A new report looking at the evidence about interventions identified to support older people with a drug problem in Scotland has been published.
The ‘Drugs-Related Deaths Narrative: Keeping People Safe’ report, , was published by NHS Health Scotland and presents findings of recent highly processed evidence about interventions to keep people safe, and reduce drug-related deaths, with particular focus on supporting older people with a drug problem.
In July 2017, the Scottish Government announced a strategy refresh to respond to the changing nature of Scotland’s drug problem. To address the health and social harms experienced by people with a drug problem, the Scottish Government and Scottish Drugs Forum are developing a “Seek, Keep and Treat” framework.
This joint initiative will examine the operational implications of engaging with older drug users, how to encourage them into services and how to keep them in treatment. NHS Health Scotland has supported the work by undertaking this rapid evidence review.
There is a clear trend of increasing deaths among older people with a drug problem in Scotland. This cohort are categorised as people aged over 35 who experience health and social harms related to his/her own use of drugs. As this cohort is likely to grow in size over the next five years in Scotland, the scope of the rapid evidence review was to respond to the specific risks and needs identified for this group of people.
Report author, Elinor Dickie, NHS Health Scotland, said: “The findings of this evidence review highlight that drug-related deaths are preventable, not inevitable.
“The health of individuals with opioid dependence is safeguarded while in substitution treatment, working with individuals to meet their needs, optimising and tailoring approaches to support people to stay in treatment is key.
“The evidence identifies critical intervention points in the first four weeks of treatment and the first four weeks after leaving treatment, as the risk of death is elevated at these times. Additionally the evidence continues to demonstrate the effectiveness for harm reduction interventions and for the approach of Scotland’s take home naloxone programme to educate and train not only people who use drugs, but their families and peers, to increase the odds of recovery from overdose.
“These findings can support the Scottish drugs strategy refresh to meet the needs of those most at risk and who we know face complex health and social issues.”
David Liddell, Scottish Drugs Forum’s CEO, said: “We welcome this publication by NHS Scotland, which supports the findings of our research on older people with a drug problem.
“Across Scotland, there is a growing cohort of people aged 35 and over who experience a multitude of health (both mental and physical) and social problems, relating to years of continued substance use. The complexities of these issues will require a fundamental rethink in how services work with the people in their care.
“For a new approach to succeed we must reach out far more effectively than we have and develop long-term meaningful relationships with people who have been stigmatised and marginalised through their own circumstances and as a consequence of policy – inadvertently or otherwise.
“The new drug strategy framework, which is being developed in consultation with the sector, will provide an opportunity to take these learnings forward into policy which impacts directly on practice and results in tangible improvements to people’s lives .”
The key points of the report are:
- There is evidence that the health of individuals with opioid dependence are safeguarded while in substitution treatment.
- One size does not fit all. Treatment approaches and services need to be tailored to the individual to support them to stay in treatment.
- It is important to consider which medications work for whom.
- The first four weeks of treatment and the first four weeks after leaving treatment are critical intervention points to reduce mortality risk.
- Psychosocial interventions in conjunction with medication-assisted treatment have been shown to contribute to improving outcomes for people with opioid dependence.
- Complex psychological and social barriers must be addressed to support individuals to access services.
- A holistic approach designed and tailored to the health and social needs of individuals will improve the effectiveness of interventions, help increase motivation and prevent drop out.
- Treatment and harm-reduction services are effective in reducing the transmission of blood-borne viruses.
- Take-home naloxone programmes have been demonstrated to increase the odds of recovery from overdose and improve knowledge of overdose recognition and management in the community.