Pharmacy naloxone pilot saving lives


Community pharmacists in Glasgow have used medicine that can reverse the effects of opioid overdoses more than 20 times since a programme to allow pharmacies to store kits to administer in an emergency began last year.


Naloxone is also being handed out to frontline workers, such as housing association staff, in a bid to tackle rising drug deaths.


In a presentation to the Pharmacy Management Celtic nations conference, members of the Scottish Drug Deaths Task Force gave an insight into the public health emergency being caused by easily available and cheap street drugs, making the case for community pharmacy to play a central role in intervening with people who are already using their services.


Dr Carole Hunter, Lead Pharmacist for Alcohol and Drug Services at NHS Greater Glasgow and Clyde – and the Royal Pharmaceutical Society’s representative on the Drug Death Task Force – says a key initiative has been to provide community pharmacies with naloxone kits:


“These are for the staff to use themselves in an emergency.


“You may think that that doesn’t happen, but in Glasgow alone, we have had 25 confirmed reports where the pharmacist and their staff have administered naloxone to people either within or in the close vicinity of the pharmacy, and I know that that is being replicated because we’ve had reports from Grampian to the Borders.”


The programme has already seen naloxone distributed to winter shelters and homeless hostels to drug users so they can support their peers, families and people when they leave prison.


Meanwhile, ambulance crews carry packs to give out following calls to non-fatal overdoses, and a pilot has begun in three pilot sites in Scotland to equip 700 frontline police officers with kits.


Last week two police officers administered Naloxone for the first time just two hours after being trained in its use.


“We were all ridiculously excited by the first effective safe textbook use by a police officer [last week],” Dr Hunter told the conference.


Dr Hunter cited research showing drug deaths in central Glasgow have all been in more deprived communities, pointing out there are usually more community pharmacies per head of the population in deprived areas than more affluent ones.


“Over the last year we have had unprecedented challenges. We’re in the covid situation, a public health emergency but, in Scotland, that came on top of the public health emergency of drug deaths. In Glasgow we also have an HIV outbreak as well.


“I think we don’t have to seek out people using drugs. This group of people are already there, they are attending the community pharmacy and the question each and every one of us has to ask is: are we making the most use of that opportunity to help to address what is a major public health issue in Scotland, the issue of drug-related deaths?”


Another speaker at the session, Chair of the Scottish Drug Deaths Task Force and Professor in Substance Use at the University of Stirling Catriona Matheson, points to post-mortem evidence showing the number of different drugs people had in their system being greater now than before, and growth in so-called “street” versions of prescribed drugs.


Professor Matheson described the situation as “grim”: “The benzodiazepines are not coming from prescribed benzodiazepines. In the past, it was the prescribed benzos that were leading the street market and now it is very much illicit benzodiazepines.


“The illicit benzodiazepines are so abundant and so cheap and of such poor quality.”


Dr Hunter says that market forces were at play and making things worse: “Drugs have never been so cheap or so freely available.


“They have always been around. In the late 80s, a tenner bag of heroin cost you a tenner. It still costs you a tenner today. And it actually weighs more than it did in the late 80s. So, even if it only kept pace with inflation, it should be at least £140.


“It’s the same for benzos. We’ve had temazepam which would have cost you £5 or £10 a tablet then – they cost pennies nowadays.


“You have to factor that into the whole equation.”


Professor Matheson said the continuing roll-out of the naloxone programme coupled with the other initiatives that have been set in motion, mean that drug use in Scotland should not be the death sentence that it once was:


“It has certainly been a very grim few years.


“With the work the Task Force is doing and now with government putting a lot of extra money and resource behind drug treatments and services, and care more generally, we hope that we will finally be able to make a change.”


by John Macgill


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Drug deaths in Scotland highest since records began


1,264 drug-related deaths were recorded in Scotland in 2019, according to statistics published today by National Records of Scotland.


‘Drug-related deaths’ are defined as deaths caused by unintentional overdoses of drugs. The figures show the toll is 6% higher than in 2018, and the highest since records began in 1996.


