Drink and Drugs News DDN Nov2017 - Page 9

News Focus For the stories behind the news www.drinkanddrugsnews.com 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 www.drinkanddrugsnews.com 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