Drugs deaths: National Mission Clinical Advisory Group minutes - April 2023

Attendees and apologies

Attendees  

• John Harden, Co-Chair, Deputy National Clinical Director
• Marion Bain, Co-Chair, Deputy Chief Medical Officer
• Adrian MacKenzie, MAT Standards Clinical Lead, Healthcare Improvement Scotland
• Catherine Totten, AHP Professional Advisor Mental Health, Scottish Government
• Chanpreet Blayney, Consultant Psychiatrist at Health Improvement Scotland
• Darren Fullarton, Associate Nurse Director, NHS Ayrshire and Arran
• Dr John-Paul Loughrey , Vice Pre Consultant Emergency Medicine and Vice Presidents of Royal College of Emergency Medicine
• Dr Ryan McHenry, Clinical Research Fellow and Registrar in Emergency, Pre-Hospital and Retrieval Medicine
• Hazel Torrance, Head of Forensic Toxicology Service, Scottish Police Authority
• Julie McCartney, 3rd Sector Harm Reduction Manager, Scottish Ambulance Service
• Kirsty Nelson, Parish Nurse, Queen's Nurse
• Mandy Ramsay, Head of Clinical and Care Governance/Registered Nurse Mental Health and Registered Nurse Adult at Turning Point Scotland
• Mark Richards, Associate Chief Nursing Officer and Executive Nurse Director in the NHS
• Roy Robertson, Professor of Addiction Medicine at the University of Edinburgh and Retired General Practitioner
• Saket Priyadarshi, Associate Medical Director and Senior Medical Officer, Glasgow Alcohol and Drugs Recovery Services.
• Sarah Donaldson, Specialist Pharmacist in Substance Use, NHS Tayside
• Steven Short, Programme Lead, Out-of-Hospital Cardiac Arrest
• Tara Shivaji, Consultant in Public Health Medicine at Public Health Scotland
• Trina Ritchie, Lead Clinician, Greater Glasgow and Clyde Alcohol and Drug Recovery Services
• Dave Taylor, Deputising for Duncan McCormick PHS MIST Team

Apologies      

• Duncan McCormick, Consultant in Public Health Medicine, Public Health Scotland MIST Team
• Susanna Galea-Singer, Clinical Lead and Consultant Psychiatrist/Chair of the Education Committee/Co-Chair Faculty of Addictions Psychiatry
• Duncan Hill, Specialist Pharmacist in Substance Misuse, NHS Lanarkshire
• Dr Isabel Traynor, Consultant Clinical Psychologist/Head of NHS Fife Addictions Psychological Therapies Service (APTS) and Lead Psychologists in Addiction Services Scotland (LPASS) representative
• Tracey Clusker, Nurse Consultant at Public Health Scotland

Also in attendance   

• Maggie Page, Scottish Government
• Morris Fraser, Scottish Government
• Alison Crocket, Scottish Government
• Alice Burling-Brown, Scottish Government
• Stuart Henderson, Scottish Government
• Sharon Mooney, Scottish Government
• Paul Sutherland, Scottish Government

Items and actions

Introduction from Chair

JH introduced himself and MB and outlined the background and core of the National Mission and purpose of the group.

The numbers of drug-related deaths in Scotland are far too high. These deaths are tragic and avoidable – reducing them is a priority for all of us. The core of this mission is taking action based on what we know works to reduce harm, promote recovery and save lives. The National Mission Clinical Advisory Group will provide clinical expertise to local and national policy and decision makers. 

• be champions of change (in response to Drugs Deaths Taskforce, Medically Assisted Treatment Standards, Residential Rehabilitation) 
• explore and consider the data and views from across Scotland and beyond and the best way to support those at highest risk, those with clinical priorities and/or those with long term conditions
• consider the data on the effectiveness of measures and advise where changes should/could be made
• be mindful of the wider harms, practical and policy implications that the challenges of these measures may cause – including mental and physical health 
• maintain links between the other working groups in the national mission, ensuring clinical input is provided and considered where required across the mission

Introductions

Each member introduced themselves and gave their clinical and public health backgrounds

Background of the National Mission

MP delivered presentation slides of the National Mission and suspected drug deaths and the contributing factors. (Slides attached for reference) 

Discussion 

JPL asked if drug misuse death figures include trauma deaths as it is certainly a theme of prehospital critical care. HT confirmed that these would not be included as drug misuse deaths which have a very specific definition based on pathology and toxicology. 

Action: HT to share data on trauma deaths where drugs was a factor. 

Discussion of terms of reference 

JH led the group through a line-by-line review of the terms of reference welcoming changes and comments.

Purpose

No points raised

Responsibilities 

• do we need to include evidence alongside data and view in point 5.3?
• does 5.4 refer to evidence-based treatment delivery or expansion of data? MR confirmed this relates to evidence base for treatment delivery

Membership

RR on point 13 - the NMCAG is ‘not a Scientific Advisory Group, it is a consensus seeking Clinical Advisory Group’. RR enquires why it can’t be both as we are working from scientific basis of evidence? Our advice should be based on some science evidence, therefore should we instead say using science to inform clinical policy. Agreed this change (action)

Fairness at work 

No issues raised

On point 19, suggested suffix changed to they, not she/he (action)

Discussion of future work/potential topics

MP delivered five items of potential future topics

• MAT standards generally. and how we ensure sustainability through clinical buy in
• MAT 7 primary care
• clinical advice on guidance for the treatment of harmful or illicit benzodiazepine use
• workforce –define size shape of clinical workforce 
• integration of clinical and psychological therapies – historically these have been developed separately, however from a patient point of view it should be an integrated and seamless interface

Points raised and suggestions of other topics of focus:

• polydrug and stimulant use - group agreed that this could be combined with the focus on benzodiazepines to look at both benzodiazepines and stimulants
• TR advised they have been approached for clinical input into work of the RR group on their framework. MP asked for the information to be sent to her (action)
• could future work include looking into injectable buprenorphine 
• Heroin Assisted Treatment – evaluation of Glasgow project due soon- suggestion that this could be incorporated into a broader harm reduction theme
• on National Mission infrastructure MAT7 PC include community pharmacy and laboratories, worthy of consideration. Group could contribute to updating 2017 guidelines on primary care due to research carried out on benzos etc
• future work should include urgent and emergency care and the intersection with primary care as a key pathway. Group agreed that this should be considered as a standalone rather than as part of the primary care discussion
• laboratory and infrastructure challenges and the need for early testing – can things be done in a sensitive, person centred-way i.e, early testing – often the toxicology test carried postmortem is the first time we find out what taken. Potential for linking in with the drug checking work which is underway
• AM asked if work has been done on iHost intervention to improve hospital care for opioids, enquire if work on Intervention improvements could be within scope of group? 

Any other business close 

• noted a need for broader representation of GPs which should be addressed in advance of June meeting (action)

No further points raised 

Decisions:

• June meeting topics
• MAT7 and primary care 
• September meeting topics
• workforce and harm reduction (benzodiazepines and stimulants)