The drug-death rate for Scotland is higher than those reported for all the EU countries and is approximately 3½ times that of the UK as a whole. Scotland has recorded the highest ever number of drug-related deaths for the past six consecutive years. There were 1,187 drug-related deaths in Scotland in 2018 – a 27% increase on 2017.


David Liddell, Scottish Drugs Forum’s CEO, said:


“The statistics announced today are a grievous reminder of the human cost of the ongoing public health crisis we face in Scotland.


“For each of these deaths, there is a family and a group of bereaved people coping with their loss, often after years of caring and supporting someone suffering from problem drug use. The cost to families and friends cannot be measured and the consequences can be serious, with the potential to have a long-term impact on their health and future lives.


“Ending this emergency must be the immediate priority for all of us and will require a concerted effort from all relevant agencies as well as political leadership and public support.


“None of us should regard these preventable deaths as acceptable or as anything other than a national tragedy and disgrace.


“The need for change is obvious and that change is long overdue.


“Thankfully, we are fortunate that the evidence shows us exactly what changes need to be made. We need people to be in high-quality treatment that protects them from overdose and death.


“Recently published treatment standards for Scotland can be a real driver of this necessary change and we are seeing encouraging improvements in services – but we must quicken the pace of change.


“The new standards insist that people gain quick access to treatment; have a choice of medication that best suits them; get the support they need to stay in treatment and access to any other supports they may benefit from. Broadly, the challenge in terms of treatment is to ensure that people with a drug problem are treated with dignity and respect.


“In addition, we need to increase the range of services across Scotland to include drug consumption rooms, heroin-assisted treatment and assertive outreach.


“We need to end the alienation, marginalisation and stigmatisation of people with a drug problem – the root cause of this issue, which reflects badly on a culture and mindset that we have allowed to develop unchallenged over many years.


“The time to challenge and end all of that has come. As part of this approach, we should decriminalise the possession of all drugs and extend the current recorded police warning for cannabis possession to apply to all other drugs.


“There is a need for leadership and a national effort to ensure this potential is realised.”



Is there a role for pharmacy in Scotland to prevent drug deaths?



For more information on the Scottish drugs forum please click here.


UK government rejects Scottish illegal drugs policy rethink


A series of recommendations from MPs to address record drug deaths in Scotland have been rejected by the UK government.


In a November 2019 report Westminster’s Scottish Affairs Committee had called for major changes to drugs policy to tackle what it called a ‘public health emergency’.


MP Pete Wishart, who chairs the cross-party committee, said he was “surprised and disappointed” at the government’s “almost wholesale rejection” of the Committee’s findings.


“What is evident is there’s little change in the government’s drugs strategy despite the death rate in Scotland from problem drug use remaining stubbornly higher than any country in Europe,” he said.


“This fact itself should demonstrate that the current approach isn’t working. This is undoubtedly a public health emergency.”


An all-time high of 1,187 people in Scotland lost their lives to drugs in 2018.


The UK and Scottish governments continue to disagree over how to respond to this, including a row over a cross-UK summit to address drugs deaths held in Glasgow earlier this year.


Calls for change by the committee included the decriminalisation of drugs, moving from a criminal to a public health approach to misuse and, most controversially, introducing pilot safe drugs consumption spaces.


But in its official response to the inquiry, published today after delays due to the 2019 general election and the coronavirus pandemic, the UK government said it does ‘not accept that problem drug use is singularly a health issue’.


It went on to say there were too many legal difficulties to permit the establishment of a trial safe drugs consumption room in Scotland, despite a call from the committee.


Kit Malthouse MP, the UK government’s Minister for Crime and Policing, rejected a call to declare a public health emergency. He said:


‘We are already taking action to tackle problem drug use and our approach continues to be a balanced one which is anchored in: education to reduce demand; tough and intelligent enforcement to restrict supply; evidence-based treatment to aid recovery; and co-ordinated global action.


‘We are continuing to increase our efforts to choke off the supply of harmful drugs and relentlessly pursue the organised criminals behind this trade.


‘Tough enforcement is a fundamental part of our drug strategy and we are taking coordinated action to tackle illicit drug use alongside other criminal activity.’


