National Mission on Drugs: annual report 2022-2023

Outcome 2: Risk is reduced for people who take harmful drugs

4.1 Overview

People are entitled to support that reduces the harms associated with drug use regardless of where they are on their recovery journey. This includes promoting safer drug consumption practices, preventing overdoses, and reducing risks when they do occur by addressing the harms caused by drug use.

4.2 Progress in 2022-23

4.2.1 National Naloxone Programme

Naloxone is an opiate antagonist treatment which can be administered to reverse the effects of opiate overdose. Scotland has had a national naloxone programme, in place since 2010. This has been stepped up as a result of increased funding through the National Mission.

Building on the work done in 21/22, priority has remained with the distribution of kits, but also further work with partners to increase the reach of kits, specifically targeting peers, family members and emergency services.

Case Study: Naloxone

Following the end of their pilot study, Police Scotland have now fully rolled out the carriage of naloxone by all front-line police officers, up to the rank of Inspector, around 12,000 individuals, with naloxone kits being carried obviously on their utility belts. To date there have been over 320 administrations by police officers with Police Scotland estimating that there is around 1 use per day across Scotland.

Through our 2022/23 funding of the Scottish Ambulance Service Drug Harm Reduction Team, it has been possible for their Clinical Effectiveness Leads to develop take home naloxone programmes, allowing paramedics to provide naloxone kits to those on scene when they attend a near-fatal overdose, whether friends, family, or peers.

Additional naloxone activity in this year has included providing further support to the peer-to-peer programme being offered across some of the prison estate with £500k being made available for this project until 2025/26. That funding has enabled further naloxone training and provision but also to begin planning for expanding this service across all 15 prisons in Scotland. We have also provided funding to the Scottish Prison Service to make naloxone, specifically the intra-nasal kits, available in all prison ‘crash packs’ (emergency first aid boxes) for use in an emergency situation.

We have also provided funding of £301k to Community Pharmacy Scotland to allow them to establish a national service which would require every community pharmacy to hold naloxone for use in an emergency.

4.2.2 Safer Drug Consumption Facilities

Safer drug consumption facilities are evidence-based services, designed to reduce harms and prevent drug overdoses. Progress has now been made in terms of a position from the Lord Advocate around a possible statement of prosecution policy for the establishment of a safer drug consumption facility in Glasgow.

However, for the purposes of this report the work undertaken was to continue to engage with UK Government officials and Ministers to seek agreement for establishing a facility in Scotland. At the same time work was underway to explore how a facility might operate within the existing legal framework and, following detailed partnership working, facilitated by Scottish Government, between Glasgow Health and Social Care Partnership, Police Scotland and Crown Office (COPFS) a service specification for a facility was submitted to COPFS in June 2022 for consideration of any related statement of prosecution policy.

In the meantime we have continued to explore how a facility might operate within the existing legal framework and, following detailed partnership working, facilitated by Scottish Government, between Glasgow Health and Social Care Partnership, Police Scotland and Crown Office (COPFS) a service specification for a facility was submitted to COPFS in June 2022 for consideration of any related statement of prosecution policy.

4.2.3 Drug Checking

Drug checking provides the ability for individuals to anonymously submit samples of drugs for testing. Once the sample has been tested, individuals receive information about the content and potency of the submitted drugs so that they can make more informed decisions about their use. It is an evidence-based harm reduction tool used in numerous countries around the world and has also been used in other parts of the UK, for example at music festivals, but has never been licenced in Scotland.

Funded through the Drug Deaths Taskforce, a two-year University of Stirling research project, exploring how best to establish drug checking facilities in Scotland, completed in May 2023. As part of that research work three areas (Glasgow, Dundee, and Aberdeen) were identified as possible drug checking pilot sites and work began to understand the opportunities and challenges setting up these facilities could bring. More information about the project can be found here - The Scottish Drug Checking Project.

