DDN Magazine November 2020 - Page 12



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With drug-related deaths once again hitting record levels , it ’ s never been more urgent to make sure we ’ re properly engaging with so-called ‘ chaotic clients ’. DDN reports

Engagement is always a tough one ,’ says Dr Bernadette Hard , GP specialist in addictions with Kaleidoscope . ‘ It ’ s always problem in services , but that ’ s the nature of the disease .’

The gamut of engagement can run from highly motivated clients paying for their own treatment , via self-referrers who achieve good levels of stability but may begin to drift away , through to those who struggle to meet appointments and frequently drop out of treatment – if they engage at all .
Much has been written about so-called ‘ chaotic clients ’, and a perennial challenge for services has been finding ways to bring more stability to this group , especially as they feature heavily in drug-related death statistics ( see news , page 4 ). Scotland has long wanted to pilot consumption rooms , which have proved effective in other countries , but legal wrangles with Westminster have made this impossible . The closest anyone has come so far has been the establishment of a ‘ safe consumption ’ van in Glasgow , which has made national headlines despite technically operating outside the law .
Heroin-assisted treatment ( HAT ) – widely accessible in the UK until
1967 ’ s Dangerous Drugs Act put paid to it , and available elsewhere in Europe – is showing signs of making a comeback , however , with a pilot programme launching in Scotland late last year ( DDN , December / January , page 4 ) and more and more police and crime commissioners coming out in favour of it .
The results from the Glasgow HAT pilot , which has been incorporated into the city ’ s Enhanced Drug Treatment System ( EDTS ) have been promising , particularly for people who ’ ve experienced homelessness or been involved in the criminal justice system ( DDN , March , page 8 ). One major benefit of the scheme has been to enable these clients to engage with other services , such as BBV , mental health or housing teams .
A number of trials are also taking place to provide longacting buprenorphine to chaotic clients , which means people no longer need to make regular trips to the pharmacy to collect medication – or be supervised taking it , something that many find stigmatising and humiliating . Delphi Medical have so far provided around 25 clients with long-acting buprenorphine , starting around ten months ago . ‘ When we first looked at the product it seemed to be aimed towards more stable groups , but the benefits quickly became apparent for the more chaotic group ,’ says head of medicines management , Colin Fearns .
It was a similar process at Kaleidoscope , says Hard . ‘ Initially the general feeling was that it was the obvious choice for people who