Other recommendations to reform the ‘adversarial’ nature of the benefits system and major changes to the 1971 Misuse of Drugs Act were similarly rejected.


However, Mr Malthouse said he agreed ‘in principle’ that it was important for both the UK and Scottish governments to work together across different agencies to address problem drug use.


Committee chair Pete Wishart said:


“The predecessor Committee’s report on problem drug use in Scotland followed one of the most extensive drugs inquiries in Scotland ever conducted.


“We argued that a public health approach will do better at tackling the drivers of problem drug use, as opposed to the stigmatisation offered by the current criminal justice approach that effectively blocks routes to recovery.


“On the proposal for safe consumption facilities, the government has repeatedly stressed that this is something that they do not favour.


“In their response to our report they re-iterated the legal challenges to a pilot being established even though we saw for ourselves how effective these facilities have been in saving lives in a number of countries round the world.


“The report of the previous Committee encouraged the government to do what is necessary to approve the proposed pilot scheme in Glasgow. This would give people using drugs greater exposure to the full range of services to help them recover. More lives could be saved.


“The government describes its approach to tackling the issue as ‘evidence-based’ but offers little evidence supporting it and fails to address why the evidence we collected should be discounted.”


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Paramedics to supply take home naloxone



Paramedics are to supply to patients at risk of an opiate overdose take-home naloxone as part of a pilot scheme in Glasgow.


The three-month trial will see those treated by paramedics for a non-fatal overdose who decline to attend hospital, and their friends and family, given a naloxone kit – which temporarily reverses the effect of an opioid overdose.


Training will be given on how to use the medication in the hope that it can be used by in the event of any future overdose witnessed by the individual before the ambulance arrives, reducing the risk of potential death.


The pilot has been funded by Scotland’s Drug Deaths Taskforce.


Public Health Minister, Joe FitzPatrick, said:


“This pilot scheme is one of a range of actions the Drug Deaths Taskforce is taking to address the public health emergency Scotland faces in terms of drug-related deaths.


“We know from the evidence that having naloxone available can and does save lives, but we also know from our database that around half of those whose death was drug-related had also suffered a non-fatal overdose at some point.


“Supplying naloxone kits through our teams of paramedics following a non-fatal overdose is just one more important action we can take to provide support to people at a time of crisis.”


Scottish Ambulance Service medical director, Jim Ward, said:


”We are committed to improving outcomes for all patients and our paramedics and ambulance clinicians often respond to emergencies to treat people who are experiencing an accidental overdose from drug use.


“This is a vital project that has the potential to help save lives – we are pleased that we will be on the front line in efforts to cut the death rate in Scotland from drug overdose, by offering this additional patient safety intervention.”


Scottish Drugs Forum’s Strategy Coordinator for Drug Death Prevention and lead of the Scottish National Naloxone Programme. Kirsten Horsburgh, said:


“This is a welcome development to Scotland’s national naloxone programme. SDF has advocated for ambulance service involvement in distributing kits for some time, due to the elevated risk of a drug-related death following a near-fatal overdose.


“SDF have provided training and guidance for this pilot, which will involve paramedics supplying take-home naloxone kits to people who decline a transfer to hospital and also to those who are present at the scene, such as family members and friends.


“The provision of naloxone is only a small, but essential, part of an effective response to Scotland’s drug deaths crisis where the majority of fatalities involve opiates. Without the availability of naloxone, it is highly likely that the number of people dying from preventable overdoses would be even higher.”


Drug-related deaths involving fentanyl on the increase


A recently published report by the Advisory Council on the Misuse of Drugs has warned of the pharmacology and toxic effects of fentanyl and related analogues. The report says that it can be concluded that fentanyl and fentanyl-analogues present a significant ongoing risk to UK public health.


Episodes of fentanyl toxicity and deaths in the UK have been sporadic and have not approached the very high numbers seen in North America.


However, rates of registered deaths involving fentanyls have recently increased and may be under-estimated because sufficiently detailed forensic analysis of drug causes is sometimes not carried out. Consequently, the role of a fentanyl in the death may not be recognised.


The public health risk associated with the misuse of fentanyl and its analogues relates to the high potency of these substances a report has highlighted. Compared to morphine, the amount of fentanyl required to produce the same analgesic effects is 50-100 times lower.