Following the end of the research period, focus has now shifted towards implementation and those three cities are close to being able to submit controlled drug licence applications to the Home Office to allow them to establish these facilities.

In addition to the three city facilities which will offer ‘point of care’ testing and be able to provide basic harm reduction advice, there will also be a national hub, based in Dundee University, which will offer the ability to undertake lab-based and more comprehensive testing but also the ability to further validate the ‘point of care’ tests. Work to establish that hub is also underway.

4.2.4 Heroin Assisted Treatment

Heroin Assisted Treatment is an Enhanced Drug Treatment Service (EDTS) which involves the provision of a heroin substitute to people with longstanding problem substance use under supervised conditions and has been shown to reduce the use of street drugs and increase the likelihood of individuals remaining in treatment.

The first EDTS service in Scotland opened in Glasgow in November 2019 and was the subject of a large-scale evaluation supported by the Scottish Government Chief Scientist Office (CSO) and Glasgow Caledonian University. That evaluation has now concluded and the findings published in June 2023 - Chief Scientist Office - Research Briefing - HAT. The recommendations from the study can be found here - Chief Scientist Office - Recommendations - HAT.

That study found that:

• The majority of people who used the HAT service in its first year engaged with services much better than they had done previously.
• Those who were still engaged after one year had reduced their illicit heroin use and had improved health and social functioning.

We are committed to supporting the establishment of additional HAT services across the country and we continue to work with local areas to explore this. For example, in January 2023 Dundee ADP was provided with funding to allow it to carry out a local scoping exercise to explore whether the city would be an appropriate location of a facility. The results of that study are expected later in 2023. The findings from the Glasgow Caledonian study will be useful in helping to shape any further facilities.

4.2.5 Benzodiazepines

The Government has provided funding through the National Mission for a cohort study by the University of Stirling on comparative patient outcomes in relation to targeted benzodiazepine prescribing. The Government is also providing funding of £274,000 per year for a pilot benzodiazepine clinic service in Fife. These projects will contribute to the evidence needed to inform further guidance on benzodiazepine harm reduction in response to the developing evidence base.

The Government will also be publishing guidelines in response to its consultation on prescribing benzodiazepines and antidepressant medications towards the end of 2023.

4.2.6 Digital Lifelines

Digital Lifelines Scotland seeks to improve digital inclusion and to design digital solutions that better meet people’s needs, to improve health outcomes for people who use drugs, reducing the risk of harm and death.

In order to focus on areas of greatest risk of harm, the programme collaborates with organisations across Scotland, particularly in the following areas:

• People experiencing homelessness,
• People being released from custody,
• People being discharged from hospital or residential services.

In 2022/23, an early adopters and small grants programme (delivered through SCVO) has supported 27 third sector organisations to supplement their existing services with digital inclusion activity. This includes the provision of digital devices and data, support to build skills and confidence, and training for digital champions. Over 1,300 people have been supported in 2022/23, and over 130 digital champions are now in place.

• 27 third sector organisations
• 1300+ people supported
• Over 130 digital champions

An evaluation undertaken by the Drugs Research Network Scotland (DRNS) in University of Stirling found strong evidence of positive impact. It stated “The personal and social benefits of the supply of devices and connectivity were acknowledged, appreciated and valued by participants. Service providers offered more than digital support, with emotional and personal support available to service users as a result of the connection through digital technology.”

Case Study: Recovery Enterprise Scotland

A person we issued equipment to has spent the last 27 years of his life in and out of prison and had no idea how to use a smartphone. The team worked with him, downloading required apps, and showing him to access emails, online accounts including DWP and banking. He had been offered employment, however, to accept the position he needed to complete his CSCS training, and in order to do this he required an email account, all of which the team arranged. He advised us that this was the first time he had felt hopeful that he could stay out of prison. He had approached other organisations on release however he had been advised that they were unable to help him. He is attending the hub on a regular basis and is receiving ongoing support to navigate his phone.