DRUG addiction services across Scotland must make changes to help vulnerable people access the help they need, according to a specialist now working with the Scottish drug death task force.
Tracey Clusker, who manages NHS Lothian’s addiction service in Dalkeith, has been running a pilot project since 2018 that aims to lower barriers to treatment for drug addiction, providing same-day access to opiate replacement medication and a wide range of drop-in services.
She claims early results have shown stark improvements in terms of access and hopes the approach will be adopted by all health boards.
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It comes as new figures from Police Scotland confirmed drug deaths are still rising, with 684 deaths linked to drugs in the first six months of last year. In 2018 there were a total of 1187 drug-related deaths in Scotland.
The Sunday National has previously reported on the need for better investment in drug services, with Scotland’s most senior figures raising concerns about the lack of psycho-social services such as counselling, mental health support and cognitive therapies on offer.
It is claimed people with serious addiction issues are often left without treatment plans and just 10 minutes a week with a drug worker. Waiting times for opiate replacement therapy (methadone or buprenorphine) are a postcode lottery and though it can be available within 48 hours in some areas, in others it can take weeks or months to secure a prescription.
Detailed forms with up to 32 pages of invasive questions about past trauma, criminal convictions and mental health history are still a prerequisite in many areas, with people with addiction issues reporting feeling judged and unable to have a say about their treatment needs.
In response Clusker has sought to do things differently in Midlothian, introducing a drop-in 18 months ago for those that were not coming to appointments rather than barring them from the services as is done in many areas. She claims all addiction services should instigate similar changes.
“Services all need to make some commitment to changing the way they work and reducing any barriers especially now we know we are going to be reporting high [drug death] figures,” she said. “Have any services made changes since last year’s figures where released? We all need to keep changing and adapting to the needs of these groups and their families.”
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Her multidisciplinary team – which includes nurses, psychologists, peer support workers who have personal experience of addiction and social workers – is bolstered by visiting services from welfare rights workers to sexual health specialists.
A recovery cafe runs alongside the service and workers sit around the table with those seeking help in an attempt to readdress the power imbalance that stops some engaging elsewhere.
“We are taking a very different approach to addiction,” she said. “We are giving people more control and power.”
With 49 people using the drop-in and a 90% attendance rate, some might have been satisfied, but Clusker believed the service needed to lower the barriers to treatment yet further. She visited a Middlesbrough service doing same-day prescribing, got the drug death task force involved and is completing a small Test of Change pilot.
Under the pilot people using opiates such as heroin are offered same day access to methadone or buprenorphine based on a positive drug test but with no lengthy questionnaire, and a “menu” of additional supports offered once their prescription has helped them to stabilise.
“When I went down to Middlesbrough I thought why can’t we be doing this?” she said. “In November and early December I worked with 15 people and got them onto same day prescriptions. There were with no adverse events [fatal overdoses], everyone got a naloxone kit [which can be administered to save lives if someone overdoses] and a higher percentage brings a family member along so they have more support.
“We are in the process of writing our findings up, looking at data before and after and we’ll be presenting that in the next couple of weeks.” Health boards in Dundee and Forth Valley have already expressed an interest.
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One man who used the service last month – but didn’t want to be named – said that the new approach was hugely welcome. Now 39, he became addicted to heroin as a teenager, had recently completed rehab but relapsed. He overdosed, was taken to hospital and was then released at 10.30pm without any treatment plan.
Previously he felt services “gave up” on people with addiction issues. “When you come in and ask for a prescription you have reached a point of desperation,” he said. “In other services I’d have had to wait and I’d have fallen back into that life [of addiction] and got lost in transit.” Instead he contacted Clusker who saw him the next day and prescribed buprenorphine. He is now planning to work back towards being substance-free but is first working with a psychologist on addressing complex trauma.
“Services are often just one size fits all,” he added. “But this is so adaptable. The barriers are reduced and there’s no ‘them and us’.”
Professor Catriona Matheson, who chairs the Scottish Government’s drug death task force, set up last July, said: “The task force sub group that is working on standards of medically assisted treatment (MAT), have ‘adopted’ the Midlothian pilot. Initial feedback seems very promising but we await the evaluation with interest.”
Campaigners and opposition politicians have claimed that not enough progress has been made by the task force but Matheson said it was already prioritising treatment services.
“Our aim is for treatment services that people can access quickly, with a range of treatment options to suit their needs and that address some of the underlying issues affecting people who use drugs,” she added. “We are progressing this strand of work as a priority.”
A Scottish Government spokesman said: “We are currently studying the Test of Change pilot scheme, alongside other available evidence, and we have taken, and will continue to take, a range of actions to address the public health emergency Scotland faces in terms of drug-related deaths.”
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