National Mission on Drugs: annual report 2022-2023

Cross Cutting Priorities

2.1 Overview

There are six priorities which cut across all our work. This chapter outlines the progress made in 2022-23 for each priority, and the next steps in delivery.

2.2 Progress in 2022-23

2.2.1 Lived and living experience

The Scottish Government has made an important commitment to put people affected by substance use at the heart of the National Mission. This means that people affected by substance use – including families – should be meaningfully involved in policy and decision making at national and local levels.

Meaningful involvement means that people have the ability to influence the outcome of decisions.

At a local level, Alcohol and Drug Partnerships (ADPs) have continued to explore ways of meaningfully involving people affected by substance use in decision making. In 2022/23, £0.5 million was made available to support this work.

Some examples of the methods of involvement and participation have included:

• The development of lived/living experience panels which can sit as part of the ADP as a formal subgroup.
• Consultation with lived/living experience groups that sit independently of the ADP, for example within recovery communities, or supported by third sector organisations.
• Externally commissioned needs analyses conducted with lived/living experience, and peer research, whose findings will feed into planning and decision making.
• Development of forums or strengthening established forums to utilise participatory budgeting.
• Supporting the employment of people with lived/living experience in the sector.
• Soliciting review from lived/living experience groups on an ADP’s current involvement and work.

The Scottish Government funds third sector organisations to grow and sustain networks of people with lived and living experience of substance use. Scottish Drugs Forum received £298,059 in 2022/23 to develop living experience engagement groups across Scotland, influence service developments, service delivery and contribute to policy and strategy development. Engagement groups are safe spaces for people with living experience to express their views, facilitated by staff from the SDF and local partner agencies, who all have lived experience. Groups are fully independent but can help inform local Lived Experience Panels or ADP sub-groups through providing group member representation. The groups feed into other local and national stakeholder groups and research and evaluation activity.

The Living Experience Engagement Groups have become active in nine regions across Scotland, with an average attendance of 100 people per week across all groups. A national group, made up of regional members, also feeds into the ongoing work of the National Collaborative.

In 2022/2023, Scottish Recovery Consortium (SRC), as part of its £630,000 annual funding, helped build recovery communities and reduce stigma across 18 ADP areas. SRC has supported recovery communities across Scotland to develop a wide range of different opportunities for their community, offering training, supporting capacity growth, and networking opportunities.

SRC has also supported 50 small groups and lived experience recovery organisations to build in size and strength. SRC administrated the Recovery Seed Fund in 2022/23 to support these small groups directly to build capacity and develop their governance, constitution, and business planning. “The Scheme,” detailed below, has developed from an idea to a charity, through the support of SRC.

Lived and living experience is also central to other aspects of the National Mission including the implementation and delivery of the MAT standards. The standards were developed by the Drug Deaths Taskforce and this included involvement of people with lived experience, including family members. The MAT standards set out clearly the need to involve people with lived and living experience in the design and delivery of local services.

The national MAT implementation support team (MIST), based in Public Health Scotland, includes staff with lived and living experience who are supporting local areas collect experiential evidence from people who are using services to help inform local services about the need for further improvements. In most cases the collection of local evidence is being carried out by peers with that experience. Having an effective experiential evidence system in place is a requirement on local services and without being able to demonstrate that this is in place the local area will not be able to claim that it has fully implemented the MAT standards.

Case Study: The Scheme, Livingston

The Scheme is a charity rooted within its community in Livingston, providing creative workshops, outreach and drop-ins, linking people with the right services through creating and developing strong partnership with other organisations.

The Scheme’s services will always be free to use, providing people with a chance to get involved in many different forms of creativity, to connect to other like-minded folk and to offer somewhere safe and exciting for people to be a part of. Everyone is welcome.

2.2.2 Equalities and human rights

The National Collaborative

The National Collaborative’s vision is to integrate human rights into drug and alcohol policy, leading to better outcomes for people affected by substance use.

In 2022/23 National Collaborative, chaired by Human Rights Professor Alan Miller, has progressed work across the following three areas.

Strategy and engagement

Broad engagement and consultation on what the National Collaborative should be led to the publication of a Roadmap (shown in figure 2). This was launched at an event in Glasgow in December 2022.