Fentanyl and its analogues are potent compounds that therefore carry a high risk of accidental overdose that may be fatal.


The report warns of the ongoing risk of fentanyls and other new synthetic opioids increasingly infiltrating the UK heroin market and increasing rates of drug-related deaths.


The report makes a number of recommendations including the following:


  • Research should be commissioned to study diversion and non-medical use of strong opioids to identify trends, drug products involved and populations at risk.
  • Government departments should conduct a full review of international drug strategy approaches to fentanyl markets, in particular, the North American experience, and consider interdiction controls that can be applied to the UK situation.
  • Toxicology analysis of samples of all deaths related to drug poisoning should include analysis for fentanyl and fentanyl analogues as nonsystematic screening hinders our capacity to understand trends in drug death.
  • Toxicology reports from all deaths related to drug poisoning should include a clear statement as to whether fentanyl and/or its analogues were included in the testing. This would enable meaningful monitoring of trends in fentanyl-associated deaths.
  • Research should be commissioned to monitor the local and national prevalence of fentanyl and fentanyl analogues in:
    • Drug seizures, including heroin preparations and counterfeit medicines.
    • Non-fatal episodes of heroin toxicity requiring hospital treatment.
  • Increased funding should be made available to the Defence, Science and Technology Laboratory Forensic Early Warning System (DSTL FEWS) programme to increase capacity to analyse un-adopted police and border force seizures.
  • Agencies with responsibilities relating to drugs of misuse should monitor the international situation and share available UK data. There should also be a comprehensive early warning system which has access to up to date consolidated UK-wide drug misuse data sets.
  • If materials are encountered in the UK or Europe that retain potency but fall outside the UK generic control on fentanyls, a small amendment to that generic control should be applied to address these.
  • Following a consultation with the research community the Home Office should expand the precursor controls to cover simple variants of ANPP, the immediate precursor to fentanyl (further details are included in this report).


You can read the full report below.


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Scotland’s drug-deaths highest in Europe


There has been a 27% increase in drug-related deaths registered in Scotland since 2017, figures published recently show. The statistics, published by the National Records of Scotland, provide details of 1,187 drug-related deaths that occurred in Scotland in 2018.


A widely predicted rise, this is the largest number of such deaths since records started in 1996 and more than double the figure for 2008, when 574 people died. Although the way in which such deaths are recorded varies across Europe, the latest figures show Scotland has suffered the highest death rate for any EU country and a rate nearly three times that of the UK as a whole.


Public Health Minister, Joe FitzPatrick, has reiterated calls for the UK Government to allow the Scottish Government to establish safer drug-consumption facilities to try to bring down the number of deaths occurring north of the border.


“The number of people who have lost their lives because of drug use is shocking,” the Minister said.


“It is vital this tragedy is treated as a public health issue, and we are prepared to take innovative and bold measures in order to save the lives of those most at risk.


“Last week, I gave evidence to the Scottish Affairs Committee and I asked for help in persuading the UK Government to either act now to enable us to implement a range of public health-focused responses – including the introduction of supervised drug consumption facilities – or devolve the power to the Scottish Parliament so that we can act.”


Earlier this month, Professor Catriona Matheson – a leading drugs expert at the University of Stirling was appointed by the Scottish Government as chair of a new taskforce to combat the rising numbers of deaths linked to substance misuse.


“I want to ensure that the work of the new taskforce which I have established is driven by strong evidence and the voices of those with experience of using drugs, and their families, are heard,” continued Mr FitzPatrick.


“I am determined to shape our services in every walk of life to prevent harm and reduce the appalling number of deaths.


“So I will give consideration to any proposals they bring forward which may help to tackle this issue and, ultimately, save lives.”


Appearing before the Westminster Scottish Affairs Committee this month, the Public Health Minister said among the options the task force would consider, he fully expected decriminalisation to be included.


The largest proportion of deaths occurred within NHS Greater Glasgow & Clyde – 394 – while 152 died within NHS Lothian, 130 in NHS Lanarkshire, and 109 in NHS Tayside.


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