Scottish Drugs Forum
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31 August 2006
COCAINE was present in more deaths than ever before in Scotland in 2005 although heroin remains the most common drug involved, according to figures released today by the General Register Office for Scotland (GROS).
Cocaine was present in 44 deaths last year – the highest since records began in 1996 and up from 38 in 2004.
One in five of the 111 deaths in the new Greater Glasgow & Clyde area and six – or 15 percent - of 40 deaths in Lanarkshire involved cocaine.
Edinburgh’s Drug and Alcohol Action Team – Action on Alcohol and Drugs in Edinburgh – says that 15 percent of deaths in the capital city alone revealed cocaine in the systems of people who had died in 2005. The GROS figures for deaths across all the Lothians show cocaine was present in four – or seven percent – of the 57 deaths locally.
2005 saw the lowest number of drug-related deaths among drug users since 1998, falling from 232 to 204 – down more than a quarter on the highest figure of 280 recorded in 2002. Overall, there were 336 drug-related deaths in all categories in 2005, down 20 (6 percent) on the 2004 figures and 46 (12 per cent) fewer than in 2002.
The number of deaths involving heroin/morphine, diazepam, methadone and ecstasy were all down on 2004 figures. Nevertheless, heroin was involved in 58 per cent of all drug deaths in 2005 compared to 63 percent in 2004.
Diazepam was involved in 90 (27 per cent), including 58 of the deaths involving heroin/morphine. Deaths involving diazepam peaked in 2002 and have decreased markedly since then.
Methadone was involved in 72 (21 per cent) of deaths – slightly fewer than last year (80 deaths).
The number of deaths involving ecstasy fell from 17 to 10 over the same period.
Most of the 204 deaths involving known or suspected users were aged 25 or over – total 172 - with the largest number of deaths (84) in the 35-44 age group.
There were significant local variations. For most NHS Board areas, heroin/morphine was involved in a majority of the deaths particularly in the new Greater Glasgow & Clyde area and in Lanarkshire, although there were much lower proportions in Lothian and Forth Valley.
Lothian and Greater Glasgow & Clyde showed relatively high proportions involving methadone, in contrast with the very low proportion in Grampian. Diazepam was involved in almost one in three (34 out of 111) of the deaths in Greater Glasgow & Clyde.
The biggest single rise in drug deaths was in Lothian – up from 36 to 57 – and the biggest drop was in the former Greater Glasgow area, which fell dramatically from 120 to 85. Greater Glasgow & Clyde and Highland now incorporate parts each of the former Argyll and Clyde area.
Other areas experiencing a fall in figures were Grampian (down from 39 to 23), Ayrshire and Arran (down from 20 to 15) and Forth Valley (down from 16 to 14).
Figures also increased in Lanarkshire (up from 33 to 40), Borders (up from 2 to 7), Fife (up from 17 to 21) and Tayside (up from 23 to 26). Western Isles and Shetland each had one death – up from zero last year – and Dumfries and Galloway remained the same at seven deaths.
Over three-quarters of those who died (77 per cent) were men – but the number of women rose from 67 in 2004 to 77 in 2005.
Scottish Drugs Forum Director David Liddell said: “While it is good to see a fall in the number of drug deaths, the figures underline key concerns already highlighted by Scottish Drugs Forum about the cocaine problem in Scotland and how we respond to it.
“Many heroin users are also using cocaine and we have already warned that services will have to rise to the challenge of treating the problems arise from these two very different drugs, which require different responses.
“However, though the growth of cocaine is of undoubted significance, we must not allow attention to be unduly focused away from heroin, which remains the number one drug of choice among problem drug users in Scotland and which is involved in the vast majority of Scotland’s drug-related deaths.”
SDF is holding a major event, Cocaine in Scotland – What’s the Scale of Risk, on 9 October 2006, in Glasgow.
21 August 2006
SYRINGE distribution practice to drug injectors in some parts of Scotland is hampering efforts to curb injecting harms including Hepatitis C, according to newly-published research commissioned by the Scottish Executive.
Needle exchanges (NX) in many parts of Scotland are failing to implement key recommendations from leading public health experts aimed at curbing the rise of bloodborne viruses (BBV), including among the 18,000 estimated drug injectors in Scotland, according to the hard-hitting report, Needle Exchange Provision in Scotland: A Report of the National Needle Exchange Survey (opens in new window).
