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PLAYING FOR KEEPS
With Scotland experiencing ever-higher numbers of drug deaths, its government is
developing a strategy to keep vulnerable older users in treatment. DDN reports
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DAVID LIDDELL
2002
‘Underlying
health
issues
aren’t
being
addressed,
housing
issues,
welfare
benefits
issues...’
COPD, within
addiction services,’ he
DRUG-RELATED DEATHS IN SCOTLAND, 1996 TO 2016
says.
900
Another issue can
be the power
800
relationship between
users and those ORT
700
services, he points out.
‘I think advocacy is
600
very important for this
population to help
500
sustain contact, but
also to help them
400
navigate their way
through and better
300
assert what their
needs are. In too many
200
cases the individual
has to fit the service
100
on offer, rather than
the other way round.
0
So while we obviously
need to put back
some of the core
funding to services,
a consensus in Glasgow that heroin-assisted
we also need to look at how that money
treatment should have been introduced
might potentially be used to change practice
already. Policy only seems to radically change
on the ground.
at the point of crisis, unfortunately, but the
‘When you’ve got a service for 3,000
level of fatal overdose deaths means we’re
people it’s very hard to deliver the person-
certainly there now.’
centred care,’ he continues. ‘A key part would
On that note, when the 2015 figures were
be that someone is seen by the same person
announced he called it a national tragedy and
every time to build up a therapeutic
the ultimate indicator of the country’s health
relationship. I think there’s broadly a
inequalities (DDN, September 2016, page 4).
consensus that things have to change, but in
With the numbers up still further, does media
terms of the very big services it can be
and public opinion in Scotland accept that it is
difficult to turn things around. So there are
a tragedy, or is there a view that ‘they’ve
questions about how the new investment is
brought it on themselves?’
used, and how you then deliver change.’
‘There’s always going to be a mixture, but
The Keeping people safe report stresses the
my experience in doing media work around
effectiveness of harm reduction interventions,
the safer injecting facility, as well as the
and plans for a consumption room in Glasgow
closure of the needle exchange in Glasgow
appear to be nearing fruition (DDN,
Central station, is that by and large they were
July/August, page 4). A key part of addressing
very supportive. Obviously they tried to find
individual need is looking at prescribing
people who were against it, b ut it seems
options, Liddell stresses – ‘matching the
there’s much more consensus that this is
substance to the individual’ – and the facility
something that’s worth trying. I do get the
aims to offer heroin-assisted treatment. Is he
sense that there is a shift, and that’s also in
confident it will happen?
terms of conversations with the wider public.
‘I think the heroin-assisted treatment part
In the face of so many overdose deaths it
is probably easier to deliver in terms of
becomes harder and harder for people to
legality issues and so on – I’d be very
optimistic that it will happen,’ he says. ‘There’s argue for the status quo.’
This summer Scotland once again broke its
own bleak record by registering its highest
ever number of drug-related deaths (DDN,
September, page 4). The 867 fatalities were
more than double the figure from a decade
ago and make Scotland’s drug-related
mortality rate the highest in the EU.
With the median age 41, and nearly a
third of the deaths in the Greater Glasgow
and Clyde NHS board area, the twin problems
of deprivation and an aging cohort of
entrenched users are looking more acute than
ever. The Scottish Government has since
announced an extra £20m funding for
treatment as well as an ‘overhaul’ of its drugs
strategy (DDN, October, page 4). It’s also
developing a framework to engage older
users and keep them in treatment, called
‘Seek, Keep and Treat’, as part of which NHS
Health Scotland has issued a new report,
Drugs-related deaths rapid evidence: keeping
people safe (see news, page 5).
‘If you look back over the last 20 years, all
of the increases in fatal overdoses have been
in the over-35s,’ Scottish Drugs Forum CEO
David Liddell – whose organisation is helping
with the ‘Seek, Keep and Treat’ strategy – tells
DDN. ‘The under 35 deaths have remained
fairly static.’
More than 120 current injectors or people
who had injected in the last six months were
interviewed for SDF’s expert working group
report, Older people with drug problems in
Scotland (DDN, July/August, page 4), with an
average age of 41. ‘So a very similar profile to
those who are dying,’ says Liddell. ‘What we
found was that they weren’t being held in
services and, alongside that, 79 per cent were
living alone. There were massive issues of
anxiety and depression, all these underlying
health issues that weren’t being addressed,
housing issues, welfare benefits issues. So the
“keep” part of the initiative is very much about
ORT and recognising the protective factors of
keeping people in treatment.’
While some countries have up to 80 per
cent of problem drug users in treatment at
any time – and with that treatment sustained
over the long term – Scotland’s current rate is
around half that. ‘I think there’s an increasing
recognition of the need to hold more of that
older population in treatment and maybe try
to integrate those other health issues, like
November 2017 | drinkanddrugsnews | 9