Best practice guide
Last week (30 August 2017) a working group of NHS and voluntary sector drug treatment providers published a set of best practice principles to support efforts across the country to address the increasing number of people dying from drug use.
(The report has a slightly odd title: “Improving clinical responses to drug-related deaths: A summary of best practice and innovations from drug treatment providers” — I would have thought the title would have focused on preventing drug-related deaths…)
For the last four years drug-related deaths in England and Wales have increased. They are now at the highest levels since records began in 1993. Scotland has also seen drug deaths increase dramatically in recent years. This is more individuals whose lives are cut short and denied the opportunity to realise a brighter future. More families blighted by the pain and bereavement that losing a loved one causes. Every effort has to be made by all stakeholders to do all they can to change these statistics, and this will involve action in all contexts in which drugs are used and among all drug users.
The focus of this document is therefore to pool and share expertise to maximise the treatment sector’s contribution to minimise early and avoidable deaths, particularly among opiate users where risk is highest.
The document focuses on five key issues:
- Identifying risk of drug-related death
- Delivering safe, recovery-orientated drug treatment
- Preventing overdose in people who use drugs
- Meeting physical and mental health needs
- Reducing the risk of drug-related death for people outside drug treatment
and sets out the key aims under each of these points in a short table:
To this end Collective Voice and the NHS Substance Misuse Provider Alliance (NHS SMPA) have worked together, with PHE’s support, to produce a set of recommendations for providers with the aim of ensuring that everything that can be done is done by service providers to help reverse this damaging trend. This demands a challenging balancing act, retaining a focus on the importance of harm reduction and safety while not undermining the opportunity and ambition for recovery of many people we work with. The document covers a number of subject areas, but detailed below are the key recommendations:
- Drug treatment services should review their information systems to enable data relevant to risk of overdose to be captured and deployed to inform individual treatment plans.
- Treatment plans should be consistent with the 2017 Clinical Guidelines and should be individually tailored to balance the protective benefits of OST with the opportunity to safely progress towards recovery. Providers and commissioners should guard against forced reductions or premature removal from treatment in a desire to achieve targets.
- All providers should establish clear protocols for managing the risk of overdose and ensure their staff are competent to implement them. This should include ensuring naloxone is widely available.
- Commissioners and service providers have a responsibility to maximise their contribution to addressing all the physical and mental health needs of service users, ensuring these are met either within their own services or by effective engagement with timely and appropriate access to primary care and specialist services in the NHS. This includes ensuring that more people are tested and treated for hepatitis C.
- Commissioners and treatment systems need to increase local penetration rates to reduce deaths among those who are currently not engaged in treatment or in contact with harm reduction services. Fundamental to this is promoting and expanding access to needle and syringe programmes.
Karen Biggs, CEO of Phoenix Futures and chair of Collective Voice, chaired the working group. She said:
It is a shocking reality that we have the highest level of death from drug use since records began in 1993. The data unequivocally proves that engaging in treatment reduces the risk of death from drug use but half of the people who die each year are not in treatment. The willingness of a wide range of providers to come together and share their best practice demonstrates the sector’s commitment to do all it can to address this.
Through the course of the last six months we have listened to people who use treatment services, researchers and analysts. No one claims to have the whole answer. The causes of the high level of deaths our communities are experiencing over recent years are due to a range of complex interrelated issues that vary depending on your age, your gender and where you live in the country.
The solutions therefore need to be sophisticated, tailored and delivered by a range of agencies working in local communities. We hope the report we have published today inspires a new commitment and new thinking and goes some way to providing a solution.
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