The 91-page report, part of the biggest ever survey of NX services in the UK, calls on the Scottish Executive to increase funding to Cinderella needle exchange (NX) services after describing the level of syringe distribution in most areas of Scotland as inadequate and far from sufficient.
The very wide variations in numbers distributed are “cause for concern” says the report, which has been published in advance of the Scottish Executive’s Hepatitis C Action Plan.
But professionals in the field told researchers that lack of sufficient funding contributed not only to the lack of accessibility of services in some areas, but also many of the variations in practice between services, according to the report.
cinderella services
“One of the messages voiced most strongly by focus group participants throughout this study was that needle exchange services across Scotland are under-funded and under-valued. People referred to them as “Cinderella services,” according to the report.
“Policies on anti-social behaviour were often seen to have higher priority and attract more funding than public health policies for injecting drug users.”
Researchers found that some services were setting out “arbitrary” limits on the number of syringes provided to injectors - in some cases, punitively – and warned “such practises are not conducive to safer injecting.”
What one-third of services said “bore no relation” to official guidance on syringe distribution issued by the Lord Advocate was (maximum 20 for the first visit, 60 thereafter and 120 for exceptional circumstances).
Nearly a quarter said that the maximum number of syringes they would distribute depended on circumstances such as whether the client was known to the service, the number of syringes returned, where the client lived and whether the service had concerns about the health of the client.
The report identified needle exchange services in Argyll and Clyde as giving out the fewest syringes per injector in 2004-2005 – injectors received an average of 57 needles per year, equivalent to one sterile needle every 6.4 days.
variations
The fact that there is no standard training for needle exchange workers in Scotland had also led to variations in staff competency and qualifications.
“Regular training and on-going support were seen to be especially important for pharmacy needle exchange providers (including counter staff). This was seen to be the key in overcoming negative attitudes among pharmacy staff.”
Participants in the study saw it as “patently unfair” that service users in some NHS Boards received a wide range of paraphernalia and others received none, said the report.
“This situation was seen to send mixed messages to clients about what constitutes safe practice, and services felt it also undermined their credibility with their clients.
“What is even more worrying is that some NHS Boards are currently faced with the prospect of having to cease distribution of certain items of paraphernalia which had previously been provided for free.
“Recent changes in allocations of BBV prevention funding have benefited some areas in Scotland, but have resulted in frozen budgets (effectively a loss of funding) for other areas,” says the report.
“Service providers expressed frustration that recent legislative changes have made it permissible to distribute a wide range of paraphernalia to injectors, but that funding allocations haven’t changed to reflect this.”
national
Many service providers and commissioners felt the need for national guidance and standards on paraphernalia distribution – because it would help to significantly reduce inequalities in provision, even though there is no evidence of the effectiveness or safety of some items of paraphernalia at the present time.
The fact that injectors themselves often choose not to take a sufficient number of syringes for their own injecting needs presents a “serious challenge” to needle exchange services, and the report called for the development of “new and innovative” methods of engaging with and educating injectors.
For instance, home delivery / back-packing services were more successful than other types of needle exchanges in reaching “hard-to-reach” populations. Women injectors in particular were often better served by back-packing services than fixed-site, or pharmacy services. Furthermore, these services also had better return rates, said the report.
planning
Meanwhile, the report also questioned the acceptability of the wide variations in practice in relation to all aspects of NX provision in Scotland. The study found a lack of robust systems for monitoring needle exchange activity at the DAT level in many areas of Scotland, suggesting that the strategic planning activities related to needle exchange were limited, says the report.
“It was clear that in many areas, those who are responsible for commissioning services do not routinely have access to sufficient and detailed information upon which to base their planning decisions. While there were examples of comprehensive needs assessments being undertaken in one or two areas, these tended to be the exception rather than the rule in relation to planning needle exchange service provision in Scotland.
"In some cases such as the provision of paraphernalia and on-site BBV interventions, this variation is associated with NHS Boards,” says the report.
“But in other areas, it would seem that some needle exchange services simply do things differently to other needle exchange services. The question which must be asked is: Is this variation acceptable?
