legal, pathological and toxicological processes. In addition, Scotland's naloxone programme is world leading and is being closely observed by many countries that are now planning similar interventions. The recurring themes of early intervention and engagement in treatment for those most vulnerable and at highest risk of death, together with infrastructural capacity, are more demanding than ever.

3.6 Last year's recommendations included the need to develop the data handling capability of the Forum. In addition the recommendation about planning and expanding national and international networks through the EMCDDA and the medium of an international conference or symposium was agreed but not progressed. The agreed position, from the Scottish Government's response, was that work in this area should be agreed and developed through the Data Collection Sub-Group and that, within limits, this would be supported. However, due to other priorities this work has not been progressed. Also, the Data Collection Sub-Group has similarly a limited capacity for initiating and developing suitable projects.

3.7 The importance of accurate and dynamic data handling is greater than ever and the Forum requires access to an academic facility to work with ISD and others in determining the basis and correct responses to our drug deaths problem. Developmental work with ISD has been very encouraging with the appointment of an intern to help with the analysis of the dataset for 2011. The following recommendation is based on the need for further development in data collection in a more substantial framework.