Mobilising the National Collaborative Network

A change team was recruited comprising 15 people with lived/living experience, as well as family members (ensuring that there is a broad range of experiences represented).^[2]

The team began a series of capacity building workshops and further reference groups were also brought together as well as an open Leadership & Learning Network, for anybody who wants to be involved in the National Collaborative. The purpose of these groups is to extend the reach of the National Collaborative and bring different experiences and expertise into the process.

Starting to implement the Roadmap

The Roadmap set out the ‘FAIR’ model of a Human Rights Based Approach shown below in figure 3.

Figure 3 The ‘FAIR’ model of a human rights based approach

FAIR:

• Facts - Develop an evidence base of experience of substance use.
• Analysis - Co-produce an analysis of the human rights engaged in experiences of subtance use.
• Identification - Identify an action plan to respect, protect and fulfil the relevant human rights.
• Review - Review and monitor the implementation of the action plan.

From January to March 2023 the Change Team planned the implementation of the ‘Facts’ stage and made a Call for Evidence. The purpose of this was to build on existing evidence and to hear from people affected by substance use in order to inform the development of the Charter of Rights and Implementation Framework. The Charter of Rights will set out how the rights to be included in the forthcoming Human Rights Bill can be effectively implemented to improve the lives of people affected by substance use.

2.2.3 Tackling Stigma

The Stigma Action Plan was as part of the Cross-government response to the Drug Deaths Taskforce report published in January 2023. This plan outlined the three key areas of focus:

• Scottish Government will lead by example by interrogating internal policies and removing barriers for those affected by substance use.
• A voluntary accreditation scheme aimed at broader structural change which will include commitments to take defined and measurable actions to challenge and remove structural stigma. This will also provide a route for service users to challenge stigma and discrimination within participating services.
• A National Programme to tackle social stigma, which will include a variety of methods and be targeted to meet the needs of the audience and challenge specific beliefs that may not be based on fact and evidence.

Our next steps will be to co-produce the detail of each of these areas of focus with people with lived and living experience of substance use during 2023/2024.

2.2.4 Surveillance and data informed

We remain committed to improving our public health surveillance around substance use and this need has been further evidenced over the last year as new substances of concern have been identified in our drug supply.

RADAR (Rapid Action Drug Alerts and Response)

We have continued to support the development and launch of Public Health Scotland’s RADAR (Rapid Action Drug Alerts and Response) system which assesses and validates information provided to them to allow for the rapid and targeted deployment of interventions to prevent and reduce the risk of drug-related harm.

This system continues to demonstrate its value through the identification of new and problematic substances and its ability to issue harm reduction information or make recommendations for wider system change.

Case Study: Rapid Action Drug Alerts and Response (RADAR)

This was demonstrated through the identification of a new group of drugs called nitazenes, which are synthetic opioids, at the end of 2022. In January 2023 PHS issued a public health alert in relation to these substances which included information for people who take drugs along with actions and recommendations for people who work in high risk settings or drug and alcohol treatment services. In addition, and in recognition of the potential increase in nitazene-related harms, the RADAR Pathology and Toxicology Network recommended that post-mortem toxicology screening be expanded to now test for nitazenes. This is now in place across Scotland and nitazenes have been detected in deaths in Scotland.

Since July 2022, RADAR has validated over 90 reports of drug-related information and harms received through the reporting form and mailbox. The majority of recently received reports relates to cocaine and benzodiazepines while around half of recent submissions report polydrug use. 30% of reports relate to drugs being contaminated, ‘laced’ or stronger than expected highlighting concerns about the unexpected effects of drugs in the market.^[3] RADAR will continue to assess emerging threats, share information to reduce the risk of drug-related harm and recommend rapid and targeted interventions.

Case Study: ASSIST (A Surveillance Study of Illicit Substance Toxicity) in the Queen Elizabeth University Hospital Emergency Department.

The purpose of this pilot was to establish the introduction of a robust toxicology surveillance system in an Emergency Department in Scotland and to provide timely and comprehensive drug related hospital attendance and clinical characterisation data to PHS. Through the work done in the Emergency Department, ASSIST is able to contribute objective information on hospital attendance and toxicological analysis to PHS and their RADAR system as well as also feeding into the RADAR threat Assessment Group and Toxicology and Pathology Network. For example, data collected from ASSIST related to the high prevalence of bromazolam is already being used by PHS to assess the threat of this new type of benzodiazepine.