“While it may be acceptable for pharmacy exchange services to be different from police custody suite exchanges, and for specialist services to deliver different interventions than A&E exchanges, it is not clear why there should be large variations in practice between specialist services, or between pharmacy schemes in different parts of Scotland.”
standardisation
Many of the needle exchange professionals, and commissioners of needle exchange services who participated in this study argued for greater standardisation.
“People wanted to see more standardised training for needle exchange providers, and greater standardisation in data collection and monitoring systems.
“People also wanted to see official guidelines in relation to paraphernalia distribution.
“However, many also pointed out that their aspirations for service development were limited by lack of funding.
“Having said that, there were clearly also instances where local Health Board policy, rather than funding per se, was the main limiting factor,” according to the report.
Needle Exchange Provision in Scotland: A Report of the National Needle Exchange Survey
9 August 2006
NEW recruits are being sought for the January 2007 intake of Scottish Drugs Forum’s ground-breaking work-based training project which prepares former users for a career in the substance use/care field.
The project will involve the trainees studying through Glasgow College of Nautical Studies for the a Level II qualification in Social Care and carrying out work experience in local services with a view to securing employment in social care.
The training involved learning about topics such as principles of substance misuse, effective communication, record-keeping, confidentiality issues, supporting people and the trainees took up placements in agencies such as Blue Triangle Housing Association, New Horizons, Turning Point Scotland, Aberlour Child Care Trust and The Mungo Foundation.
Trainees also have access to additional training such as Steps to Excellence; Critical Incidents; Group Work and STRADA modules.
Seven of the trainees from 2006 have already achieved their initial goal of finding work in social care, employed by organisations such as Blue Triangle Housing Association, Momentum STAR, The Mungo Foundation and Turning Point Scotland.
One course member said: “I can’t believe that I got offered a place, it’s the first time I’ve been honest in an interview.”
Another said “I did not only have my assessor, I had all the other work colleagues, to go to for help and support.”
“I’ve really enjoyed being part of the staff team, helping other people with issues I had myself, it’s a two way street.”
Yet another said: “It feels like another step moving on from addictions, closer to employment.”
The Addiction Workers Training Project (AWTP), was set up to help overcome the barriers to employment former users face because of their drug history while preparing them for work in the field.
Two of the people involved in the 2006 training course have been invited as champion learners at Learndirect Scotland’s Celebration of Learning event in September. The first course in 2005 saw nine trainees graduated from the AWTP and thirteen further trainees hope to graduate by December 2006.
Applicants for the 2007 course must be living in Glasgow and be able to commit to the project for 50 weeks
They should have EITHER:
OR
Applicants will need to provide two references, one of which should be a support worker.
These posts carry Enhanced Disclosure status and at least two years should have passed since the last conviction. However, convictions can be discussed at interview and will not necessarily prevent people from involvement.
In 2007, two options for receiving income while on the course will be open to trainees. They can be either waged for 30 hours per week (£165 per week before deductions) or remain on benefits during the project.
Trainees on benefits will attend college one day and take up placement as a volunteer three days per week.
People can indicate a preference for waged/benefits on the application form and this can be discussed in more detail at interview.
You can download an information flyer on the 2007 AWTP course here (Word Document 314KB). For further information about the course, contact Catriona Gibson, tel 0141 221 1175 or email Catriona@sdf.org.uk
For requests for application forms only, contact Lisa McKibben tel 0141 221 1175 or email Lisa@sdf.org.uk
8 August 2006
SCOTTISH Drugs Forum held a membership consultation on the Drug Rehabilitation and Treatment Bill in the Scottish Parliament on Friday 21 July.
South of Scotland MSP Rosemary Byrne - who is Co-Chair of the Scottish Parliament's Cross Party Group on Alcohol and Drug Misuse - is seeking support for her Bill which aims to improve services for drug users and their families.
The Bill proposes:
SDF members wishing to view or download the results of the Membership consultation can do so by accessing the Members-only area of the website. Once logged in, click on the Membership News or Consultations and Responses tabs on the drop-down menu.
For more details of the Bill, see www.scottish.parliament.uk/business/bills/membersBills.htm
Anyone - including SDF members - wishing to respond to the consultation cand send them to Ms Rosemary Byrne MSP, 106 Montgomery Street, Irvine KA12 8PW or email: James.Byrne2@scottish.parliament.uk