Prevalence of problematic drug use in Scotland

The Scottish Government is funding a collaborative project between Public Health Scotland and the University of Bristol to produce a new estimate of the prevalence of problematic drug use in Scotland. The project will use routinely collected linked data and statistical modelling to estimate and monitor the number of people in Scotland who use opioids problematically. The findings will inform Scottish Government and PHS’s response to drug-related deaths and harms in Scotland. Initial findings from the project are expected in early 2024. Future stages of the work will incorporate additional drug-related date to estimate changes in prevalence over time and the prevalence of other forms of problematic drug use.

Drug and Alcohol Information System

The Drug and Alcohol Information System (DAISy) is a national database that holds data about drug and alcohol services, including prisons data, across Scotland delivering specialist tier three and four interventions. DAISy gathers demographic and treatment data about people who engage with drug and alcohol treatment services and aims to enable a better understanding of the impact of drug and alcohol treatment services at both a local and national level, inform policy and practice development and provide timely information to support local service delivery, improvement and planning.

On 27 June 2023 we saw the first publication of statistics from DAISy on people presenting for initial assessment for specialist drug and alcohol treatment services in Scotland during 2021/22 and 2022/23.^[4] The report contributes to our capacity to monitor the uptake of alcohol and drug treatment across the country and is pivotal to our efforts to understand and improve delivery of services in our communities and to target positive intervention and support where it is needed most. It also presents us with insight into the demographics of those seeking help as a result of their alcohol and drug use and the underlying issues that they are presenting with.

Drug data linkage

Scottish Government also funds work at Public Health Scotland on linkage of drug-related health data sources. This ongoing work aims to construct a linked dataset based on a cohort of drug users which can then be linked to other data sources to generate indicators of outcome data for this population. The database forms a basis for answering a wide range of public health surveillance questions and will be used to analyse the size and composition of the population with problematic drug use, mortality, and morbidity among people with a drug use problem and the impact of specialist drug treatment and care.

2.2.5 Resilient and skilled workforce

It is vital that drug and alcohol services are able to attract, retain, and support staff. It is also of vital importance that the workforce has the right skills and knowledge to support people with substance use problems.

In recognition of the complex challenges impacting upon the workforce, the Scottish Government established a Workforce Expert Delivery Group (WEDG) in September 2022. The group brought together key stakeholders, from across the sector, with the requisite understanding and influence to identify how best to respond to key challenges.

Members of the WEDG have been progressing the following actions:

1. The development of a single platform for access to training and key workforce resources;

2. A mapping exercise to facilitate improved data capture and workforce planning; and

3. The development of principles to allow organisations to support employees with lived and living experience.

Workforce Action Plan

The Scottish Government has been progressing the development of a workforce action plan. This plan, which will be published in Autumn 2023, will set out the steps we will take to support the development a skilled and resourced workforce required to deliver the national mission.

This action plan will be informed by a robust evidence base of research on Scotland’s drugs and alcohol workforce. The action plan will reflect what we have heard during extensive engagement with key stakeholders across the sector, including those responsible for service delivery and people with lived experience of substance use. The WEDG has been instrumental in advising how key workforce challenges should be prioritised and addressed.

2.2.6 Psychologically informed

We continue to work to improve how we support people experiencing co-occurring mental health and substance use issues. As well as continuing focus on implementing the MAT standards, which include requirements for all MAT to be psychologically-informed (MAT standard 6) and trauma-informed (MAT standard 10), in November 2022 we published a rapid evidence review on co-occurring mental health and substance use conditions and set out to Parliament our plan for improvement. (See Outcomes 3 & 4).

To meet our shared ambition with COSLA and many other partners for a trauma-informed and trauma-responsive workforce across Scotland we announced in January 2023 plans to expand the existing Transforming Psychological Trauma Implementation Coordination Network (TPTIC), and recruit a National Lead specialist post with experience in substance use and trauma-informed practice. This will ensure that both specialist and generic services that people who use drugs may encounter are trained and equipped in trauma-informed practice to ensure appropriate responses and support are given.